| | Making the global case for Men's HealthReceived 11 January 2010; accepted 12 January 2010. Siegfried Meryn Editor-in-Chief of jmh and President of ISMH April Young Advisory Board Member jmh The great success of last October's World Congress on Men's Health (WCMH09) is both an occasion to celebrate and a call to redouble efforts to advance our cause. Unprecedented attendance, innovative session formats and approaches, a wider range of topics than ever before, and a palpable enthusiasm for the well-being of men have fortified the global platform for improving men's health policies and practices. In the field, there is perhaps a better opportunity than before to complement developments in the clinical arena with more holistic notions of health and comprehensive approaches to care and health management for men. Harnessing a measure of the momentum to garner attention to the social determinants of men's health – especially poverty – is critical to ensure that this historic moment benefits significant numbers of real men in a real way. Certainly, indications are consistent with the WCMH09 theme: Men “suffer more and die sooner.” The course of many physiological and psychological diseases is more severe in the male gender. The gender differential is unfavorable to men in their experience of stress, as it is more likely to manifest in men as debilitating physical, mental, and behavioral conditions than in women. Furthermore, relatively greater exposure to violence and injury and elevated behavioral risk increase the frequency of debilitation and premature death among men. We know that poor men suffer disease, stress, violence, and injury even more, that they confront higher behavioral risk, and that they will meet their demise from these factors with even greater frequency in shorter timeframes than their more privileged counterparts. The dearth of consideration for poor men in the global health policy community and the, at best, inadequate attention to social determinants in our own emerging field of men's health warrant our leadership and action. If men's health researchers, practitioners, and policy advocates do not demand diligent and meaningful consideration for poor men, who will? How might this be done? What would an agenda look like for 2010, mindful of the urgency to bring light to the health concerns of the group with the worst outcomes – poor men? Capturing male vulnerability  The priority for many global health policies and development programs tends to be “vulnerable” groups. We see a near-exclusive commitment among multi-national organizations, many states’ governments, and philanthropic organizations to maternal and child health. Programs and advocacy efforts to improve men's health and well-being are only infrequently discussed in these contexts and rarely funded. To focus on matters of men in international health and development policy, it is probably necessary, first and foremost, that we capture and represent the reality of vulnerability among men. The Men's Health field in its nascence has not yet compellingly represented the vulnerabilities of men and how men's jeopardies are not separate from, but are intertwined with, those of women and children. Doing so requires that we cast suspicious eyes upon simplistic notions of male privilege and male agency. These ideas can mislead, obscuring the reality of men's vulnerability and suffering. Questioning the prevailing assumptions about men's experiences and their well-being will further enable us to acknowledge that poverty magnifies men's vulnerabilities and generates many of the disparities we see in health outcomes among groups of men. Expanding indicators of community well-being Labor, justice, education, and health statistics indicate that men are doing very poorly in distressed communities around the world. Often behind these numbers there are a predictable set of experiences and realities among which are incarceration, under-education, under-employment, unaddressed behavioral and mental health needs, and problematic access to health services. Despite this, though, our indicators of community well-being are usually markers of maternal and child health. Measures such as infant mortality, rates of prenatal care, vaccinations, and mothers’ literacy are central to assessing the state of a society or community. Were we to explore indicators beyond these, by considering markers associated with men, what would we see? And, how might that inform what we do? Would our interventions look different if the number of men returning with new HIV infections to a neighborhood from correctional institutions were an indicator of community well-being? If the number of male suicides, or the frequency of untreated mental health disorders were on the radar as well, what would they demand of our policies and how would it shape what states, and multi-national and philanthropic organizations regard as the critical interventions? Shaping the Men's Health field to seek global change In order to speak effectively for men and to reach privileged and poor men, we must be thoughtful about the field of Men's Health. As stewards of an emerging field, we are presented with the opportunity and the responsibility to decide what it encompasses. For instance, thoughtfully and deliberately broadening our field as it takes shape to include poverty studies, prison health, and other important social realities would enable participation in the discussion of social determinants of health – a powerful discourse in global health policy circles, which is, for the moment, associated almost exclusively with women and children. In addition to pressing for better male-centered approaches in clinical, pedagogical, and technological domains, the Men's Health field can have a strong and visible role in health policy reform and even in broader social reform. An advocacy-minded Men's Health field could call for, and participate in, recalibrating global health and development policy. In addition to improving men's health outcomes, how might poor communities change if attention to men were to complement the commitments to maternal and child health? The vision in the Vienna Declaration on the Health of Men and Boys in Europe, the progress it has inspired in EU policy, and positive developments in national health policy in countries such as Australia demonstrate that large-scale systemic change is possible. Broad-based, active support from a Men's Health field that is articulate about the realities of male vulnerability and the circumstances that produce it could expand men's health advocacy into a coordinated global agenda. Men's Health in 2010: developing an advocacy-minded field If we decide that the Men's Health field can, and needs to, lead discussions about broad global strategies to improve men's health outcomes, what are the steps toward such an ambitious program? ISMH advocacy committee on global policy Perhaps first, at such an exciting time in the history of the Men's Health movement, an interdisciplinary, international committee within the ISMH should be dispatched to deliberately cultivate awareness and support among global foundations and multi-national governmental organizations. Data Naturally, generating the relevant data and analysis on men's health and their social experiences is critical. Despite the current shortage of support within multi-national governmental organizations, most nation-states, and global foundations, there may yet be opportunities to gather empirical data in studies being conducted for other purposes. Where possible, when clinical investigations, treatment impact studies, as well as social research studies involving men are being designed and conducted, including income and social marginality – and such categories as race and ethnicity, language group, nationality, and sexual orientation – among the queries may produce compelling information about men and their health experiences. Workforce development Recruiting men's health researchers and advocates into the multi-national governmental organizations, global foundations, and to posts within national governments could accelerate the pace of change. Currently, there seem to be very few people within influential global policy and funding organizations who are working on men's health. Therefore, seeking roles in public and private agencies for those with clinical, research, and social expertise in men's health should perhaps be a critical part of our agenda as an emerging field. Positive developments ISMH Consensus Conference on Men's Health Maintenance through the Aging Process ISMH's undertaking of sole sponsorship of a conference in New York City in April 2010 is potentially a watershed moment in the history of the Men's Health movement. By breaking with the customary reliance upon pharmaceutical company support, marketing considerations need not shape the meeting agenda. The conference can pursue its laudable goal to issue guidance for primary care and specialties on men's health maintenance, disease detection, and prevention throughout the aging process. To this end, knowledge, approaches, and practices in Men's Health have been heavily influenced by the profit motivations of large private pharmaceutical concerns. The opportunity to forge a broad protocol issuing from a holistic perspective on the physiological, psychological, behavioral, and social aspects of men's experience opens up new territory in the pursuit of better health for men. jmh series on social determinants of health Over the next several months, jmh will include original research, commentaries, and reviews on the social determinants of men's health. Building on the WCMH09 panel, “UK, US, Europe, and beyond: social determinants of men's health,” the coming jmh articles will be designed to draw attention to the reasons behind the consistent occurrence of poorer health outcomes among men, to clarify the clinical relevance of the social aspects of men's health, and to advance the social determinants approach within the Men's Health field. While there is much to do, there is much about which to be enthused in Men's Health at the outset of the year. We have sufficient momentum toward the thoughtful, fervent stewardship this emerging field requires to improve the lives of men in their communities and to become a force in global health policy. a Medical University of Vienna, Austria b Collins Center for Public Policy, Miami, Florida, USA  Corresponding author.
PII: S1875-6867(10)00003-5 doi:10.1016/j.jomh.2010.01.001 © 2010 Published by Elsevier Inc. | |
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