Tag Archives: men’s health

Public Health in Action – Anchored Upstream

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Public Health River Metaphor

A man was fishing in the river when he noticed someone was drowning. He pulled them out and attempted to resuscitate them. Shortly afterwards, he noticed another person in the river and saved them too. He then noticed another, and another and another. Soon he was exhausted and realized he would not be able save all of the drowning people.

He went further upstream to find out why all these people were falling into the river.

On arriving further upstream, he discovered a broken bridge was causing people to fall into the river and end up drowning where he had been fishing.  He decided he would fix the bridge to stop them falling in, instead of fishing them out after they were already drowning.

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There’s a radio ad campaign for the Powerball Lottery in my local area, Raleigh-Durham, North Carolina that has stood out to me more than the hundreds of others I hear on the radio. In the ad,’Wolfman’ (picture Michael J. Fox in the Teen Wolf movie) visits the barber shop for his regular hair cut. ‘Wolfman’ throws out a few ideas – maybe I should shave it all off? “Or maybe a mullet?” His barber asks why the sudden change from his usual cut. ‘Wolfman’ described that his life was so monotonous lately and he wanted to change things up a bit. The barber then responds by recommending that ‘Wolfman’ purchase a Powerball ticket because every jackpot is worth at least $40 million – a life-changing amount; a change that  coincidentally ‘Wolfman’ was looking for. A disclaimer followed in the final seconds stating the odds of winning a Powerball jackpot, which was a measly 1/292 million. Ads, like this one, that tap into our well of emotions leave us particularly susceptible to any product that marketers are hawking, despite the impossible odds or practical necessity in one’s life.

While 1/292 million are nearly impossible odds, 1/4 seems almost certain in comparison. A recent article from the Atlantic highlighted results from Urban Institute’s study on medical debt. 23.8% of adults under 65 in the US has medical debt. Southern states, like Mississippi and Arkansas, have higher rates of medical debt – both over 35%. Furthermore, insurance coverage had a minimal positive effect: 23% of adults with health insurance still had medical debt compared to 31% of uninsured. As mentioned in the article, this has been a common criticism of the Affordable Care Act, aka Obamacare: that expanding health insurance does little to reduce high costs of health care for individuals (out-of-pocket costs) as well as the healthcare system as a whole.

Health policy in most recent years have been focused primarily on health insurance and affordable access to healthcare services. In the river metaphor above, focusing on health insurance would be akin to pulling people out of the river while they were drowning – providing them healthcare when they were sick, rather than figuring out how to prevent, or at least greatly reduce the risk of, illness. In public health and health care lingo this is what’s referred to as “looking upstream.”

In my interview below, Dr. James Leone, professor at Bridgewater State University, describes his career in “looking upstream.” Other upstream heroes of mine include:

Dr. Rishi Manchanda

Dr. Camara Jones

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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 professor at Bridgewater State University.  Describe why you’re passionate about Improving men’s health…why others should care about the health disparities between genders.

James Leone: My journey into public health education and higher education was a bit random/arbitrary. I began in clinical practice serving as a certified athletic trainer (ATC) where I worked in various settings including: professional with the New England Patriots, clinical outreach at high school, collegiate and physical therapy clinics. I also worked with coordinating rehabilitation clinics and strength and conditioning services in a variety of settings. Not too long into my clinical practice, I received an offer to teach sports medicine/athletic training at Southern Illinois University Carbondale, which was a new challenge for me professionally. I continued to teach and clinically practice, but my love of education rose to the top of my priorities, so I pursued a PhD in public health education. I saw value in what I could contribute on an individual level with people, however, my brain has always been geared towards the “bigger picture” – I guess you can say I embrace an upstream mentality/approach. This was my entry into health promotion and public health studies. I made my way up to Bridgewater State University (BSU) after serving on faculty at Southern Illinois University Carbondale, Northeastern University, and The George Washington University (GWU). Additionally, I currently serve as an adjunct professor at Northeastern University where I have taught courses in athletic training, physical therapy, physician assistant studies, and recently in the master of public health program.

As previously mentioned I have embraced a more “upstreamist” approach in my world and professional view. That said, I realized that male health always seemed to be lacking whether from personal experience or reviewing study after study and large data sets. I always have championed efforts to advocate for groups, be it my athletes or gender (in this case). Also, in 2007 I was approached by my former Chairperson at GWU to offer a class in men’s health, which I quickly embraced since my thought process was already in-tune with this topic. I quickly realized that evidence was lacking in terms of “why” men live sicker and die sooner than women. Also, there were few academic resources (i.e. books) from which to facilitate the topic. I set out consuming as much as I could to develop my course and my knowledge in this area of research. This journey led me to propose a textbook on male health (published in 2012) as well as develop two courses on male health (one at GWU and the other at BSU, presently). I am currently pursuing opportunities to develop male health curricula further so that beyond greater awareness of the topic and issues, we can move dialogue into action and advocacy by training public health professionals and providers on gender-specific needs of men and boys.

So, why do I care about male health topics? I have always been an advocate for people, ethics, and basic human rights. Poor health outcomes in males challenges these aforementioned principles, negatively impacting overall population health. From the public health perspective, we are morally and professionally obligated to help right these wrongs so as to create a more equitable society aimed at a “true public health for all.” I believe Sir Geoffrey Vickers captured it best in his quote, “public health consists of “a successive re-defining of the unacceptable.” I believe gender disparities, particularly those affecting men have been “unacceptable” and warrant our full and undivided attention at present times.

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

JL: My commitment is based on my ethics and morals, which guide my actions. My intolerance for average often guides my “drive” to improve most things in my personal life and professional practice. Knowing that I do work that directly corresponds to people’s health and experiences is more than enriching for me on a daily basis. When times get rough I often remain mindful of the transient nature of life and experiences – the viewpoint “nothing is guaranteed in life” often helps me to keep my life and work perspectives in check most days.

Me: I saw your presentation at this year’s American Public Health Association (APHA) conference on men’s health as a national security concern.  Can you describe your perspective on this issue?

JL: I was in a graduate school lecture discussing public health initiatives and Harry Truman’s 1946 speech was referenced in the talk. As part of that talk, Truman commented on the nature of the military and investing in the health of the youth to strengthen the defense system of the U.S. Of course, at the time, the vast majority of the military were younger men whose overall health and qualifications for military service were being called into question. The latter point got me thinking as to what it would be today; likely, things have gotten worse with rising overweight and obesity issues nationally. This perspective motivated my presentation at APHA in November. Overall, I think this is an incredibly important issue for two main reasons: 1. Of course we want to a strong system of defense if called upon, and 2. And perhaps most importantly, poor men’s health brings to light the overall issues in male health in the U.S. When we are able to gain the attention of the Department of Justice and Department of Defense, we might actually see Congress move on some of the issues in men’s health that we have been advocating for over the past few decades.

Me: What made you decide to be involved in the men’s health movement and the American Public Health Association Men’s Health Caucus (MHC)?

JL: I saw the APHA MHC as a strong platform from which to pool my energies and resources on advancing male health. I value like-minded people, but also, I am challenged by various ways of thinking and working towards solutions in these groups. I have learned that even though there is a shared value and perspective, we all have something unique to contribute to the conversation over men’s health. The men’s health movement attracts me simply because we as a society must look upstream to the issues that we generalize and deal with downstream. We have grown too normalized with poor men’s health and the forces that drive it. I think working with Men’s Health Network, MHC, and APHA can embolden an area that has gone largely unnoticed even at the detriment of society.

Me: What are the current needs in the Boston metro area (or focus in on the city you live in) as they relate to social determinants of health (i.e SES, poverty, access to care, transportation, safety, etc.)?

JL: I consider Boston and the surrounding areas as “lucky” because we have so much access to health, healthcare, education, and most of the social determinants that can positively affect population health. However, when we look below the generalized population data, we still see a consistent and stark contrast in the health of the privileged and the socially marginalized as with most other major cities. Boston struggles to meet the needs of harder to reach populations and men just like most other major cities in the U.S. We do have some excellent and progressive programming such as the Men’s Health Center (Whittier Street) in Roxbury and the men’s health program through Cambridge, however, the salient question is always: are we meeting the needs of the most vulnerable at the right moments so as to promote long-term individual and population health – I guess time and statistics will tell that story.

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Public Health in Action – The Secret Life of Males

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It was in fifth grade when I first read a handful of James Thurber’s “The Secret Life of Walter Mitty.”  My teacher, Mrs. Dalton, used Thurber as an example of descriptive writing, what she referred to as “Show, not tell” or SNT for short.  I vividly remember writing a story similar to Thurber’s Walter Mitty, where I would drift back and forth from real life to daydreaming and back again – racing a car in my daydream, only to be scolded by the grocery store manager for barreling the shopping cart into an innocent pyramid of watermelons.

Now more than two decades later, I still chuckle at Thurber’s humorous tales; humbled by his seamless transitions between fantasy and reality.  But on a deeper level, the life of Walter Mitty illustrates distinct social norms and narratives.  Walter’s fantasies transport him into a life that’s far more exciting, full of adventure and intrigue, and completely different from his normal life.  He’s the stoic commander of a helicopter flying into a snowstorm or the Air Force captain taking a few drinks of brandy before jumping behind the machine gun turret.  He becomes his own hero; a figure of admiration by those around him.  But the story beneath reveals a few underlying messages to males, in particular: take risks, be heroic and be brave.  And those messages are absorbed, accepted and passed from generation to generation.  These “rites of passage” have a profound effect on personality, lifestyle and behavior. Moreover, they may also explain the following:

Males are:
*less likely to have health insurance
*half as likely to visit a healthcare provider
*employed in the most dangerous of professions – fishing, mining, fire fighting, construction
*more likely to take risks at younger ages

As a result, males aren’t as healthy as their female counterparts.  And for a group of this size, roughly 150 million, the impact on society is a staggering thought.

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I had a chance to catch up with Dr. Michael Rovito, assistant professor at UCF about his passion and interest in men’s health.  Let’s check out his story.

 

Me: How did you end up doing the work that you’re currently doing?  Describe your journey to your current role as assistant professor and researcher at UCF.  Describe why you’re passionate about making men healthy…why others should care about the health disparities between genders.

Michael Rovito: I had an unorthodox path to practicing public health, actually. I obtained a BA in Geography and a MA in Urban Studies. I was a bit aimless with life goals and no real idea of what I wanted to do with my career. During my graduate studies, I had a class called ‘Medical Geography’. An epidemiologist taught the course and it opened my eyes to the idea of public health and what I can do, not just with my own career, but for other people. I don’t think we really reflect on how we can assist others with our profession and that was my ‘eureka’ moment with public health.

After I realized I wanted to get into public health, I reflected back on my life and the health behaviors I made when I was younger and I focused in on men’s health. The notion of life course perspective was brand new to me so I dove in head first, borderline psychoanalyzing my past habits and trying to predict my future health outcomes. I chuckle now at my naiveté at the whole process, but it’s what we all do when we discover a new toy or gadget, right? We kind of go overboard a bit. But, I am thankful for my rather intense puzzling of the past with present outcomes as I remembered a time when I was 16 and I discovered a lump on my testicles. I thought it was cancer. Being the mid-90’s, there wasn’t the internet that we know today. No WebMD. No Google. So, I just kept quiet and suffered silently. Eventually I broke down and told my parents. That anxiety is some serious stuff. Worrying about the possibility of having cancer at 16 with no information…it was pretty rough.

Eventually I saw a urologist and fortunately it was not cancer. I went through the cancer scare right around the time of my introduction to public health so I thought to myself that I needed to help other guys who were in the same situation as I was. I wanted to help them feel less confused, more comfortable, and empowered. So, after obtaining my PhD in Public Health from Temple University in Philadelphia, I decided to devote my professional life to, again, helping males get healthier in any way possible – from learning new information to practicing new preventive behaviors. Whatever it took, if I can help even in the slightest sense, I wanted to do that. It seems like a simplistic mantra to explain why I do what I do, but deep down, I think most of us who practice public health have similar ambitions.

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

MR: I guess I should say “who” inspires me now is my wife and my daughter, and my little Shiba Inu, Lola. What currently inspires me? Making sure they have the best life possible. Having this new family of mine has REALLY changed my perspective on life. I had always heard while growing up how kids and family life changes you, but I shrugged that off and rolled my eyes at it. I mean, how would I know just how much that would alter my view on life if I never had them? It’s understandable, I guess. But, now, I can’t let them down. That’s what drives me everyday.

But, before my family, my inspiration was to succeed where most of the people I grew up with didn’t. The odds of leaving the little Appalachian town in the hinterlands of Pennsylvania were certainly not in my favor growing up. There’s certainly nothing against not leaving, but I needed to leave. I wanted to leave. So, finding the means possible to leave, to grow, and mature in ways that weren’t readily available to me was my primary motivator. If anyone reading this ever grew up in small town America, they can relate. They can relate to the entirety of John Cougar Mellencamp’s discography serving as the official soundtrack to their lives. My inspiration then was to make a new soundtrack.

Me: Describe your research interests and/or current research projects.

MR: I have two primary research interests: testicular self-examination (TSE) promotion and intervention/instrument design within young adult and adolescent male populations. In terms of the TSE work, I am currently focused in on the health policy side of it all. I am embroiled in a push to directly challenge the USPSTF review of the TSE and its “usefulness”.  In terms of the intervention and instrument design, I developed a series of tools and assessments that can be used in outreach programs that can capture great data on current outcomes and indicators of future outcomes.

Me: What made you decide to be involved in the men’s health movement and the American Public Health Association Men’s Health Caucus (MHC)?

MR: Advocacy is very important to me, as is disseminating my work to a broader body of my peers. MHC does that for me. APHA/MHC provides a pathway, not only to share my work, but also provides a means to collaborate. That’s very important. I can’t stand the thought of being a professor if I can’t profess to people. I can’t stand the thought of having a degree in public health and not actually getting my work into the public. So many of academics don’t actually practice what they preach, which frustrates and angers me. What’s the point? But, MHC is one way that I can get my ideas to others and perhaps implement them in the field.

Me: What are the current needs in central Florida (or focus in on the city you live in) as they relate to social determinants of health (i.e SES, poverty, access to care, transportation, safety, etc.)?

MR: Central Florida has the same needs as pretty much the rest of the country, but it’s just amplified due to the huge population growth and the diversity here, which makes it a bit different than some other areas of the US. But, overall, the needs are the same: we need to inform, we need to empower, we need to advocate.

Public Health in Action – A Silent Health Crisis

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Of all the things in the fields of both public health and healthcare that pique my interest and attention most, it’s health disparities, specifically the numbers 5 and 7.  In a country as productive and innovative as ours, it’s a particularly vexing reality check whenever I’m faced with those two numbers, which I’ve listed below along with their respective contexts.

5  – the difference, in years, of life expectancy between genders

*Life Expectancy at Birth in 2013: Female 81.2 years  Male 76.4 years

**Races considered: Hispanic, White, Black

5 & 7- the difference, in years, of life expectancy between females & males respectively

*Longest life expectancy to shortest in each gender

Health disparities are the end products of a variety of complex factors including, but not limited to the social determinants of health: SES, transportation, access to healthcare, employment, etc.  Additionally, they are also impacted by biological (our genes and family history), social (our culture and networks) and environmental (our physical surroundings) factors.  Lastly, health disparities are impacted by individual health behaviors and lifestyles.

The numbers 5 and 7, to me, represent a collective challenge: how can we bring these numbers down, thereby reducing  health disparities in our country?  What other perspectives do we need outside the fields of public health and healthcare to reduce health disparities?

My conversation with Steve Petty, Corporate Director for Community Health Improvement at INTEGRIS Health could offer some insight to the issues I’ve raised above.

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Me: How did you end up doing the work that you’re currently doing?

Steve Petty: I have been working in health care for 29 years.  I started in a marketing/public relations role and several other areas and have worked in community and employee wellness for the last 20 years.

In community wellness, our mission (the same as INTEGRIS Health) is to improve the health of the people and communities we serve.  Our department works in many at-risk, minority and under-served communities.  The state of Oklahoma has very poor health indicators for about everything you can possibly imagine.  We are working to provide health, wellness and health education services to those most in need, but to also educate people in general about the need to take care of themselves – know their health numbers (blood pressure, cholesterol, etc.), to get routine and regular exams, among others.

One area that continued to grab my attention was comparatively poor health indicators for men.   It was alarming to discover that such few men actually went to a regular doctor or health provider, let alone had access to any type of screenings.  INTEGRIS had been doing a Women’s Health Forum for many years then.  Most of their outreach efforts were for women who had insurance (employer-based or from retirement) but a majority of them were proactive with their health for the most part.

Two of my colleagues and I developed a proposal that would address men’s health in a different way that wasn’t intimidating to men, but still covered all aspects of their health and education.  Our leadership liked the idea, but a few seemed skeptical that we would be able to attract men to a health event.  We were confident that we could succeed if we tied it to something they were interested in, so, naturally, we partnered with the local sports radio station and used humor to make it a different kind of health event.

In our first event in 2004, over 300 men attended our event and we’ve had steady attendance ever since.  We continue to add more events and health screenings which have proven successful and have replicated many of these screenings and events in our rural communities where we have smaller hospitals and populations with limited access to health education programs and services.

We started planning our event back in 2003 and realized there wasn’t a lot of information on men’s health events anywhere.  Through internet searches, I stumbled upon the Men’s Health Network (MHN) webpage.  We finally found a resource to help us secure health education literature for our upcoming men’s health conference and MHN’s Jim Boyd and Scott Williams were crucial partners in planning that event and others since.  MHN has been one of our biggest supporters and partners in our efforts to improve the health of men and boys in Oklahoma.  The partnership has given me the opportunity to present our program and services across the country and at the 2009 International Society on Men’s Health in Vienna, Austria.  I’ve served on several committees through recommendations by MHN, and that’s how I got involved with the American Public Health Association (APHA) Men’s Health Caucus (MHC).  I was fortunate enough to be involved with the caucus early and have served in several positions since its inception in 2008.  I currently serve as the chair for the MHC and represent our group in the APHA’s Caucus Collaborative.

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

SP: I’m inspired by all the work being done which focuses on the health of men and boys.  It’s amazing to see how awareness and interest to keep men healthy has escalated over the years among government officials, businesses, marketing professionals and the public as a whole.   I’m also inspired by all of the great programs and services we’ve implemented here in Oklahoma, not just for men, but to improve health outcomes for the entire population, including children, senior citizens and minority populations.  We have a long way to go to show impact, but we are slowly making progress throughout the state.

Me: Can you share some of the progress you’ve made at INTEGRIS as it relates to men’s health outreach?

SP:  A large percentage of men have only limited contact with physicians and the health care system as a whole. Men not only fail to get routine check-ups or preventive care, but often ignore symptoms or delay seeking medical attention when sick or in pain. These poor health habits take their toll – beginning at early ages and rising significantly as males reach retirement age.

Because INTEGRIS is determined to raise awareness of this “silent crisis” and turn the tide, we’ve implemented an innovative men’s health initiative, Men’s Health University (a.k.a. Men-U). It’s designed to educate men and their families on the importance of men taking charge of their own health. Established in 2004, Men-U consists of free screenings and information, physician seminars, an annual wellness fair, (the 2006 event drew more than 700 people), and this website devoted solely to men’s health.

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By bringing men back into the health care system, INTEGRIS is helping them overcome one of their biggest health risks – that of just being a man. And knowledge is power. Even if males are aware of just two numbers, blood pressure and cholesterol, and take active steps to lower them if either reaches an unhealthy range, it can make a huge difference in their longevity.

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Me: Describe your vision for Integris Health.  Where do you see Integris and/or MHC in 1, 5 or 10 years and what kind of impact do you plan to make?

SP: My vision for INTEGRIS Health is really coming together for our community.  INTEGRIS is one of the few health systems in Oklahoma that gives back to the community in such a substantial manner.  We are finding new partnership and collaborative opportunities with agencies and organizations who have similar missions.  Additionally, we continue to explore innovative ways to make an impact on the health and wellness of our communities by sharing resources and services with partners like the Regional Food Bank, Oklahoma City County Health Department, the local Federally Qualified Health Center, churches and colleges.  All of these groups are coming together to hold events, offer services, programs and share resources, all of which help us improve the lives and health of our targeted communities.  I hope in the next year, our work to develop a comprehensive health, wellness and education resource center will come to fruition.  I hope we can replicate this model across our service areas in the next 5 to 10 years.  This will make a huge impact on patient access, especially if we can get other hospital systems to join with us.

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

SP:  The needs in all of these areas listed above are, unfortunately, not being met in many areas.  We observe access to care being a recurring obstacle for many individuals.  People can’t afford health insurance through the Affordable Care Act and/or their co-payments, so they have to use our emergency departments as a clinic or their healthcare provider.  We have about 19 free clinics in the metro area that are at capacity due to unmet needs of populations with limited resources or circumstances – uninsured, undocumented and underprivileged.

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Oklahoma, as a state, faces many challenges as documented in their annual state report, however, passionate community leaders like Steve Petty and his colleagues are working diligently to improve health outcomes at the local level.

“Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it’s the only thing that ever has.” –Margaret Mead

If you’re interested in learning more or working with Steve to improve health and well-being in Oklahoma, contact him at Stephen.Petty@integrisok.com.