the global case for action
DESCRIPTION
“THE GLOBAL CASE FOR ACTION: ACKNOWLEDGING POVERTY AS A DETERMINANT OF MEN’S HEALTH” SCIENTIFIC PROGRAMME DAY THREE THIRD JAPAN-ASEAN MEN’S HEALTH AND AGING CONFERENCE 03 DECEMBER 2008 SINGAPORE Plenary 8: jmh and ISMH Joint Lecture Dr. April M. W. YoungTRANSCRIPT
The Global Case for ActionThe Global Case for ActionAcknowledging Poverty as a Acknowledging Poverty as a Determinant of Men’s HealthDeterminant of Men’s Health
Third Japan-ASEAN Men’s Health Third Japan-ASEAN Men’s Health && Aging AgingConferenceConferenceSingaporeSingapore
03 December 200803 December 2008
April M. W. Young, PhD, April M. W. Young, PhD, Collins Center for Public Policy Collins Center for Public Policy
Siegfried Meryn, MD, Siegfried Meryn, MD, International Society for Men’s HealthInternational Society for Men’s Health
JMH-ISMHjoint lecture
Three Key PointsThree Key Points
Health Health disparitiesdisparities among men among men related to related to social vulnerabilitysocial vulnerability deserve deserve attentionattention..
Reducing inequitiesReducing inequities should be should be an indicator of our field’s an indicator of our field’s progress.progress.
Men’s health field can contribute Men’s health field can contribute to to global structural reformglobal structural reform..
Social vulnerabilitySocial vulnerability ((including povertyincluding poverty)) is is
associated with associated with health disparities health disparities
among men.among men.
Point OnePoint One
Poor men lack access to basic Poor men lack access to basic health carehealth care
For example, in the U.S.:For example, in the U.S.:
No national policy or program for No national policy or program for physical exams, screenings, or physical exams, screenings, or health-promotion for menhealth-promotion for men
Existing programs are for poor Existing programs are for poor children and poor motherschildren and poor mothers
Sources of Insurance Coverage in 2004
Employer Medicare Medicaid/SCHP Direct-purchase Military Uninsured
Percentage of men with usual primary care provider by income, U.S. 1999
Negative/poor Near poor/low Middle High
Percentage of men uninsured for any Percentage of men uninsured for any
period in past year by race, U.S. 1999period in past year by race, U.S. 1999
White Black Asian/Pacific Islander American Indian/Alaska Native
Percentage of men with usual primary Percentage of men with usual primary care provider by education, U.S. 1999care provider by education, U.S. 1999
Less than high school grad High school grad At least some college
Percentage of men uninsured for any period in past year by education, U.S. 1999
Less than high school grad High school grad At least some college
Distribution of uninsured andDistribution of uninsured andtotal U.S. population by incometotal U.S. population by income
as measured by Federal Poverty Level (FPL) in 2004as measured by Federal Poverty Level (FPL) in 2004
Below poverty 100-199%FPL
200-299%FPL
300-399%FPL
400-499%FPL
Over 500%FPL
Probability of males dying (per 100) ages 15-59 years by income in Latin American and Caribbean countries
Chile
Costa
Rica Ecua
dor
Hondu
ras
Nicarag
uaPe
ruBrazil Colombia DominicanRepublic
Guatemala Mexico Panama Venezuela
Life expectancy and disability-free life Life expectancy and disability-free life expectancy by income for men in Canadaexpectancy by income for men in Canada
Life expectancy Disability-freelife expectancy
Global Attention toMen’s Health Disparities
Point TwoPoint Two
Reducing disparitiesReducing disparitiesshould be ashould be a
performance indicatorperformance indicatorfor our fieldfor our field
Men’s health field is usually Men’s health field is usually evaluated by:evaluated by:
scientific advancesscientific advances detection capabilitiesdetection capabilities treatment capabilitiestreatment capabilities
Men’s health field’sMen’s health field’s
greater potential to detect greater potential to detect diseases and conditions…diseases and conditions…
greater potential to treat greater potential to treat diseases and conditions…diseases and conditions…
… are unrealized among socially vulnerable men.
How many/whoseHow many/whoselives do we improve?lives do we improve?
Persistent socioeconomic inequalities in ischemic heart disease for 6 Euro nations
Persistent socioeconomic inequalities in stroke mortality for 6 Euro nations
Men’s HealthMen’s HealthGlobal Field GoalGlobal Field Goal
KeyKey:: attention to social determinants of attention to social determinants of men’s health men’s health
KeyKey:: closing gaps, diminishing disparitiesclosing gaps, diminishing disparities
effect multi-state cooperationeffect multi-state cooperation quantify existing disparitiesquantify existing disparities establish performance indicatorsestablish performance indicators
MEN’S HEALTH FIELD CAN HELP!
More research on poor men and health disparities related to poverty.
Attention to health concerns of poor men in clinical settings (e.g., lack of access to care, low health literacy, labor and environmental exposure risks, possibility of incarceration history).
Advocacy for poor men’s health needs in international health and development discourse (as complement to maternal and child health).
Point ThreePoint Three
The men’s health field can The men’s health field can contribute to global contribute to global
structural reformstructural reform
Areas to make a contributionAreas to make a contribution
policies for aid to developing policies for aid to developing nationsnations
policies for assisting policies for assisting marginalized sub-populationsmarginalized sub-populations
immigration policiesimmigration policies health education standardshealth education standards
Centers on health and well-beingInsists upon access
Requires appropriate services, advice, and informationAdvocates focus on men’s health
Describes current conditions and their impactCalls on nation states, EU organizations, health providers,
others
The Vienna Declaration on the HealthThe Vienna Declaration on the Healthof Men and Boys in Europeof Men and Boys in Europe
The Vienna The Vienna DeclarationDeclaration
Recognise men’s Recognise men’s health as a distincthealth as a distinctand important issueand important issueDevelop a better Develop a better
understanding of men’s attitudes to healthunderstanding of men’s attitudes to healthInvest in ‘male sensitive’ approaches to Invest in ‘male sensitive’ approaches to providing healthcareproviding healthcareInitiate work on health for boys and young men Initiate work on health for boys and young men in school and community settingsin school and community settingsDevelop coordinated health and social policies Develop coordinated health and social policies that promote men’s health.that promote men’s health.
Call to ActionCall to Action
Men’s health fieldMen’s health field cliniciansclinicians researchersresearchers policy analystspolicy analysts advocatesadvocates
measure track intervene
should
Encouraging signsEncouraging signs CJ Ng and colleagues, “What matters most CJ Ng and colleagues, “What matters most
to men in Japan and Malaysia?...”to men in Japan and Malaysia?...” WY Low and colleagues, “Satisfaction with WY Low and colleagues, “Satisfaction with
quality of life among men with erectile quality of life among men with erectile dysfunction…”dysfunction…”
SH Teoh and colleagues, “Can sexual health SH Teoh and colleagues, “Can sexual health be a successful and sustaining portal to be a successful and sustaining portal to men’s health?”men’s health?”
WS Tan and colleagues, “Relationship WS Tan and colleagues, “Relationship between SLOH and other co-morbidities in between SLOH and other co-morbidities in Malaysian men”Malaysian men”
H Sasaki, “ED guidelines in Japan”H Sasaki, “ED guidelines in Japan” EM Khoo, “Cardiovascular risk in aging EM Khoo, “Cardiovascular risk in aging
men.”men.”
INCARCERATION CRISISU.S. has less than 5% of the world’s
population. But it has almost 25% of the world’s prisoners (2.3 million people).
China is second, with 1.6 million people in prison (excluding hundreds of thousands in “administrative detention”).
63Japan
88Germany
151England
627Russia
751USA
Prisoners per 100K population
Source: International Center for Prison Studies at King’s College London
InequitiesInequities racial/ethnic marginalizationracial/ethnic marginalization low educational attainmentlow educational attainment low literacylow literacy poor housing, living poor housing, living
environmentsenvironments contact with state coercive contact with state coercive
apparatusapparatus exposure to war, violenceexposure to war, violence
Result in…Result in…
hindered employment hindered employment opportunitiesopportunities
economic insecurityeconomic insecurity desperate survival tacticsdesperate survival tactics catastrophic illnessescatastrophic illnesses disabling, traumatic injuriesdisabling, traumatic injuries
Men’s health fieldMen’s health field can intervene by can intervene by focusing on needs focusing on needs and experiences of and experiences of marginalized men.marginalized men.
Global Global Goal for theGoal for theMen’s Health FieldMen’s Health Field
healthhealth equity equityMany thanks to
Collins Center for Public Policy
International Society for Men’s HealthJournal for Men’s Health
Community Voices: Healthcare for the Underserved
Third Japan-ASEAN Men’s Health Conference Organising Committee