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FirstHealth of the Carolinas
Men and their health By Dick Broom

During World War II, North Carolina led the nation in the percentage of men rejected for military service because of poor health. In one six-month period during the middle of the war, the rejection rate was an astonishing 57 percent.

Today, the health picture for men in North Carolina is much brighter than it was 65 years ago. Men generally live longer and healthier lives.

But North Carolina men still lag behind men in the country as a whole in several important indicators of health. With some of those indicators, such as death rates from stroke and lung cancer, North Carolina men have actually lost ground. From 2000 to 2004, they died at a higher rate than in 1999 to 2000.

We know all this because of the 2007 North Carolina Men’s Health Report Card prepared by the FirstHealth Community Voices program. Community Voices is one of eight programs around the country funded by grants from the W.K. Kellogg Foundation with the aim of improving access to care and shaping health policies.

While state and national report cards on women’s health and children’s health are common, the Men’s Health Report Card was the first comprehensive evaluation of the status of men’s health in North Carolina and, possibly, the first in the nation.

The state of men’s health
Men, on average, die six years younger than women. Nationally, men have higher mortality rates than women for each of the top 10 causes of death including heart disease, lung cancer, colon cancer and stroke.

The picture is even worse for North Carolina men, and especially for minority men.

The Men’s Health Report Card compares the most recent statistics on disease and death rates with data from a few years ago. It shows, for example, that the percentage of adult men in North Carolina with diabetes increased from 6.4 percent in 2002 to 8.5 percent in 2005.

The report card also compared the most recent North Carolina figures with the latest national data. In 2005, the percentage of men nationwide with diabetes was 8 percent.

The report card assigned letter grades to men’s health in each disease category based on whether North Carolina men are doing better or worse than they were a few years ago and better or worse than the national average. An A” grade indicated more than a 20 percent improvement; “B” = 10-20 percent better; “C” = between 10 percent better and 10 percent worse; “D” = 10-20 percent worse; “F” = more than 20 percent worse.

For diabetes, North Carolina men received an “F” for the trend over the last few years and a “C” for how their rate of diabetes compares to the national average.

The report card looked at the percentage of men affected by major chronic diseases, infectious diseases, and violence and injuries. It also compared state and national data on substance abuse, mental health problems, preventive health practices, and barriers to health including poverty, unemployment and lack of health insurance.

North Carolina men received a “C” grade in many categories, meaning they are neither gaining nor losing much ground. But they received significantly more grades of “D” and “F” than of “A” and “B.”

Some good news, too
The Men’s Health Report Card was compiled by Roxanne Leopper, policy director for FirstHealth Community Health Services, which administers the Community Voices program, and Chris Hoffman, Community Health Services’ data analyst.

According to Leopper, while the report card paints a rather gloomy picture of the state of men’s health in North Carolina overall, the news isn’t all bad. For example, the grades for preventive health practices, such as colonoscopies to check for colon cancer and PSA tests for prostate cancer, were for the most part “C” or higher.

Roxanne Leopper and Chris Hoffman

“That means men in North Carolina are at least staying steady in getting health screenings,” she says. “And although the mortality rates for colon cancer and prostate cancer aren’t getting better, they’re not getting worse.” The death rates from stroke are disappointing, but not as bad as they might be.

“North Carolina men are holding steady as far as the trend over the last few years is concerned,” says Leopper. “Compared to U.S. men, they are still far enough behind to get an ‘F,’ but the gap isn’t getting larger. That’s something, at least, but we would like to see the gap start narrowing.”

According to Hoffman, another positive sign is the trend in the rate of smoking among North Carolina men.

“The rate is decreasing for both white and minority men,” he says. “It is still higher than the national average, but if it keeps going down, we hope that over time we’ll see the rate of smoking-related illnesses go down, as well.”

Minority men in North Carolina are, on average, less healthy than white men and have higher mortality rates for nearly all of the major causes of death. For example, from 2000 to 2004, the annual death rate from heart disease was 285 per 100,000 for white men and 334 for minority men.

Minority men in North Carolina die of diabetes at more than twice the rate of white men. The death rate from stroke among minorities is half again the rate for white men.

Minority men also have higher rates of high blood pressure, obesity and asthma, and they have higher death rates from lung cancer, prostate cancer and colorectal cancer.

The one major cause of death for which white men have higher rates than minority men is chronic lower respiratory disease.

According to Leopper, the Men’s Health Report Card only puts out the need for attention to men’s health. The next step, she says, is action.

“There is a deficit of health care safety nets for men despite the fact that men comprise 48 percent of the adult population in North Carolina,” Leopper says. “It is time to make a difference in men’s health in North Carolina. This report card is the first step in recognizing and increasing the awareness of the outstanding health care disparities.”

Advocates for men’s health are urging the state to establish an Office of Men’s Health similar to the Women’s Health Branch of the Department of Health and Human Services. Hoffman would like to see a state men’s health office produce a report card on men’s health every two or three years, if not annually.

“We got it done the first time, but it wasn’t a small undertaking,” he says.

In gathering data for the Men’s Health Report Card, FirstHealth Community Health Services received assistance from the Cecil G. Sheps Center for Health Services Research at UNC and the North Carolina Division of Public Health.

Roxanne Leopper and Chris Hoffman of FirstHealth Community Health Services unveiled the Men’s Health Report Card at the first-ever North Carolina Men’s Health Summit in January.

Organized by FirstHealth Community Voices, the summit was held at the William and Ida Friday Center for Continuing Education at the University of North Carolina at Chapel Hill. Policy makers, health care providers, health educators and public health officials from around the state attended the event.

The Men’s Health Summit included short presentations about programs that have been started in several North Carolina communities to educate men about important health issues such as high blood pressure and prostate cancer.

“We talked about how local programs can make a difference, how we can take local program models and implement them statewide, and how important it is for policy makers to have this sort of information,” says Leopper.

The purpose of both the report card and the Men’s Health Summit was to generate greater awareness of men’s health issues and to encourage policy makers and health professionals to put greater emphasis on finding ways to improve men’s health.

FirstHealth hosted the Men’s Health Summit, which was based on the theme “It’s Time to Make a Difference.” Planning committee members included representatives from the American Heart Association, the N.C. Institute of Minority Economic Development, the Men’s Health Network, the N.C. Office of Minority Health and Health Disparities, the American Cancer Society and the North Carolina Comprehensive Cancer Program.

Men and preventive care
Men are in general less healthy and die younger than women. They are also much less likely to go to the doctor unless they are really sick.

Could there be a connection?

“Men are not as good about preventive care,” says Howard Johnson, M.D., of the FirstHealth Family Care Center-Richmond Family Medicine in Rockingham.

“Around here, they are most likely to start showing up for preventive care at 65, when they finally get to Medicare. Unfortunately, if they are here before that, they usually have a disease. We don’t see a lot of completely healthy 65-year-old guys.”

Why do men avoid going to the doctor, especially for periodic check-ups and health screenings?

Dr. Johnson says there are probably many reasons, including lack of time. It’s hard for some men to take the time off work.

“I also think men worry that the doctor will find something, and if it isn’t found, they don’t have to deal with it,” he says. “If a doctor tells them to stop eating this or start doing that, they have a more difficult time ignoring it. They don’t want to be told something that is going to rule their life.”

Bo Kopynec, M.D., of the FirstHealth Family Care Center- Ellerbe, has a simpler theory about why men stay away from the doctor’s office.

“I think men are adolescents until they are about 55,” he says. “It takes them a while to grow up.”

Dr. Kopynec is joking, of course, but there might be a kernel of truth in his theory.

Howard Johnson, M.D.

Bo Kopynec, M.D.

“The reason I say that is that when people are young, they kind of feel invincible, and guys seem to hang on to that feeling of immortality much, much longer than women do,” he says. “To me, the biggest issue in men’s health is trying to get them to realize that there are things they can be doing now that can keep them living as long as possible and in as healthy a state as possible.”

Those things include eating a healthy diet, exercising, not using tobacco and having certain screening tests when they are recommended.

“It’s fairly common for guys in their 40s and 50s to ask me about a PSA (prostate cancer test), but rarely do they ask me about preventing heart disease or other common causes of

death,” Dr. Kopynec says. Women are much more likely to ask questions and seek preventive care, Dr. Kopynec says. He thinks that is partly because many women get used to going to the doctor for annual Pap smears to check for cervical cancer when they are in their late teens or early 20s.

Dr. Johnson says childbirth and vaginal exams also have made women more accustomed to the kinds of “invasion” that some health screenings involve.

“In my experience, women are more willing to have colonoscopies,” he says. “Men will usually do it if you recommend it strongly, but they aren’t as gung-ho about the idea. They’re not gung-ho about having a prostate exam, either.”

Dr. Johnson says he has found that if health information and advice are presented to men in an informal, non-threatening way, a lot of them will listen. As part of the City of Rockingham’s contract with FirstHealth’s insurance company, FirstCarolinaCare, Dr. Johnson talks to gatherings of city employees once a year about health issues. Most of the employees are men, and many of them are middle-aged or older.

“After hearing me talk about some reasonable things they can do to make their lives better and some things they should do at least once a year, a bunch of people have come in to have their cholesterol checked or to have a prostate exam or PSA test,” Dr. Johnson says.

One of the fastest-growing health problems among both men and women—as well as children—is obesity. Dr. Kopynec says his patients include about an equal number of men and women who are seriously overweight.

“The difference is that women are nine times more likely to ask me for help with their weight,” he says. “At least they are starting off in a better place and, consequently, more of them are likely to succeed in losing weight and getting in better shape.”

As important as it is for women to have mammograms, men to have prostate exams and PSA tests, and nearly everyone over 50 to have a colonoscopy, Dr. Johnson thinks it is probably even more important to exercise and avoid smoking. Those are the best ways people of either gender can improve their chances of having good health and a long life, he says.

“Managing your blood pressure and cholesterol is important, but if you don’t exercise and strengthen your heart, you’ve got a problem,” he says. “And if you eliminate every other risk factor and don’t stop smoking, you’re still likely to die earlier than you would if you didn’t smoke.”