Article

Keywords

Public health

Preventive medicine

Men’s health

NGO’s role

Osman Ali,School of Medicine, UniversitiMalaysia Sabah, Malaysia.Tel: +60 88 320 000;fax: +60 88 320 098.

E-mail address:osmanali@ums.edu.my (O. Ali).

Effective public health education in men’s health

Osman AliAbstract

Men have been marginalized, despite the fact that they were more dominant than females. They always have a higher riskof injury due to occupational hazards and have higher mortality than females. In general, rate of injury at works, roads,schools and places of recreation are higher among men. Similarly, the physical disabilities are higher in males. Prevalencerates of hypertension and newly diagnosed diabetes mellitus are also higher among men. This reflects the high rate ofexposure to risk factors in men such as improper food intake, smoking and alcohol intake. In addition, men do not takeaction immediately to get treatment when they have symptoms of disease. It is quite common, the disease is detectedlate in men and they are exposed to early death. It is a habit of men who are not concern about their health as theyusually are the head of the family and the main breadwinner. They should be strong or look strong in order to supportthe family economically and socially. This causes them not to take serious precautions to prevent disease. Men are also lessprepared to attend thehealth talk, less attending the health screening or providing time for recreation and eating nutritiousmeal. Effective preventive action should be taken by the government and NGOs to promote male involvement in diseaseprevention activities in order to maintain the continuity of humankind in the future. © 2011 WPMH GmbH. Published byElsevier Ireland Ltd. All rights reserved.

Introduction

Aremen endangeredspecies? On average,men

die younger than women (>5 years different)

and the higher death rate than women. Most

of the deaths are lifestyle and occupational

related. Since the evolution of mankind, man

has been assumed the high risk jobs such as

seeking foods through hunting and gathering,

involving in fight, clashing between groups

or ethnics etc. In fact, the shorter life span

in man is presumed to be “natural” and

“inevitable”. It is believed as “the hazards

of being male” [1]. Life expectancy among

males is always lower compared to females

in Malaysia. It was 57 years old among women

in 50s compared to men in 55, and now the

women has reached 79 years old as compared

to 73 in men [2].

Why men died earlier than women? It

has been known than man is more prone

to die from diseases such as lung cancer,

ischemic heart disease, stroke, AIDS, prostate

cancer etc. Many of these non-communicable

diseases (NCDs) are related to life styles

such as smoking, sedentary lifestyles, lack

of exercise, alcoholism, drugs trafficking or

occupational such as occupational stress,

exposures to carcinogenic substances etc. [3].

Social independent and liberalization has

exposed them to sexual relationship with

multiple partners and sexual freedom that

result in fatal sexually transmitted diseases.

Being male, it has been accepted socio-

culturally that men are stronger, masculine

and more dominant than women. So it

is accepted in many societies that man

should not seek for health care early since

the conduct or behavior will reflect the

weakness of the man. Many diseases in man

become deadly, not because they are not

preventable or treatable but most of the

time they were diagnose very late and at

incurable stage. It is also known that man

has lukewarm and lackadaisical attitudes

toward health promotion program provided

by the health authorities [4]. Their low level

of health knowledge and skill make them

unable to appreciate the ill health. Health

belief and ego of man such as being ill

equates “being weak”, fear, denial, threatened

masculinity has influenced their health

seeking behaviors [5]. They always considered

waiting for appointment and service as waste

of time and not economical.

The way forward in men’s health

All men will be able to improve their life

expectancy and quality of life by reducing

premature mortality through early diagnosis

and prompt treatment of disease precursors,

implementing positive lifestyles, increasing

physical andmental health, reducing violence

and addiction, and supporting the national

policies on men’s health [6]. Public health

approach should be used to empower people

to take care of their own health. By

empowerment, men should take control over

to improve their own health [7], it is a social-

action process that promotes participation

of people, organizations, and communities

towards the goals of increased individual

and community control, political efficacy,

S12 jmh Vol. 8, Suppl. 1, S12–S14, April 2011 © 2011 WPMH GmbH. Published by Elsevier Ireland Ltd.

Article

improved quality community life and social

justice [8]. The main public health activities

that can be implemented include health

screening, healthy lifestyle promotion and

specific health promotion activities such

healthy partnership, enhancing communica-

tion and capacity building. Two approaches

of public health education can be applied in

the community namely high risk individual

and mass approaches. In individual, health

education and skill are given based on

individual’s risk whilst in mass approach, the

health education is given by collective action

by the community (community participation)

or for the community to reduce average risk

of getting the disease.

Health promotion for men ingeneral practice setting

Men are known to avoid encounter with

health care system for the stated reasons.

However, psychologically men probably will

response and cooperate to the call by

providing or arranging the suitable environ-

ment for the consultation or meeting for

them. Men like the collaborative partnership

approach rather than doctor’s authoritative or

paternalistic approach to medical problems.

They preferred long consultation, detailed

discussion on their problems and skilled

professionals who understand their problems

which is sometimes involving their livelihood

and personal life [9]. The environment of the

meeting must be ‘safe consultation’s room’,

men’s friendly environment and men’s style

of delivery. The meeting should be of low

economic impact such as after office hour,

night or weekend. The core qualities men

value when communicating with GPs in

primarycare settings include the adoption of a

“frank approach”, demonstrable competence,

thoughtful use of humor, empathy, and

prompt resolution of health issues [10,11].

Doctors or health professionals involved in

consultation must address lifestyles change

such stress management, enhance physical

activity and positive dietary changes. The

health professionals must also be well trained

to handle men’s problem.

Men’s health needs in healthpromotion

Since men are considered as special ‘being’

in health care system, they need special

attention. They require longer consultation

with doctor and better relationship with

trained staffs. They must be trained in

appropriate language and good communi-

cation skills to deal with men’s problems.

The consultation place must be created

to be a male friendly environment (male

friendlywaiting roomwithpamphlets, posters

relevant to men’s health issues). Men want

equal partnership approach to their health

in safe facilitated environment. Among the

activities for men’s health clinic are risk

factors screening targeted to high risk men

(hazardous occupations, sedentary job, aged

etc), appropriate follow up and long term

management of CVD risk factors such as high

BP, smoking, high cholesterol, low physical

activity, obesity, excessive alcohol, providing

skills on stress management, good nutrition

practices and exercise andmale specific issues

such prostate enlargement and impotence.

Barriers for men to primary careservices

There are always barriers for men to get

the health services in primary care facilities

either from government or private health

facilities [12]. Rural men have a geographical

isolation and strong masculinity belief.

Among the urban poor, many men are

unemployed and working all the time to

generate income for a living. For many who

are affordable, they distance themselves from

the facilities because the settings are neither

attractive nor suitable for men’s consultation.

In many cases, the clinics are manned by

untrained staff with poor communication

skill, lack of knowledge and confidence,

and do not understand the men’s issues or

suffering. Government health clinics are also

limited by time constrain during consultation

and providing services only during office

hour.

Opportunistic health promotionactivities

It is also advisable to promote health among

men at their working site (health forum

and screening), men’s health nights such as

sport club, pub, community hall, religious

gathering at mosque, church or temple. In

some countries, the men’s health week is

introduced aims to increase the awareness

of preventable health problems among men,

encourage early detection and treatment

of diseases, and encourage seeking regular

medical advice for disease and injury [13,14].

jmh Vol. 8, Suppl. 1, S12–S14, April 2011 S13

Article

Men’s health promotion programin Malaysia

Currently, there is no special or specific

program for male in primary care setting.

Wellness clinic is established for general

health screening. Specialist clinics for men

are available in major hospitals and The

National Population and Family Development

Board Malaysia (LPPKN) is mainly on sexual

and reproductive consultation [15]. Workers’

health screening is done in various sectors

for compliance to Occupational and Safety

Act (OSHA). Healthy lifestyle campaigns for

general public are organized annually to

promote health in all population; in general,

no special or specific program for men in

Malaysia. Not many aware about men’s week

in Malaysia except father’s day and no special

celebration to augur this day. Men’s health

policy is long overdue and need special

attention by the policy maker.

Conclusions

It is timely that men need more attention

and care on their health. Health care

should be delivered to suit their emotional

and socio-economic needs. Government and

communities should support themen’s health

policy to develop healthy society.

Conflict of interest statement

The author has no conflict of interest to

report.

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