Prospects for the development of the ‘Men's Health’ program in Russia

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• Where are we now?
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While the rapid development of civilization, as we know it, has brought numerous comforts to people, it has also caused global environmental problems. Chemical changes to the structure of air and water (including drinking water), pollution and exhaustion of soil resources, pollution of food, the radioactive background, etc can have a profound negative impact on the health of all living creatures, including that of humans.

Whereas changes in the demographic indices of Russia began to be painful in 1992, since 1993 the natural decline in the population has been steady, at the high rate of 700–900,000 people a year. This means that the country will lose half of its population within 80 years. According to researchers, the low birth rate and the growth in the death rate are the most burning issues for health care in Russia; these account for the dramatic drop in the population in general and in the number of children and adolescents in particular.

The ratio of children to the general population in the country has decreased from 24.1% to 18.6% over the last 10 years (as at 2002). In the first half of the year 2005, the death rate in Russia exceeded the birth rate by a factor of 1.7, and has even reached a factor of 2–3 in 27 regions of the country. The natural increase in the population has become negative, and this is the first time in Russia's post-war history that depopulation has become marked, as its value had previously remained virtually unchanged. According to a United Nations classification scheme, the population of a country is considered to be old if the proportion of people aged above 65+ years exceeds 7%. In Russia, this parameter is 12.9%, which is likely to create numerous problems in the future, one of which is a change in the pension age and in the old age pension scheme. Alongside the decline in the population, the divorce rate has been steadily high. Due to these negative factors, the population in Russia has started to fall rapidly. In 2005, the population loss was nine million people.

Statistical data show that the life span in Russia is lower than that in the West: by 10–15 years in men, and 6–8 years in women. The mean life span of men in Russia is only 59 years, while that of women is 72.3 years, the difference being 13.3 years. In contrast, in post-industrial nations the difference is only 7 years. These demographic data are indicative of the adverse state of the nation's health, particularly as far as men's health is concerned. Thus, the problems we are facing in this country with regard to the improvement in men's death rate and life span are extremely complex and they will take a number of years to solve. The issue of men's health in Western Europe was raised 10 years ago, whereas in Russia the problem has only recently been seen as deserving close attention. In this country, being healthy needs to become as prestigious as being wealthy. Even though today that purpose seems hard to achieve for our population, the mere perception of urgency on behalf of the state-supported institutions may well be regarded as a success.

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Where are we now? 

Despite the urgency, the development of andrology in Russia over the last few years has been a kind of ‘apple of discord’ between the various medical specialties directly involved in men's health problems. In this connection, the main problem was the creation of a common information space for discussing the medical and social issues of men's health.

Andrology has been increasingly attracting the attention of health care professionals from various specialties. In this connection, expert training in this area is a problem that is of the utmost importance. We do feel that it is improper practice that, following a 2-week training course, ‘newly-made andrologists’ are required to take responsibility for the treatment of all men's diseases, being simultaneously both urologist and endocrinologist, as well as psychiatrist, neurologist, and cardiologist. Being a dabbler in each of these clinical specialties, such ‘andrologists’ are, not infrequently, unable to gain an understanding of a difficult clinical situation. Certainly, each physician or surgeon should be able to diagnose and treat men's diseases, within the limits of their major specialty; however, it is necessary to remember that the urologist will never replace the endocrinologist, neurologist or psychiatrist, nor will these specialists replace the urologist. Depending on the country, andrology is considered to be a subspecialty of a major medical discipline such as urology, endocrinology or sexology. Similarly, not just in Russia but also in many other countries, a uniform international system has not yet been established for the training of specialists in men's health care.

In our opinion, andrology should be based on a multi-disciplinary approach that includes urology, endocrinology, sexology, psychiatry, internal medicine, etc, with the physiological and pathological processes of the male body being the subject of study. We find such a view of the science of the man to be more correct and devoid of the numerous contradictions in this field that are currently prevalent among health care specialists.

Thus, as Lev N. Gumilev said:

“When the science (whichever) accumulates data more than a usual memory is able to store, it is forced to search for tricks and ways of systematizing the material; otherwise, it is very likely to get breathless with the disorganized information. Fragmentation of science into an ever-multiplying number of separate branches is not a way out as their coordination is practically impossible. Hence, we should search for ways of integration of knowledge, i.e. the principles of generalization of the isolated data within the system”.

Thus, in 2003, we began holding a Men's Health meeting as an annual National Conference in Russia. This helped to unite various health care professionals. The constituent congress of the National Russian Society for Men's Health took place in 2006. The main objective of the Society, which is supported by the Ministry of Health, consists of the development of the state program for men's health care and its implementation. Given this multi-disciplinary approach to the men's health problem, we have created a logo for the National Society of Russia for Men's Health that is a puzzle consisting of elements that depict the various medical specialties involved and make up a symbol of the man as a whole.

The implementation of the Men's Health Program in Russia can be analyzed using data from several regions of Russia as examples. In Moscow, for instance, the Program for the early detection of prostate disease has been successfully realized over the last 4 years, which has allowed the creation of a system for the early diagnosis and treatment of this disease. For the period 2002–2006, 1,102,262 regular physical examinations of men older than 50 years of age have been made. The implementation of this Program resulted in:

In the Sverdlovsk Region, nine surgeries have been provided with modern medical equipment and they have begun to function within the framework of the Male Urologic Health Program. Within a single year, that Program resulted in the examination of 29,982 patients and the recognition of 33,993 various cases of male ill health. This helped to provide all those patients with the specialized medical care and follow-up that they needed.

A three-stage Program for optimizing men's health care has been developed in the Rostov Region. The first stage of that Program led to the recognition of numerous diseases in men. Similar programs are either underway or are planned in other parts of Russia, namely Moscow, Penza, Samara, Altay and other regions. It should be noted that similar programs have been launched throughout the whole country and therefore require the support of the authorities. However, there are a number of issues to be solved:

The priorities and promising future directions in the area of men's health problems, and the steps required to further improve high-level health care, as we see it, are as follows:

Undoubtedly, the solution to these and related problems consists of close collaboration and integration with international medical societies. Professor Meryn's visit to Moscow last year to attend the constituent congress of the Russian Society for Men's Health, and participation by our delegation in the international forum of the 2007 World Congress on Men's Health and Gender (WCMH’07) provide evidence that the integration has begun. These and many other unsolved issues were the subject for discussion during a round table meeting that took place on September 23rd, 2007 during the WCMH’07 in Vienna.

We would like to see a permanent sharing of experience in men's health issues with researchers throughout the world, and the inclusion of Russia in any system of international research in the area of men's health.