June, MEN'S HEALTH Month

June is men's health month, a time dedicated to raising awareness about early detection and treatment of health conditions that proportionally affect men and boys. To do so, we are looking at the health hurdles experienced by men and boys, as well as some possible solutions we can implement in the healthcare system to help improve men's health. We aim to provide insight into men's global health issues, including cardiovascular disease, mental health, and cancer.

Cardiovascular Disease

Heart disease accounts for 13 % of all deaths in sub-Saharan Africa (10). In the United States of America, 1 in 4 adult men dies due to cardiovascular diseases (11). In comparison, South African men are more likely to die from ischaemic heart disease with a 3.0% mortality rate and women at 2.7% (14). Factors that make men more susceptible to cardiovascular diseases include lifestyle choices such as smoking and excessive alcohol consumption.

According to the CDC, evidence-based best practice for cardiovascular prevention includes; team-based care, which involves two or more healthcare multidiscipline practitioners addressing cardiovascular disease according to their fields, such as a pharmacist, dietician, general practitioner and cardiologist. The collaboration would enable timely identification of risk factors, patient education, effective disease management and self-care. For example, patients can self-monitor and record their blood pressure outside clinical settings with their approved devices(15). At a policy level, governments should regulate the cost of cardiovascular treatments, incentivise healthy lifestyles and implement support systems to improve treatment adherence(13).

Mental Health in Men

According to a report from the South African Society of Psychiatrists (SASOP), South Africa is ranked 10th on the list of countries with the most suicides. The data shows that women's suicide rate as 9.8 per 100,000 people and men's as 37.6 per 100,000 people (9

Men are less likely to receive treatment for their mental illness and are four times more likely to commit suicide. Men face unique risks due to cultural stigma associated with expressing feelings, representing toxic masculinity. Toxic masculinity manifests when boys are conditioned not to cry or show vulnerability when expressing their feelings. It is crucial to check up on loved ones, especially the men in our lives, and encourage frank conversation about mental health. Some of the shortcomings in the South African health care system include that; only 5% of the national health budget is allocated to mental health. A 2019 survey by the University of Cape Town showed a shortage of mental health experts in some provinces and that only three provinces had a child psychologist (2).

Regarding the de-stigmatization of mental illness, we need an all-hands approach that includes involvement religious groups, communities, social groups, schools and workplaces. Some best practice recommendations include creating safe spaces for treating men with mental health so men could feel more comfortable and relaxed, the mental health budget needs to be increased, we need to improve access to psychology services, and adopting a gender-sensitive approach that embeds mental health services within community areas frequented by men.

Cancer in Men

In the USA, the cancer mortality rate for men is 189.5 per 100,000, and 35.7 per 100.0000 (5), while in South Africa, there is a smaller gender gap, with a mortality rate of 70-72 per 100.000 in men and 68-70 per 100.000 in women (12). Lung cancer accounts for the highest cancer deaths in South African men, accounting for 13.95% of all cancer deaths. Two possible reasons explain the cancer gender gap: men are more likely to participate in unhealthy lifestyle behaviours such as the lack of exercise, excessive alcohol use and smoking. The second reason could be a lack of interaction with healthcare system. Women interact with health professionals regularly seeking birth control during pregnancy and child-rearing and are more concerned about their overall health. This interaction with the healthcare system allows women to timely check for worrying symptoms and get a diagnoses and treatment. Men are stereotypically less likely to seek medical help when experiencing early signs of medical conditions (6).

Best practices in improving cancer services include a more person-centred approach to care involving multidisciplinary teams such as health promoters, psychology, screening services and specialized services in surgery, radiotherapy and chemotherapy. Furthermore, clear communication between the patient and the healthcare professional is essential, educating men via sports commercials or popular tv shows is recommended and accessibility to a healthcare facility near the patient's home could be improved by integrating healthcare services in places frequented by men. Some insurance companies have shown that incentivising healthy lifestyles through a reward point system is an effective behavioural change intervention (4)(7)(8).

Men are an integral part of society and their health has significant socioeconomic impacts on families, communities and the country. It is therefore important to collectively improve the education, screening, diagnosis and management of men's health conditions.

Reference List

1. Woodward M. (2019). Cardiovascular Disease and the Female Disadvantage. International journal of environmental research and public health, 16(7), 1165. https://doi.org/10.3390/ijerph16071165

2. Gumede, W., 2022. 2021-10 - Untreated mental illnesses impact SA's economy, social and family stability - Wits University. [online] Wits.ac.za. Available at: <https://www.wits.ac.za/news/latest-news/opinion/2021/2021-10/untreated-mental-illnesses-impact-sas-economy-social-and-family-stability.html> [Accessed 21 June 2022].

3. Africa S. South African labour market is more favourable to men than women | Statistics South Africa [Internet]. Statssa.gov.za. 2022 [cited 21 June 2022]. Available from: https://www.statssa.gov.za/?p=14606

4. Robertson S, Gough B, Hanna E, Raine G, Robinson M, Seems A et al. Successful mental health promotion with men: the evidence from ‘tacit knowledge’: Table 1:. Health Promotion International. 2016;:daw067.

5. Cancer Statistics [Internet]. National Cancer Institute. 2022 [cited 21 June 2022]. Available from: https://www.cancer.gov/about-cancer/understanding/statistics

6. Why are men more likely to die from cancer? - Cancer Research UK - Cancer news [Internet]. Cancer Research UK - Cancer News. 2022 [cited 21 June 2022]. Available from: https://news.cancerresearchuk.org/2009/06/15/why-are-men-more-likely-to-die-from-cancer/amp/

7. What is Good Practice in Clinical Cancer Care? - European Cancer Organisation [Internet]. Europeancancer.org. 2022 [cited 21 June 2022]. Available from: https://www.europeancancer.org/2-content/72-the-code-what-is-good-practice-in-clinical-cancer-care

8. Men & Cancer | CANSA – The Cancer Association of South Africa [Internet]. Cansa.org.za. 2022 [cited 21 June 2022]. Available from: https://cansa.org.za/mens-health/

9. Gumede N. Suicide high among men in South Africa | Witness [Internet]. Witness. 2022 [cited 21 June 2022]. Available from: https://www.news24.com/witness/news/kzn/suicide-high-among-men-in-south-africa-20220606

10. Yuyun M, Sliwa K, Kengne A, Mocumbi A, Bukhman G. Cardiovascular Diseases in Sub-Saharan Africa Compared to High-Income Countries: An Epidemiological Perspective. Global Heart. 2020;15(1):15.

11. Centres for Disease Control and Prevention, National Center for Health Statistics. Underlying Cause of Death, 1999–2019. Accessed January 12, 2021.

12. Made F, Wilson K, Jina R, Tlotleng N, Jack S, Ntlebi V et al. Distribution of cancer mortality rates by province in South Africa. Cancer Epidemiology. 2017;51:56-61.

13. Downing J, Rose T, Saini P, Matata B, McIntosh Z, Comerford T et al. Impact of a community-based cardiovascular disease service intervention in a highly deprived area. Heart. 2019;106(5):374-379.

14. Mortality and causes of death in South Africa: Findings from death notification 2017 [Internet]. Statssa.gov.za. 2022 [cited 21 June 2022]. Available from: https://www.statssa.gov.za/publications/P03093/P030932017.pdf#page44

15. Centers for Disease Control and Prevention. Best Practices for Cardiovascular Disease Prevention Programs: A Guide to Effective Health Care System Interventions and Community Programs Linked to Clinical Services. Atlanta, GA: Centers for Disease Control and Prevention, US Dept of Health and Human Services; 2017.Available from:Best Practices for Cardiovascular Disease Prevention Programs (cdc.gov)