Public Health in Action – Time for a Reality Check

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Back in 2008, in the summer between semesters at graduate school, I took an internship with the Men’s Health Network (MHN) in Washington, D.C.  I had no idea then how transformative it would be.  Looking back now, it was a reality check of sorts.

In the semester before my internship, I took a class on U.S. Healthcare Delivery and Comparative Health Systems, both of which examined existing healthcare policies – in the U.S. and countries abroad – as well as then presidential candidate Obama’s proposed healthcare reforms (early foundations of the Affordable Care Act).  Those courses catapulted my awareness and understanding of systems-level thought and practice on population health.  And it inspired me to gain firsthand experience in Washington.

After eight weeks at MHN I came to the realization there was an underlying issue that couldn’t be addressed with access to healthcare services.  Health insurance was thought and continues to be thought of as a solution to our nation’s health woes.  Unfortunately, there’s one population that remains constant with respect to health disparities – men.  Regardless of race, men live an average of five years fewer than their female counterparts.  Additionally, men with health insurance do not fare much better; the gap still exists.

My internship experience at MHN left me wondering: why and how can this be improved?  I can recall many conversations I’ve had from outreach programs in the various DC/Maryland/Virginia communities.  Attendees pass by the MHN booth and are usually puzzled.  My first question was always, “Who lives longer, men or women?”  Every single person, man or woman gets this right – women do by a few years.  My follow up question is more difficult to answer: why?

Answering why men are disproportionately less healthy and how to improve their health and wellness is extremely complex and something that advocates have been working on for decades.

Dr. Jesse Mills, urologist from The Men’s Clinic at UCLA is a passionate physician and advocate to improve men’s health and he shared his vision with me (below).

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Me: How did you end up doing the work that you’re currently doing?  Describe your journey to your current role as the head of The Men’s Clinic at UCLA.  Describe why you’re passionate about making men healthy…why others should care about the health disparities between genders.

Jesse Mills: In medical school, I quickly developed an interest in sexual dysfunction and microsurgery for male factor infertility.  This led to a residency in urology and a fellowship in male reproductive medicine and surgery.  My first position out of fellowship was in a large group urology practice in Denver where my practice diverged away from general urology into complete sub-specialization in male sexual health and reproductive medicine.  I founded the first comprehensive men’s health center in Colorado: The Center for Men’s Health at The Urology Center of Colorado.  After 8 years in Colorado in private practice, I realized how important men’s health is and the lack of a medical school or residency curriculum for the discipline.  Thankfully, Dr. Mark Litwin, chair of Urology at UCLA, shared my vision and we both quickly saw the opportunity to not only provide expert, evidence-based care to the men of Los Angeles and beyond, but also to foster an interest in men’s health among medical students, residents and fellows.  My passion for men’s health comes out of my own passion for being a healthy male.  Why is it that I know how to exercise, eat well and be on top of my health screenings so that I can stay lean, fit and energetic and live a preventative lifestyle?  I didn’t learn this directly in medical school but I pay attention to research in fitness and nutrition and I want to share this with my patients and medical professionals alike. Gender health disparities are interesting and one would think easy to fix.  Women become enfranchised into the adult medical world at 18 with their first pelvic exam.  Men don’t have a regular screening until they hit age 50.  In those ensuing 32 years, guys can do a lot of damage to themselves and cost the healthcare system billions of dollars in preventable disease.  If a man could spend a half hour with a men’s health expert every year and get his vital signs checked, get updated on nutrition and fitness, get a physical exam and appropriate blood tests checked and leave the office with health goals for the next year, how great would that be?

 

Me: What inspires you on a daily basis, especially when things get hard?

 JM: My biggest inspiration is my wife.  She is strong, encouraging and understands how hard I work to further the cause of men’s health and she is my greatest reality check.  For example, the amount of hours I’ve been putting in to launching the Men’s Clinic at UCLA have definitely taken away from my personal fitness time.  Without offending me, the other day she just happened to ask me, when my shirt was off, “when are you going to get back in the gym?!”  Turns out even I need a men’s health specialist to keep me on track—mine just happens to be my wife.  When things get stressful, my best outlet is turning to exercise, walking my dogs, taking a few moments to re-calibrate and focus on what’s important:  family and living a meaningful life.

 

Me: In what ways can healthcare and public health professionals engage men to be more proactive in their health?

JM: Don’t be afraid to confront men.  Any patient of mine will tell you that I’m brutally honest with them about their weight, diet and exercise.  Not a visit goes by that I don’t remind them to stick with their nutrition and exercise plans.  Every doctor needs to not only tell a man he’s overweight, smoking or drinking too much but also let the man know you’re there to help.  From the urology perspective, it’s easy for me.  I tell a man the health risks he can prevent including obesity, diabetes, and cigarette smoking will all lead to sexual dysfunction and low testosterone.  Men’s health is sexual health and sexual health is overall health.  We all know the studies showing that men with erectile problems in their 40s are twice as likely to have severe cardiac disease within 10 years than men with normal sexual function.

 

Me: Describe your vision for the Men’s Clinic at UCLA.  Where do you see it in the next year, 5 and 10?

JM: My vision is to develop a national, reproducible model for comprehensive men’s health that demonstrates positive outcomes.  I want to show, through research, that when I see a man in his 30s with erectile dysfunction or infertility, he can become a healthier 50- and 60-year-old.  I also want to develop a medical school curriculum that makes future doctors aware of how to effectively treat all aspects of men’s health and continue to collaborate with other medical disciplines.  In 5 years, I’d like to have satellite clinics around Los Angeles where men will see well-trained physicians and extenders who follow American Urological Association Men’s Health Checklists for screening and interventions and provide the same passionate and compassionate care that I can provide in Westwood and Santa Monica.  In 10 years, I’d like to have enough physicians that have trained in our UCLA fellowship that we have a national model for men’s health.

 

Me: What are the current needs in Los Angeles as they relate to social determinants of health (i.e SES, poverty, access to care, transportation, safety, etc.)?

JM: Los Angeles is at least 40 different communities living under one title.  We have some of the wealthiest zip codes in the nation and some of the poorest.  We have, in public health, for so many years looked to increase access to health care.  On a trauma and cancer level, that is critical.  However, preventive medicine delivered outside of the hospitals would be dollar for dollar more worthwhile.  I fully support the opinion of Corey Booker, U.S. Senator from New Jersey, that so much health care starts with building fundamentals of nutrition and exercise to keep men out of the hospital in the first place.  For the billions of federal dollars spent on diabetes medication, we could spend a fraction on nutrition education and reduce the diabetes epidemic and dependency on pharmaceutical solutions.  I love the idea of urban gardens and decreasing federal subsidies that favor processed foods over fresh fruits and vegetables.  Los Angeles is the greatest growing environment in the country and is a perfect testing ground to allow inner city youth access to fresh fruits and vegetables on their blocks.  There’s no reason we can’t educate children on proper, unbiased nutrition at an early age.  I grew up in the era where school lunches considered ketchup a vegetable!  We have to do better than that.

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Jesse Mills, MD

The Men’s Clinic at UCLA

Dr. Jesse N. Mills is a urologist specializing in male reproductive medicine and surgery with a busy surgical practice focusing on vasectomy reversal, sperm retrieval, microsurgical varicocelectomy, Peyronie’s disease and penile implant.

His clinical specialties revolve around men’s health and include male hormone management, sexual and ejaculatory dysfunction, male fertility and Peyronie’s disease. He also has a special interest in restoring fertility and sexuality in men with spinal cord injuries

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