Goal

1. Enhancing Migrant Men’s Health: A Systems Approach to Increasing Access to Health ServicesAlfonso CarlonCenter for Health Training512-474-2166Acarlon@jba-cht.com 20th Annual Midwest Stream Farmworker Forum, November 18-20th, Austin, Texas

2. Goal Improve health outcomes for men…for women.. children families communities

3. Overview Gender and Socialization Personal and Professional Attitudes Comprehensive Planning Model Implementation Challenges

4. Culture of Men

5. Health Effects of Men’s Socialization

6. The very attitudes and behaviors that increase men’s health risks… …are considered normal and expected.

7. Compared to girls, boys are: • Seen as stronger and less fragile • Discouraged from seeking help • Ridiculed and punished if they do seek help • Encouraged to take risks

8. Six Major Health Risk Factors for Men: • Fail to adopt health promoting behavior • Engage in risky behaviors • Adopt traditional stereotypes of masculinity • Conceal vulnerability • Perceive themselves to be invulnerable • Lack health knowledge

9. 1. Men Fail to Adopt Health Promoting Behaviors • Do not have regular, routine health exams • Eat less fiber and more fatty, salty food • Are more often overweight

10. Do not do testicular self-exams • Use less sunscreen • Sleep less and not as well

11. 2. Men Engage in Risky Behaviors Driving • Drive dangerously • Speed • Drive under the influence of alcohol or drugs • Wear seatbelts less often

12. Male Risk-Taking Behavior In 2002, men accounted for: • 89% of all pedal-cyclist fatalities. • 69% of all traffic fatalities. • 68% of all pedestrian fatalities. In 2002, of drivers involved in fatal accidents: • 25% of male drivers were intoxicated. • 12% of female drivers were intoxicated.

13. Risky Lifestyles • Engage in risky sports, work, travel • Carry weapons • Have physical fights

14. “Don’t be a sissy.” Men Hold Traditional Beliefs “Guys always want it.” • Men who hold traditional beliefs: • have more sexual partners • don’t wear condoms “All the guys are doing it!.” “Be a man!”

15. 4. Men Conceal Vulnerability

16. Men delay getting help. • 3 of 4 college men did not get help for STDs from 2-6 months after developing symptoms.

17. 5. Men Perceive Themselves to be Invulnerable Most men: • believe their health is “excellent” or “very good” • report better health than women, even though they die younger and have higher death rates. • don’t think they are at risk for illness or injury.

18. Men of all ages are at high risk for STDs and HIV, yet they report little concern.

19. Half the men with testicular cancer are not diagnosed until the advanced stage when it is fatal or disabling. Lance Armstrong

20. 6. Men Lack Health Knowledge • less knowledgeable about health and diseases • less experience with the health care system • reluctant to ask questions

21. How Gender Stereotypes Influence Service Provision • Men’s health risks are invisible • Men receive inadequate information • Men are given conflicting messages about masculinity vs. health promotion in the following areas: • Violence • Drinking • Sexual activity

22. The Gender Health GapLife Expectancy, 2004 Men dying 5.2 years sooner than women 1920: average age of men at death was 53/women 54.6 2004: 75.2 men/80.4 women More males than female are born 105-100 By age 35, women outnumber men At age 100 women outnumber men 8-1

23. a. Men’s Health Risks are Invisible • depression is not diagnosed in many men. • Mental health clinicians failed to diagnose nearly two-thirds of depressed men.

24. b. In medical encounters, men receive: • less information • briefer explanations

25. Men are Given Conflicting Messages Drinking Sexual Activity

26. Key Points to Remember • Men rarely seek  make the most medical help of every encounter • Men deny or  ask many open- minimize symptoms ended questions • Men are reluctant  give lots of info to ask questions

27. Male Sexuality and Sexual Health

28. MSM or MSMSW?

29. 30 Million Men Have Sexual Problems • Low sex desire • Aversion to sex • Pelvic steal syndrome • Premature ejaculation • Inhibited ejaculation • Retrograde ejaculation

30. 40% of men have impotence problems by age 40 Contributing factors: • Age • Smoking • Diabetes • High blood pressure • Prescription drugs • Depression

31. Myth: “The Bigger, the Better”

32. Risky Sexual Behavior Males tend to: • Begin sexual activity early • Between first intercourse and first marriage, typically have around 10 years of being single and being sexually active • Have more sexual partners • Have unsafe sexual practices • Have sex under the influence of alcohol or drugs.

33. Trends In Men’s Health2007 Leading Causes of Death(MMWR, Nov 27th, 2009, Vol 58 No 56.1303 Quickstats) Causes of Death Men Women Heart 237.7 154 Cancer 217.5 151.3 Accidents 55.2 25.8 CLRD 48 36 Stroke 42.5 41.3 Diabetes 26.4 19.5 Flu/Pneumonia 19.3 14.2 Suicide 18.4 4.7 Kidney 17.8 12.5 Liver 12.7 5.9 Suicide 18.4 4.7 Homicide 9.6 2.5

34. The Racial Health Gap Hispanic American males are: • 16% less likely to receive treatment for prostate cancer. • More likely to die from accidents (3rd leading cause of death, as opposed to 5th leading cause of death for white/black males). • 3.1 times more likely to die from homicide.

35. The Racial Health Gap African American males are: • 2 times more likely to die from prostate cancer. • 2.2 times more likely to die from accidental death. • 9.8 times more likely to die from homicide.

36. Few Men Make Sexual and Reproductive Health Visits Annual visits per 100 men 15-19 20-24 30-34 35-39 40-44 45-54 25-29

37. Rank – Reasons Men Seek Reproductive Health Care • Urinary tract, penis, scrotum, or testicles • Family planning • Prostate problems • STI

38. Rank – Reasons Men Seek Reproductive Health Care • STI 52% • Urinary tract, penis, 20% scrotum, or testicles • Prostate problems 18% • Family planning 8%

39. Reactions? Implications? Why do you think men are more likely than women to have poor health outcomes? What messages does society give to men about taking risks and seeking health care?

40. History of Increasing Male Involvement in Reproductive Health in Texas • 1990 Building Infrastructure • 1998-2005 Community Based Projects • 2003-2008 Clinic Based Projects • 2010 – Texas Paradigm Shift DSHS state GOAL to increase males served by 25% by 2013

41. Title X Family Planning Annual Report (FPAR) 2008-2009 • 20% Increase in males seen in DSHS funded FP clinics • Male Gonorrhea testing up 36% • Male Chlamydia testing up 23% • Male Syphilis testing up 48% • Male HIV testing increased 52%

42. Benefits of Providing Services to Men • Addressing men’s own health needs • Benefits of joint RH decision making • Effective treatment of STIs requires men’s involvement • The need for men’s involvement in pregnancy and parenting • Opportunities to improve the lives of both men and women

43. Defining Needed Services • Information • Skills • Counseling • Preventive health care • Clinical diagnosis and treatment (Sources: American Medical Association, EngenderHealth, Urban Institute and others)

44. Challenges • Nursing certification • Clinic flow • Providing male-friendly tests • Outreach and in-reach • Building community partnerships

45. Obstacles to Addressing Men’s Needs • No consensus on standards for male sexual and reproductive health care • Provider reluctance to offer services for men • Services focused on women and medical needs • Lack of information about men’s needs • Inadequate medical training • Gaps in financing

46. 2005 Region II Male Involvement Advisory Committee, DHHS, Office of Family Planning ( ,

47. Health Beliefs Yours Theirs

48. Medical Model Health absence of disease Prevention to avoid disease Seeks specialty practitioners Decisions – individual Disease bio-medical Traditional Model Health harmony – body, mind, spirit Prevention not recognized concept Seeks herbalist, priest, shamans Decisions – family Disease – god, curse Cultural Dynamics Influencing the Clinical Encounter

49. Independence Individualism Individual interests priority Reliance – nuclear family Interdependence Collectivism Individual interests subordinate Reliance – nuclear & extended family Cultural Dynamics Influencing the Clinical Encounter

50. Communication Informal Direct Direct eye contact Distance - professionalism Communication Formal Indirect Indirect eye contact Closeness – builds rapport Cultural Dynamics Influencing the Clinical Encounter