Abstract: Presented at the American Public Health Association,
November 2002, Philadelphia, Pennsylvania

Title: Impact of the health status of African-American men on African-American women and children

Men as a group are less likely to utilize the health care system than women, a factor that accounts in part for their lower average life expectancy. American men are less likely to carry
health insurance, less likely to have seen a physician in the previous year, and more likely to delay seeking healthcare than American women. Health care utilization rates appear poorest among African-American and Latino men. The health status of American men is often narrowly perceived as an issue limited to the referenced group. However, health problems affecting men may have a profound impact on women and children with regard to health and disease,
economic status, quality of life, and family stability. Men's health issues may affect women and children directly and/or indirectly through reduction or loss of income, medical expenses, and disruption of family relationships. Paternal health issues, including military and occupational chemical exposures, have been associated with specific birth defects in children.

The likely association between male underutilization of health care services and cultural / attitudinal factors, as well as the likely association between male health and the health status of women and children warrant increased attention by health care professionals.

Men may have more stoic attitudes towards pain and fear by virtue of gender role training (stoic attitudes are often culturally prized among males) and work role training (men are disproportionately represented in physical labor jobs which necessitate tolerance for
discomfort). In addition, female-targeted medical specialties such as OB/GYN and women's health may help to habituate women towards regular contact with physicians early in life. The lack of comparable male-targeted specialties and health care programs may hinder men's ability to actively participate in the health care system. These cultural and attitudinal factors may lead to poorer health outcomes by reducing adaptive responses to pain, injury and
fear, such as avoidance of painful / dangerous circumstances or seeking health care when ill.

Addressing the health of males as an issue affecting the broader community could potentially lead to improved health outcomes for the nation as a whole. Studies that measure gender-associated stoic attitudes towards pain, responsiveness to fear, and ability to identify with participation in the health care system are warranted. Appropriate measures of association could then delineate the relationship between these variables and health care utilization rates / health outcomes.

Abstract: Presented at the American Public Health Association,
November 2003 San Francisco California

TITLE: Characteristics of Effective Health Outreach to African-American Men, a Medically Underserved Population

African-American men are well known to underutilize the health care system relative to other demographic groups. African-American men are especially unlikely to carry health insurance or to have seen a physician / have a physical examination in the past year. Distrust of the health care system, deeply ingrained culturally based stoic attitudes towards pain, and fatalistic attitudes may make African-American men an especially difficult group to engage in
preventive health care.

In Atlanta Georgia, Men's Health Day (1999) and the HIM Summit (2002) were public well-attended health screenings with substantial African-American male participation. Screenings included blood pressure, PSA testing, nutrition, cardiovascular health, blood glucose screenings, exercise, dental health and healthy lifestyles instruction.

Factors contributing to the surprisingly high participation of African-American men included involving the entire family to bring men in / help them understand health regimens (such as taking medications properly); taking time to explain and promote understanding of disease processes and management; emphasizing the person as a whole, “not just a prostate”; addressing performance issues (including sexual performance); providing well-prepared
samples of healthy foods both as reward and example that eating well need not sacrifice taste; and publicizing health screenings through multiple and diverse media venues, including radio, television, and African-American churches.

Traditional approaches have failed to engage and/or retain African-American males in the health care system. Studies that measure the effectiveness of alternative approaches are warranted. Appropriate measures of association could then delineate the relationship between these methodologies and health care utilization rates / health outcomes.

At the conclusion of the session, the participant (learner) in the session will be able to:

1. Recognize disparities in health care utilization rates based
   upon race and gender.
2. Identify at least three barriers to the participation of African-American males in the health care system.
3. Identify at least three approaches that could potentially
   facilitate the engagement and retention of African American men in
   the health care system.

Author(s): Jean Bonhomme M.D., M.P.H. & Ronald Braithwaite, Ph.D.
Department of Behavioral Sciences and Health Education
Emory University School of Public Health, 1518 Clifton Road,
Atlanta, GA 30322 Phone: (404) 524-7237
email: jbonhom@sph.emory.edu