Men step into the spotlight

BASYA LAYE

What first comes to mind when you think, men's health? Prostate cancer, erectile dysfunction, heart disease? What about osteoporosis, depression and hormone problems?

The Men's Health Initiative of British Columbia (MHIBC) is an academic program of the department of urologic sciences at the University of British Columbia in conjunction with Vancouver General Hospital. MHIBC is one of a few programs in the world with a full mandate to improve "men's health and quality of life through leadership, awareness and education campaigns, research and disseminating best practices in clinical care."

The impetus to create this program has been building for several years but it only recently has taken on a defined and active mandate, under the guidance of Dr. Larry Goldenberg, a clinical scientist and urologic surgeon. Goldenberg is widely recognized for his leadership role in prostate cancer research and treatment, and is founding director of the Prostate Centre at VGH.

As part of their mandate, MHIBC has also created a website (aboutmen.ca) to disseminate information about health and risk factors for men, their physicians and their families.

In an interview with the Independent, Goldenberg spoke about the momentum needed to further develop the initiative, which was just launched last month. Women's health programs have been around for decades and Goldenberg doesn't hesitate when asked if the same model can be applied to men.

"Health care for men is an area that really has not been addressed through a men's lens ... we've been looking at it through a women's lens for many years and have been successful in developing programs that are gender specific."

He continued, "Gender-based programs are important for delivery of health-care services."

A major concern is men's lower life expectancy compared with women. The social and economic impact of early male death on families and on society should not be underestimated, Goldenberg pointed out, sharing a list of sobering statistics: "For example, in one study ... almost 50 percent of women are widowed by the age of 65 and more than half of elderly widows who are living in poverty were not poor before the death of their husbands. By age 95, women outnumber men eight to one in our society."

Goldenberg drew attention to a 2002 World Health Organization statement that recognized that the way to work towards gender equity is by "look[ing] at the biological differences between men and women, look[ing] at the different roles in society and, in order to achieve the best standards to care of health care for both genders, we have to recognize that there are different needs, different issues, different obstacles, different opportunities." Goldenberg warned, "We need to identify these and get this information out."

While we have a high level of medical and clinical expertise in British Columbia, what we don't have, he said, "is coordination, so the Men's Health Initiative is designed as an umbrella organization to coordinate, collaborate and, I think most importantly, to communicate. So, the big three C words."

Goldenberg has a plan of attack: "We have to communicate through a series of social networking and marketing to get the messages out. There are huge numbers of men in all decades of life who are at risk for a variety of health-related issues and may not be aware of those risks, so they need to be made aware and then given the option to act on those risks."

He pointed out two important parameters of men's health: life expectancy and health expectancy.

"Men have higher rates of death from certain diseases, so women get heart disease too, but men tend to get heart disease younger and to die more often at a younger age. What that results in is an increase in the potential years of life lost.... The reality is there are a lot of men who live to be 90, you know, we don't all die at 76. It's an average ... what brings down the average is that there are a lot of men dying at a younger age ... dying in motor vehicle accidents, risk-taking behavior, suicide.

"The other area is something called health expectancy. So, you could live to be 79, 80, but if you're sick for the last 10 or 15 years because you didn't look after yourself when you were younger, you're a huge burden, not just to yourself but, to your family and society. We look at the gap between health expectancy, the number of years of your life that you're actually healthy versus life expectancy, the day you die. And that gap, ideally, should be zero. Wouldn't it be nice if we all lived perfectly well until the day we die?"

Taking the time to dispel some conventional wisdom, for example, that men avoid seeking care, Goldenberg said, "The gestalt that's out there – men just avoid health care, if they have a symptom they ignore it, they react rather than proact, women are more interested in prevention than men are – those are generalizations that have never been proven in research, so part of this initiative is going to be research on those kinds of questions."

Goldenberg is excited about the potential for this initiative to become a real outreach program.

While most are familiar with men's health problems that include the "prostate and the penis," MHIBC aims to go beyond these traditional models of men's health to address some little-known risks. One of these is men's risk for osteoporosis, a bone-density disease overwhelmingly associated with postmenopausal women.

Goldenberg said this is a serious concern for men. "Men over the age of 60 are high risk," but even more worrisome, "if a man gets a fracture because of osteoporosis, statistically, they're more likely to die than a women who has a fracture from osteoporosis.... We've got to get out the message to men, when they're in their 40s or 50s. These are the risk factors for osteoporosis, self-assess yourself, have a look at these, if you think you're at risk, go talk to your doctor about it."

Most of all, Goldenberg wants people to be curious. "Understand what your own risks are, understand where you stand in the paradigm of the world of health. It's not fear-mongering, it's reality.... This isn't about telling men you've got to exercise and eat your fruits and vegetables. Understand, at least listen, then, you're a grown up, make your decision. Do you want to eat less fat? It's up to you ... we're giving you the information.

"Ultimately, if we can impact on five percent of the male population and save five years of illness on five percent of the male population – that's not unachievable. Say, two million males in the province, five percent is 100,000, that's 500,000 man years of health and that's a little goal – only five percent of men.... So, what is that, $1000 a year in drugs and medicines and health care? What does that translate to? Five billion dollars. So the savings to society are huge and it's not a huge effort to do it, it's got to be a coordinated effort."

While Jewish men of Ashkenazi heritage are more likely to develop Crohn's disease or be a carrier for Tay Sachs, the real health differences exist between socioeconomic groups, with the poor being hardest hit. Goldenberg said, "The average gap between health and life expectancy is about 10 years. But in some poor socioeconomic groups, the gap can be as much as 15 or 17 years ... poverty hits everybody, Jewish and non-Jewish."

Currently, Goldenberg said, the public is funding MHIBC and the Jewish community has been at the forefront of that support. "Last year, we raised $1 million with the help of the CFHU [Canadian Friends of Hebrew University]. We had an evening event that was co-sponsored by CFHU and VGH-UBC Foundation. We raised $2 million: $1 million went to Hebrew University and $1 million went to our men's health program."

Goldenberg is well aware that the MHIBC will likely serve as a model for other men's health-care initiatives around the globe.

"I think we can develop a model here that will be looked at in many other parts of the world. You know, there are only [two] academic chairs in men's health in the world and two of them are in the U.K.... I would love to have the first academic chair in men's health in North America and the third one in the entire world. There are 176 academic women's health chairs in the world that I'm aware of, in that range. There's been a 30-year-old women's health movement, it's provided us an excellent model for men to analyze, to learn from, not to compete with – we're not here to compete for resources – but we want to emulate what the women have done and help men live healthier lives."

Goldenberg is energized and committed to meeting these objectives. "It's a huge undertaking," he said, "that's for sure."

For more information on MHIBC, visit aboutmen.ca.

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