Continence Coach: Wellness with Masculinity: Closing the Gap
Historically, the female in the household assumes chief responsibility for the wellness of each family member — identifying and assessing symptoms, researching suspected ailments or illnesses. In years past, she used reference books in the library and consulted friends. Today, she searches websites, conferring with “friends” in online forums and chat rooms, finding the right expert practitioner, and making the appointment.
Often, the responsibility extends to transporting and escorting the patient to the appointment, ordering and picking up prescribed medications, and supervising instructions, both pharmacological and behavioral.
At the National Association For Continence (NAFC), spouses frequently join their husbands on telephone calls to pepper us with questions about treatment options for post-prostatectomy incontinence. It is not uncommon to see at least one third of all men attending an UsToo! chapter meeting on the topic in the company of their wives. One could easily argue that the majority of advertisements for erectile dysfunction drugs are purposely directed to women, not men, considering scenes of romantic bathtubs on the shore at sunset and smiling husbands happily painting indoors when the weather beckons them to play golf or fish. In fact, a study of more than 7,000 pages of print advertising for healthcare products revealed that only 25% were directed at male consumers.1
At the NAFC, our mission does not distinguish between genders. Because we serve both equally, we salute the Men’s Health Alliance for hosting a landmark conference in the fall of 2012 in which 50 organizations participated. From discussion about the disparity between American women and men with respect to quality of life, access, and motivation to engage in healthcare services and products, a seminal position paper2 was released in March to begin promoting National Men’s Health Month in June to frame issues and opportunities to enhance the health of boys and men across the nation.
From funding research for a cure for breast cancer to recognizing and facilitating treatment for mental health illnesses such as depression, women have scored great strides across recent decades for their own health issues. Countless patient advocacy groups have taken shape and mobilized the female voice for the allocation of greater sums of money and attention. Meanwhile, according to the Centers for Disease Control and Prevention, America’s male population dies at 76.2 years of age, 5.6 years (on average) earlier than women, who celebrate an average age of 81.8 years, and at higher rates from nine of the top 10 leading causes of death.3,4 According to the position paper, men make half as many preventive care visits and are far less able to identify their primary care provider as women. The gender gap is evident in numerous similar comparisons, and the gulf widens for male racial/cultural minorities, men with lower incomes, and men without healthcare coverage.5
Frankly, it is unacceptable that in the wealthiest nation on earth African American men are twice as likely to die from prostate cancer as their Caucasian counterparts, largely because their tumors are more advanced by the time they are diagnosed and their follow-up for subsequent treatment (eg, radiation) is more sporadic. Young adult Native Americans are three times more likely than white American males to commit suicide and eight times more likely at middle age to die from an alcohol-related death. The prevalence of HIV/AIDS is three times greater among Hispanic males than white American males; Hispanic males are six times more likely never to have visited a primary care provider and eight times more likely never to have seen a dentist.4
The position paper acknowledges progress under federal initiatives by the Department of Veterans Affairs and the Indian Health Service. It also mentions recent contributions by the Men’s Health Caucus legislated by Congress held by the American Public Health Association in 2010, at which delegates called for new policy development, research, and outreach efforts. However, an urgent call to action is still needed for substantial progress in improving health statistics to be made swiftly. Already, health economists estimate the annual federal cost attributed to health disparities in men and boys in the United States today is between $142.2 and $148.7 billion.6 This figure excludes taxpayer burden at state and local levels, as well as costs incurred across the private sector, including loss of productivity for employers, lost wages by employees, and erosion of personal wealth by households.
It may be easy to view this problem as being too huge for individuals to make a difference. But a role exists for each of us — health educators, marketers, patient advocates, healthcare administrators, and providers, as well as friends, family members, and citizens of a local community. Additional follow-up calls may be needed to ensure adult male patients keep appointments with providers. Extra reminders may be warranted for men to schedule a periodic assessment of blood pressure, blood sugar, weight, and the like. Publicity and marketing campaigns should be created to appeal to the male gender, not just speak to what is presumed to be the woman’s traditional role. All of us can encourage fathers to send a positive message as role models to their sons, with behaviors that reinforce health-seeking as a part of both wellness and masculinity. Women need to continue to go the extra mile for men. What are you doing in your work and in your home life to close the gap and end the unacceptable disparity? You may need to raise the bar on your health — not just continence — coaching.
Dr. Muller is the Executive Director, National Association For Continence (NAFC). The NAFC is a national, private, nonprofit organization dedicated to improving the quality of life of people with incontinence. The NAFC’s purpose is to be the leading source for public education and advocacy about the causes, prevention, diagnosis, treatments, and management alternatives for incontinence.
This article was not subject to the Ostomy Wound Managment peer-review process.
1. Giorgianni S, Cooper J, Zinka K. Comparison of print media health advertising to boys and men compared to women and girls. American Public Health Association Annual Meeting Symposium. San Francisco, CA. October 27–31, 2012.
2. A Framework for Advancing the Overall Health and Wellness of America’s Boys and Men, 2013. Alexandria, VA. Men’s Health Alliance. Available at: www.menshealthnetwork.org/stateofmenshealth. Accessed June 17, 2013.
3. Centers for Disease Control and Prevention. 2012. Health, United States, 2012. Available at: www.cdc.gov/nchs/data/hus/hus12.pdf. Accessed June 17, 2013.
4. Murphy SL, Xu J, Kochanek KD. Deaths: Preliminary Data for 2010. National Vital Statistics Report. 2012;60(4): 1–52.
5. Kaiser Family Foundation. The Uninsured: A Primer — Key Facts About Americans Without Health Insurance. Washington, DC: Commission on Medicaid and the Uninsured;2010.
6. Brott A, Dougherty A, Williams ST, Matope JH, Fadich AN, Taddelle M. The economic burden shouldered by public and private entities as a consequence of health disparities between men and women. Am J Mens Health. 2011;5(6):528–539.
