Silent Crisis
Health care providers try to overcome attitudes and cultural biases that affect the way men take care of themselves

By Donna Hemmila
October 24, 2002

When Gary Shelton, MSN, RN, visits high schools to talk about safe sex, testicular self-exams and other health practices, he finds a predictable amount of nervous tension among the teenage boys.

"First there's the giggles and throwing around the model I bring, then we get down to business," said Shelton, an oncology nurse specialist at New York-Presbyterian Hospital, Columbia Presbyterian Center's Herbert Irving Comprehensive Cancer Center.

Unfortunately for many men, as they age, their comfort level with health care doesn't seem to improve much. Men are less likely to see a doctor regularly, less likely to take advantage of preventive screenings and less likely to seek care when they're feeling poorly.

Men also die sooner than women, and the life expectancy gap has been widening.

In 1900, women in the United States lived an average of 2.8 years longer than men, according to the National Center for Health Statistics. By 2000, the life expectancy difference had increased to five years. Women live, on average, 79.5 years compared to 74.1 years for men.

Men's health advocates see this widening life expectancy gender gap as a sign of what some call "the silent crisis" in men's health. Men's Health Network, a Washington-based nonprofit advocacy group, points to the greater number of males dying from heart disease, cancer, AIDS, suicide and accidents as even greater proof of the deteriorating health of American men.

In 2001, Rep. Randy "Duke" Cunningham, R-Calif., a prostate cancer survivor, made a move to combat the health crisis. He introduced a bill to establish a national Office of Men's Health within the Department of Health and Human Services.

This new health department, modeled on the Office on Women's Health, would promote men's health screenings and research into male-specific diseases, such as prostate cancer. The 60-year-old congressman attributes his survival to an early diagnosis when he had a prostate screening test during a checkup.

His bill, co-sponsored with Rep. Jim McDermott, D-Wash., is attracting bipartisan support with more than 50 co-sponsors.

"The need for this is absolute and overwhelming," said Ronald Herald, MSN, a member of the advisory board for Men's Health Network, which is lobbying for the bill.

The Men's Health Act of 2001 is in the House subcommittee on health, energy and water. With issues such as homeland security occupying lawmakers, there are no guarantees the bill will make it out of committee this year.

Yet public support for the bill is growing, said Harmony Allen, spokeswoman for Cunningham, and the president could establish an Office of Men's Health by executive order if the bill doesn't succeed. The question is how to balance all the competing health care funding needs for research and education, she said.

Need for change

Although not all health providers see a need for a federal agency for men's health, many are calling for a bigger effort to change the way men approach wellness. To do that will require overcoming attitudes and ingrained cultural biases that influence the way men take care of themselves.

Not only do men seek less care, but they seek it later in life, said John Swartzberg, MD, a clinical professor of medicine in the School of Public Health at the University of California, Berkeley.

"Women are acculturated to seeking care because of gynecological and obstetric care," Swartzberg said. "Women get plugged into the health system at a much earlier age than males."

Swartzberg, who chairs the editorial board of the UC Berkeley Wellness Letter, doesn't see a need for a gender-specific national health office. The Women's Office on Health was established in the last decade to address a disparity in medical research and education. There's no lack of research on men's health issues, he said, and the difference in the number of men and women dying from heart disease and lung cancer has been narrowing. Still, he said, more has to be done to improve men's health, and public health nurses can make a difference.

That brings up another problem. Many men are reluctant to talk about their health and ask for advice from female health professionals. Yet nearly 95 percent of nurses are women.

That's another byproduct of acculturation, Swartzberg said. From a young age, women are accustomed to taking their health care instruction from a male doctor, so they don't suffer the same reluctance to talk about intimate body functions with someone from the opposite gender. One solution is finding more male nurses, Swartzberg said.

Shelton, who delivered a session at the Oncology Nursing Society congress on the male cancer experience, said men in general aren't comfortable talking about how they feel. They're definitely uncomfortable talking with a woman-even a nurse-about their sexual functioning.

At times, he said, female nurses feel uncomfortable as well and could project those feelings onto the patient. Nurses have to make themselves talk about sexual practices, alcohol and drug use, and other personal health issues with men. If they can't do it comfortably, they need to find someone else to talk to the male patient. But they need to broach the topic as part of their job, Shelton said.

"It's our role to get into people's lives and let them know what they need to know," he said.

Foreign territory

Laura Fennimore, MSN, RN, director of education for the Oncology Nursing Society, understands why male patients aren't comfortable talking to a female nurse. Some cancer therapies throw men into foreign territories. "Engorged breasts and hot flashes aren't things men expect to be talking about," said Fennimore, an oncology nurse for 20 years. Sometimes, the nurse isn't comfortable on her side of the conversation, especially if she's close in age to the patient, she said, but she has to overcome these feelings.

Women play a significant role in men's health, and they suffer drastic consequences when the man in their life falls ill. Fennimore's father died of prostate cancer in 2000, and she saw firsthand how her mother had to take on the family role he vacated. Not only do women nurse the men in their lives, but they also have to take on additional roles and duties when their man no longer can perform them.

Often, it's the woman in a man's life who drives his health care, said Herald, a nurse consultant for Kentucky's Department of Public Health. His wife prods him to get a checkup or health screening. She tells him she doesn't want to grow old without him. That intervention is important in promoting men's health awareness. Herald also believes health care practitioners need to tailor the message to appeal to men's goal-oriented nature.

"Women are much better at taking general health information than men are," Herald said. "Maybe it's a chemical imbalance in our brains. We have that immortality complex. We think we're going to live forever and, when we get sick, then we tend to hold a grudge."

Men are less likely to respond to the general health education that says a healthy diet helps control diabetes. Instead, a man will respond to the information that losing 20 pounds will help control his diabetes. Give him that information, Herald said, then help him set a reasonable time frame to lose those pounds.

Many men won't seek out health information. They don't ask as many questions as women patients, and they don't take advantage of hospital education resources, said Bob Lumpkins, MS, RN, vice president of patient care services at Harris Methodist H.E.B. hospital in Fort Worth, Texas.

A seeming lack of inquisitiveness about a diagnosis could signal that a man is in denial, Lumpkins said. Nurses need to be on the lookout for any patient who seems to struggle with accepting a health problem. In those cases, he said, the nurse has to take the initiative in putting out the needed information.

Male models

In the Department of Veterans Affairs health system, more than 90 percent of the patients are men, said Pat Quigley, Ph.D., ARNP, director of patient safety in the Tampa, Fla., center of the Veterans Integrated Services Network. The VA health care system also attracts more male nurses from the pool of military medics and health care professionals. This connection to military life creates a bond that motivates men to take care of themselves, said Quigley, president of the Florida Nurses Association.

The department also trains patients with chronic illness to work in education programs for others with the same conditions, and leads support groups and provides patient education. The men trust each other and feel comfortable with the interactions, she said. This is a model other hospitals and clinics should look into, Quigley said.

Swartzberg advocates addressing men's health issues outside the hospital setting and reaching men at an earlier age. Health education needs to find young men where they're likely to see it, such as Web sites and magazines. The message needs to fit their concerns.

Tell young men they will look better and have more energy, Swartzberg said, and emphasize the positive rather than the negative things that could happen to them.

The men's health crisis needs attention on multiple levels, he said: The food industry needs to provide more healthy diet information, and the film industry needs to stop depicting smoking on the silver screen. About 70 percent of health problems are preventable with healthy living, he said.

"None of this is rocket science," Swartzberg said.

Contact Donna Hemmila at dhemmila@prodigy.net