Unequal World
Article Outline
According to a recent study by M. Ezzati, of the Harvard School of Public Health, between 1983 and 1999, men's life expectancy decreased in more than 50 U.S. counties. Now, 4% of American men can expect their lives to be shorter than, or at best, the same length as those of people in their home counties two decades ago. Neither the United States nor Russia (see jmh, Volume 5, Issue 2, 2008) have anywhere near the world's longest life expectancy. Neither is even in the top 40 – not the “new rich” nation of Russia nor the richest nation on earth, the United States, are among the healthiest countries. Elizabeth Gudrais, in her August Harvard Magazine article, points to the fact that disparities in health tend to fall along income lines everywhere: the poor generally get sicker and die sooner than the rich. Even worse, the gap between the rich and the poor is growing! No doubt a comparison between continents and countries, as well as research findings, is often specific, and general conclusions must be drawn cautiously.
Young et al. argue along these same lines in their editorial “Poverty and Men's Health” [1]. The authors once more remind us that poor men's relatively constrained access to care, their environmental exposures, and their behavioural and attitudinal risk factors correlate with elevated levels of morbidity and mortality. Health-compromising factors such as tobacco use and alcohol consumption appear especially prevalent among poor men in many countries — among them Russia, India, and China. In response to phenomena such as excessive rates of smoking and dangerous alcohol consumption among men, the authors call for commonsense measures such as smoking cessation and alcohol abuse prevention approaches that are male-specific and customized to reach the socioeconomic strata at greatest risk. Young et al. also draw our attention to incarceration, a phenomenon of growing influence in so many countries around the world. They remind us of the troubling fact that just as the poor are more likely to suffer negative health outcomes, socioeconomically disadvantaged persons have a greater likelihood of incarceration. Rightly pointing out that health disparities between privileged and poor men are manifest in some measure across nations, Young et al. invite us to apply the insight of our field of men's health to the predicament of an important but often overlooked population.
The new jmh Social Determinants Section acknowledges the critical importance of issues of disparity, social marginalisation, and health to our field. Led by Section Editor Dr. Henrie M. Treadwell, the Social Determinants Section will shed light on these pivotal topics and provide readers with cutting-edge analysis. At jmh, we believe strongly that the men's health field certainly has a contribution to make to the fight against inequality within our societies. The Social Determinants Section will provide researchers, practitioners, and advocates with useful analytic tools for the quest to address the health needs of all men, their families, and communities.
I had the honour this past April to deliver the opening keynote address on the health of poor men at a visionary conference in the U.S. The conference, organized by Community Voices: Healthcare for the Underserved at Morehouse School of Medicine's National Center for Primary Care in Atlanta, Georgia, applied perspectives from the fields of law, politics, social policy, medicine, and media to the issue of health inequities. I focused in my remarks on the confluence of risk factors, including lack of access to adequate health care, incarceration, exposure to violence and war, dangerous labor conditions, and under-resourced communities, that in country after country are associated with negative health profiles. These risks have particular relevance to poor men's health outcomes. The position of my address on the conference agenda was both an opportunity to bring a global perspective to a U.S. discussion of the social determinants of health, and a sign of progress in the area of health disparities. By deciding to look at disparities and social determinants of health globally, by making comparisons and seeking similarities instead of differences between U.S. poor, the poor in India, in Russia, in Austria, and around the world, we can call on the world community and international agencies to likewise globalize their focus.
Raising another key issue is the editorial by Jouni Varanka [2] of the Finnish Ministry of Social Affairs and Health on “Mainstreaming men into gender-sensitive health policies”. Finland's presidency of the European Union in 2006, marked the first time gender equality issues were assessed from the male view point. An example of that focus was an expert conference entitled “Men and Gender Equality: Towards Progressive Policies.” I strongly recommend that all who are interested in gender and male health policies read the excellent summary editorial and also the compelling conference proceedings [3]. Interestingly, Varanka avoids using the term “men's health,” offering three arguments for doing so. First, there are some reservations about tackling problems pertaining to men, as evident for example in the UN and EU conclusions on men and gender equality. Second, the fact that gender-mainstreaming, as a process, has already been underway for some time and is part of the accepted language, e.g. of the World Health Organization (WHO). Third, that there are some disadvantages to looking at men's health and women's health as separate issues. I believe that these arguments have merit, particularly within the highly political world of the UN, EU, and the WHO. However, I look forward to the reactions to the Varanka editorial.
The WHO acknowledges the rising epidemic of obesity, pointing out that it is soon to be the world's single largest cause of preventable diseases and premature death. Very helpful and timely, is Louis Gooren's [4] review on obesity in this issue, which discusses the latest scientific evidence.
In addition, in this issue of the jmh we are pleased to present a paper by Gallagher et al. in the oft–neglected subject area of men's mental health. Gallagher et al.'s, paper on “Deficit schizophrenia, gender and social class of origin” [5], as well as the excellent review with recommendations on “Men, depression and masculinities” by Oliffe and Phillips [6], deserve the attention not only of psychiatrists and specialists but also of a wide readership. It is important that we deepen and broaden the understanding of the psychiatric and psychosocial issues men face to enable early diagnosis and better customisation and targeting of preventive mental health programmes and specific treatment to men.
References
- . Poverty and Men's Health. jmh. 2008;5(3):184–188
- . Mainstreaming men into gender sensitive health policies. jmh. 2008;5(3):189–191
- Varanka J, Närhinen A, Siukola R, editors. Men and Gender Equality. Towards Progressive Policies. Conference proceedings; 2006 Oct 5–6; Helsinki, Finland. Helsinki: Ministry of Social Affairs and Health; 2006.
- . Obesity: new aspects. jmh. 2008;5(3):249–256
- . Deficit schizophrenia, gender and social class of origin. jmh. 2008;5(3):245–248
- . Men, Depression and masculinities: a review and recommendations. jmh. 2008;5(3):194–202
PII: S1875-6867(08)00153-X
doi:10.1016/j.jomh.2008.08.001
© 2008 Published by Elsevier Inc.
