UNMET NEEDS Friday May 16, 2014 Orlando, FL Global report on the state of men’s health Committee members Professor Alan White Co-director Centre for Men’s Health, Leeds Metropolitan University, England Professor Allen Seftel Chief, Division of Urology, Cooper University Hospital, Camden NJ Professor Doris Bardehle Co-ordinator of the Scientific Board of the Foundation of Men´s Health, Berlin Professor Larry Goldenberg Head, Department of Urologic Sciences, University of British Columbia, Canada Dr Chris Ho Chee Kong Urologist/Sexual Medicine Consultant, Universiti Kebangsaan Malaysia Medical Centre, Malaysia Professor Gary Wittert Head, Discipline of Medicine, Director, Freemasons Foundation Centre for Men’s Health, University of Adelaide, Australia The work of the Unmet Needs Committee • To identify what can be learned about the health of men from the current national and international men’s health reports • To liaise with the other Committees to determine the unmet needs from their new analyses • To prepare a chapter giving an overarching statement on the state of men’s unmet needs for the ICUD report Reports covered The reports covered in the first phase analysis include: The 2011 European Commission ‘State of Men’s Health in Europe’ (SOMH) report; The Health of Australia’s Males: 25 years and older (2013); ‘Where are the Men? Chief Medical Health Officer’s Report on the Health & Wellbeing of Men and Boys in Northern BC, Canada (2011) A Roadmap to Men’s Health: Current Status, Research, Policy and Practice (2010) Canada Asian Men’s Health Report (2013). There have also been a number other important country reports that have been referred to from Germany, Ireland, Denmark and Austria. Structure to the review The male population Health Status Social determinants and intersectional factors Lifestyle & preventable risk factors Health Services and Health Service Utilization Communicable diseases Non-communicable diseases Mental Health Accidents, Injuries and violence Sexual and Reproductive Health Academic and research base for men’s health Policy Development Overarching statement on key unmet needs The Male Population - Demographics The reports cover nearly 2½ billion men across the globe. In all the countries covered by the reports there have been changes noted in the demographics of the male population, with the most significant being the increasing number of the elderly and very elderly. The SOMH report notes that this is mirrored by a fall in working age men as a result of reduced birth rates The Male Population – unmet needs There is a lack of research that has explored the health implications of men’s changing demographics. Greater attention needs to be placed onto the educational approaches taken with boys. There needs to be better recognition of the impact of being a father plays on the health of men and their children. There is an absence of any real strategic discussion on how the aging population will be managed. There is a lack of strategy to support the many men who are working as full time carers for relatives and friends Health Status – unmet needs A notable feature from all the reports is the high level of premature death in men (for instance, 630,000 males, 300,000 females across the EU27 die during their working years – 15-64 years). All the reports highlight the wide range of life limiting diseases men are exposed to and that many of these premature deaths are avoidable, with estimates ranging from 50% to 70%. The high rate of premature mortality of men is one of the main unmet needs in Men´s Health and has to be recognised and seen as a priority action point. Social determinants and intersectional factors – Unmet needs • More research is required exploring the impact of the social determinants and intersectional factors on men and how these differ from their effect on women? • The collection of socio-demographic data in the population statistics / or health interview survey should be guaranteed in all countries for stratified analyses of health status. • More focus is needed on the health of men at the times of transition, both personal (i.e. divorce) and societal (i.e. recession). Lifestyle & preventable risk factors – Unmet needs Poor lifestyles and preventable risk factors need addressing to reduce the high rates of premature death and morbidity in men. But men should not be seen as solely to blame - this is a society wide issue. There is still a lack of smoking cessation policy in many countries, which needs to be addressed and this includes public awareness programme, clinical services, clinical practice guidelines, screening programmes, health care practitioners training, school health education and research. Lifestyle & preventable risk factors – Unmet needs In many countries over 60% of the male population is either overweight or obese, leading to high levels of co-morbidity. Male focused weight loss interventions should be instigated. Greater attention needs to be given to getting men more physically active and the avoidance of sedentary behaviour. Greater focus on support for managed alcohol consumption and the avoidance of illicit drug use. Health Services and Health Service Utilization - Unmet needs Many men are missing out on preventative health care. Greater development is needed of health promotion initiatives that support men to adopt positive health behaviours and to increase control over their lives. Health services need to be focused onto the specific target group, rather than taking a ‘one-size-fits-all’ approach. Health and social services need developing with a clear focus on gender competency in the delivery of services - health services should be more male friendly. Health Services and Health Service Utilization - Unmet needs More school-based and parent-oriented programmes and practical sessions with boys and young men are needed to increase knowledge and help seeking skills with regard to health. More attention should be given to the opportunity of reaching out to men in the workplace and sporting settings where they are more likely to be successfully targeted. Greater partnership building with agencies who have access to men, such as prisons, welfare services, employment exchanges, homeless shelters, to improve access to health services. Health Services and Health Service Utilization - Unmet needs Greater attention should be paid to the training of health and social care professionals to communicate more effectively with men. Consideration should be given to the development of Men´s health centres in a similar way to the established women´s health centres. There should be qualification profiles developed for “Consultants for Men´s Health”. Communicable diseases - Unmet needs Immunisation programmes that reach into male communities are needed, especially those most at risk. Many countries are still resisting developing policies relating to HIV prevention and treatment. Changing attitudes towards HIV are affecting prevention campaigns. More work is needed to reach out to men who have sex with men and Intravenous drug users. Non-communicable diseases – Unmet needs Getting a more robust research agenda developed on the causative factors relating to men and the non-communicable diseases seems warranted. Many men are walking around with undiagnosed high cholesterol, hypertension and diabetes through ineffective early detection health programs. Non-communicable diseases – Unmet needs Few countries have a cancer plan to tackle men’s high burden of cancer. Many men are still unaware of the signs and symptoms of cancer, including prostate cancer. There is a need to de-link diagnosis and treatment of prostate cancer. Improved diagnosis and treatment regimens are needed for respiratory disorders to reduce chronic morbidity. More awareness raising needed on men’s risk of osteoporosis, both for the public and health care professionals. Accidents, injuries and violence issues – Unmet needs All countries require Public Health policy measures at a population level to address the harmful risks behaviours which cause all kinds of accidents. Many countries have a lack of road traffic accidents policy and agenda. To reduce the health gap between countries in the field of Road Traffic Accidents - the low mortality level of accidents in Netherlands should be a benchmarking model for other countries. Intervention programmes are needed for male perpetrators and male victims of violence. Mental Health There seems to be high levels of undiagnosed mental health problems in men, this would seem to be linked to the definitions of anxiety and depression in men and the and the poor sensitivity and cultural inappropriateness of the diagnostic tools Mental Health – Unmet needs There is an urgent need to support men to recognise and cope effectively with stress. There is the need for a clear framework for suicide prevention and mental health service provision that will support men who experience stress in their lives. There is the need to have positive mental health promotion campaigns to reduce the stigma of mental health problems to encourage men to seek help. Mental Health – Unmet needs There are unmet needs for particular groups of men and boys who have special mental health concerns, i.e. veterans, men in the criminal justice system, older men, men living in rural areas, minority ethnic men, men with eating disorders, men with post-traumatic stress disorder, mental health problems of gay men, homeless men, mental health problems of men who have been sexually abused in childhood or sexually assaulted as adults. Sexual and reproductive health – Unmet needs National sexual health strategies are needed to address the sexual and reproductive health needs of men. There is limited data on the appropriate use of testosterone replacement therapy . Men and health professionals are not aware of the full health implications of erectile dysfunction. Relatively common causes of hypogonadism, for example Klinefelter syndrome are not screened for, despite the data supporting early intervention. Greater public awareness of the sexual and reproductive health needs of men is required. Limitations of the current Men’s Health Reports Limitation on data comparability – They don’t all share the same framework – Not all the topics are covered in each report – Topics are covered in different ways making it difficult to know if you are comparing like with like – There may be issues with regard to coding quality of morbidity and mortality data Limitation of data availability – – – – Not all countries collect detailed data Difficult getting age stratified data Difficult getting sex-specific data Lack of data on social determinants and intersectional factors • Limitations to the coverage of the reports – No data from the USA and South America and only part of Canada – There are a number of countries not covered by any of the reports: i.e. Belarus, Ukraine, New Zealand – No data from Africa Academic and research base for men’s health There is a growing field of gender medicine that needs to be encouraged and in addition it’s important to develop specialised academic programmes on men´s health. This work needs to be appropriately funded through national and international bodies such as the NIH and the EU-Framework programmes for Europe. This work should also be supported by the development of research Institutes with chairs for Men´s Health. Policy development Though the reports cite that many policy developments have had a major effect on the wellbeing of men, such as no-smoking bans, enforced road traffic legislation and workplace health and safety, these are not universal. Many countries require encouragement and support to address populationwide public health needs. The Asian Report identified a widespread lack of policy for male specific issues. Policy development There is an overall lack of policy aimed specifically at the health and wellbeing of men. This policy would need to span the social determinants of health and be focused onto men’s emotional and mental health as well as physical health. Policy should aim to help develop a positive self-image for men, which opens up better life perspectives and to act to reduce the risks men face and to enable the development of protective factors. Policy development This policy should be developed within the countries, but should be promoted and supported by major international health organisations such as the World Health Organisation, the World Bank, the United Nationals and the European Commission. These organisations can support this work by, for instance establishing a health indicator within the European Commission’s Core Health Indicator set (such as ‘difference in life expectancy between males and females, premature mortality males and females, suicides with disaggregation of diseases and conditions by age and sex). Policy development There should be a concerted effort to establish a national action plan for men’s health and support should be given to help guide countries in developing and implementing a national men’s health policy. Consideration should also be given to the creation of Centre for Excellence for Men’s Health and the strengthening of the International Society for Men’s Health to enable it to have a greater role in the development of men’s health in each country. In counties that do not already have strong men’s health organisations, this work should support the establishment of men/gender health associations in all countries under the roof of public health associations. Areas of concern regarding men’s health Overarching statements on key unmet needs The reports all note that men’s health has been lacking attention, and this has adversely affected the opportunities to reach out to men to reduce premature death and to create healthier lives for men and women, and boys and girls. There is a real need to have greater recognition of the interplay between physical and mental health with more integrative approaches to overall wellbeing.