A Closer Look at Men's Health: Risks, Screenings, and Prevention

Men die almost 6 years earlier than women are almost 4 times more likely to die by suicide in Illinois. This June, we’re recognizing Men’s Health Awareness Month and discussing how Illinois is taking steps to close this gap. In this episode of This Is Public Health, Andrew Lerch, Section Chief for Men’s Health at IDPH, shares insights on the current state of men’s health in Illinois, why preventive care is often overlooked, and how we can better engage men in their own health journeys.

Jim Leach: Welcome to This Is Public Health, a podcast from the Illinois Department of Public Health. June is Men's Health Awareness Month, a good opportunity to focus on the illnesses and issues unique to men and on some of the social pressures that may impact how or if they receive care for those issues. Our guest is Andrew Lerch who is the Section Chief for Men's Health at IDPH. Andrew, thank you for joining us. We want to dive right in with the basics. When we talk about men's health, what are we talking about? What falls under that definition?

Andrew Lerch: Sure, and yeah, Jim, thanks for having me on, and I appreciate the opportunity to speak on this topic. So, when we're talking about men's health, typically we're talking about 2 different kind of topic areas or focus areas. So, the first is the more specific biological focus or characteristics, and this includes things like prostate and testicular cancers and improving awareness and outreach to focus on prevention, screening, diagnosis, and treatment of those conditions. Traditionally, I think this is what most people attribute to men's health or these types of efforts for prostate cancer screening outreach, and this is what you've seen historically in Illinois as well with different grants and focuses over the last 15 to 20 years.

Andrew Lerch: But second is a more broad, overarching focus on all of the factors that currently contribute to the outcome differences we see for various conditions. So, the best way to look at this is kind of generally at life expectancy. So, it's often referred to as the life expectancy gap, but when we look at the difference between men and women here in Illinois, it's up about 5.8 years. Across the country anywhere from about 3.5 to 7.5 years difference in how long you're expected to live. So, there's a variety of factors that fall into that umbrella term about life expectancy gap, and that's things like early death from heart disease and cancer, high rates of suicide, high rates of substance abuse and overdose, unintentional and intentional injuries, and then also things like behavioral differences, so men being more likely to smoke or drink alcohol, especially binge drinking, and then the overall decreased likelihood to go to the doctor is a common one that comes up as well. So, the legislation that created the Men's Health Section has a focus on all of these issues, so all of these issues that contribute to disparities and men’s health outcomes, and then working with stakeholders like mental health providers to address them.

Jim Leach: Well as you noted, it is important to focus on some of these specific illnesses that are unique to men like prostate or testicular cancer, but we do want to do a little bit of a deeper dive into this other part of men's health, the broader issues about risk factors behaviors, and the way that men perceive their own health, and also the expectations that society places on men. So, how does that all add up to create an overall picture of men's health in Illinois and across the country?

Andrew Lerch: So yeah, this is a focused area where a lot of research is beginning to be again, focused, and emerge, so I'm excited to learn more as we go, so I can speak from a more evidence-based approach on this. But when we discuss masculinity, which is the term that's often used to lump all these things together, so the social norms, the learned behaviors, the expectations that men may perceive or feel, it's a topic that's being highlighted within a variety of men's health initiatives or if we're trying to provide immense health wins to establish programs. So that means trying to more effectively increase participation or outreach and just bring men into the program or the system.

Andrew Lerch: So, when looking at how this fits the overall picture, it's really about context. So, when we look at the outcome differences that we're seeing across the variety of things we mentioned earlier, how can we best develop systems and buy in to increase that participation? Primary example of this would be looking at mental health and the potential factors that are suggested to be contributing to suicide rates in men, which are unfortunately almost 4 times higher in men than women here in Illinois, and that’s seen kind of across the country and globally as well. So, the data is pretty clear that boys and men are diagnosed less frequently with depression and kind of on that front end of any kind of emergency. So, with that, is that because of norms or behaviors or expectations and stigma, the self-reliance and reduced help seeking that we often attribute to kind of this masculinity topic? It's probably not all of it, but it's definitely suggested as being a factor that's worth exploring, and there are unique ideas being implemented to see how barriers like those can be navigated.

Andrew Lerch: So, common things of these type of programs include collaborating with workplaces like frontline medical providers or the construction industry to try to meet men where they're at, and that may be at work versus having the time or the availability to go and seek out a more formal treatment, and then try to promote awareness of services and anonymous self-screening options that put men in control and allow them to make those decisions to seek care, but maybe on a more anonymous basis first and then build from there.

Andrew Lerch: Another point you brought up is risk factors, so that's again where data does support considering male-focused outreach. So, we know that men are more likely to do things like drink alcohol, smoke cigarettes, and own a firearm. Therefore, the thought process would be that it makes sense to have more male-centered educational campaigns, such as informing about the link between alcohol, cigarettes, and cancers, or promoting the link between firearm storage and the reduced possibility of dying from suicide or protecting their family from unauthorized access. Another one would be just highlighting the link between excessive alcohol use and depression. So, a lot of these examples are out there, and we're starting to see them come to fruition in different countries and that's something that we're looking for to potentially advocate for here in Illinois.

Jim Leach: You've touched on this already. It's kind of an accepted truism and almost a stereotype that men are less likely to get regular checkups or diagnostic tests, or they're more likely to ignore symptoms that could signal something serious. Is that in fact the reality, and is that picture changing at all?

Andrew Lerch: So unfortunately, yes there is some truth to that, and the data does support it here in Illinois as well as a lot of the efforts I've referenced across the country and across the world. A lot of it is focused on increasing male participation in these types of things.

Andrew Lerch: For Illinois specifically, we look at self-reported behaviors on one of our large-scale surveillance systems, so the data is there that does show men have reduced participation in general, so whether that's going to a yearly checkup or even having just an established primary care physician at all. This is a major factor that's often suggested as a cause for men dying from those things like heart disease at earlier ages because those things that could be easily identified with a blood pressure screen are not happening and that treatment and that follow through, that process doesn't necessarily get started at those young ages.

Andrew Lerch: So, this is where we go back to that topic of norms and asking the question on how to really make differences from a young age and then on these kinds of things. So, one example that comes up oftentimes is when contrasting the differences between men and women and transitioning from that young school age to adulthood. So oftentimes, this is when men kind of get dropped from the system and their behaviors tend to start changing. So, when you look at a girl who graduates from high school and transitions into adulthood, they oftentimes have regular visits with an OBGYN through their 20s and 30s. And this was where men really don't have that transition period, and it's not as maybe expected to go to the doctor every year. So, this is some ideas that have been established or proposed is to use things like fatherhood to really engage men who may have no other exposure to the health care system. So, if they are there and they're around, can we promote checkups or screenings or just give educational materials at those times to try to begin those screenings, especially as men start to approach you know that the 40s, late 30s, where these things tend to start showing up and at mile bubbles?

Andrew Lerch: With trends, you had asked about do we see this changing? So fortunately, we do see, if we look at the last decade of data, we are seeing improvements in men reporting increased likelihood of routine checkups, or having a doctor established, or even having medical coverage. Specifically, about 3/4 of men in Illinois report having gone to the doctor in the past year. About 80% say they have an established doctor, and a little over 90% have health care coverage. So, these are all improved compared to where they were about 10 years ago. However, there are of course individuals who don't fall within those ranges, and those are the ones that we really are trying to establish more outreach to and are likely more at risk. Unfortunately, things like having a lower income and fewer years of education do increase the likelihood that you don't fall within those categories, and just for overall context those numbers, even though improving, are still all lower in men as compared to women too.

Jim Leach: You're listening to This Is Public Health with the Illinois Department of Public Health. Our guest is Andrew Lerch, Section Chief for Men's Health at IDPH, during this Men's Health Awareness Month. Andrew, as you noted a lot of these factors seem to start in at a very young age. Boys are historically brought up to play through pain, and if something 's bothering you, just deal with it. That applies really both to physical and mental health. So, what do men need to know about when and why they should seek treatment for various concerns?

Andrew Lerch: So yeah, first and foremost, I think it's important that men just have a good understanding of the magnitude of these issues. So unfortunately, many families have been impacted by a lot of these topics like suicide and overdose, firearm violence, or losing a loved one from a young age from heart disease and personally that's something that's affected my family, and that being said, I don't think many people truly understand how disproportionately these things are affecting boys and men, or it's just become kind of commonly accepted that that life expectancy difference is present and there's nothing we can do about it.

Andrew Lerch: So, when discussing these common developmental themes of playing through pain or what's typically kind of associated with mental health, but that “stop crying be a man,” those type of statements, it's important to recognize that those lessons aren't working very well, and especially when we're looking at health outcomes.

Andrew Lerch: So, regarding treatment, for physical health especially the best strategy is simply following recommendations that are established and being informed on risk factors. So, knowing how age and family history or your racial background might increase your risk of certain things like cancer and knowing when to be screened and when these things really start to increase in importance are vital.

Andrew Lerch: For mental health, this might look a little bit different. An important consideration that's really starting to come out in the literature is how men may present differently than women when it comes to mental health disorders. Specifically, men are more likely to, what's being referred to as, externalize their behaviors, so this means they might have anger outbursts or be highly irritable, and they might present a little bit differently than how you might expect with more of like internalized behaviors, which is more so being withdrawn and quiet, and this is suggested as a primary reason why you might see reduced depression screenings actually noting that in young men. So, there's also a more likelihood to turn to coping strategies, like excessive alcohol and substance abuse, or distraction methods, like video gaming, excessive exercise, or sleeping, so being able to recognize these behaviors in yourself or in a loved one, a family member, are important, and they might be starting points to refer for one of those self-screen anonymous depression screens that I mentioned earlier, or if things are more emergent, calling the 988 crisis hotline to seek help.

Jim Leach: You can find out more about some of these screening guidelines and these resources for help at the IDPH website. We'll have more coming up on that in just a moment. You know, none of these issues we're talking about are particularly new, Andrew, so why are we seeing this increased awareness of and focus on men's health in general, and more specifically, on things like the mental health of adolescents and young adult males?

Andrew Lerch: So unfortunately, like you said it's not necessarily a new issue, particularly with life expectancy or chronic disease, but when we look at mental health and the continual rise and concerns for deaths by suicide or substance abuse, I think that is really what is driving a lot of the more recent awareness campaigns. However, there are additional initiatives that I think are just really starting to gain momentum, and when we look at that, I'm talking about a policy, government initiatives, large organizations, like the World Health Organization has begun recognizing men's health within their long-term strategies, and depending on where you receive your media, whether it's social media or more of your traditional news, you do start to see these stories help out more and more. And if you're looking for the data, you're starting to see more investment in that, too, in the literature.

Andrew Lerch: So, as far as government initiatives, I kind of mentioned that we're a prime example here in Illinois, so new positions and programs dedicated for men's health. On a federal level, there have been a few proposals over the last few administrations for an Office of Men's Health. Nothing has been developed to this point. There is a Congressional Men’s Health Caucus, however, that's doing some work in the area. And then if you're someone who looks overseas, there's a growing list of countries beginning to initiate men's health within their federal policy and invest in it. Really Australia and Ireland being the primary too. So, I think you're going to continue to see data emerge from those efforts, and that's something that may continue to build some positive momentum for improving the outcome of men.

Jim Leach: Really exciting to see these initiatives. Let's focus now more on what's happening here in Illinois with this dedicated Men's Health Section at IDPH. What are some of the strategies that you are deploying on this issue, and how do you hope they will make a difference?

Andrew Lerch: So, for the Men’s Health Section here in Illinois, first priority has been establishing a large network and finding out who are the interested stakeholders, whether it's academic institutions, organizations, or any kind of programs that are already established for men's health. Our program is relatively new, so it's something that really building this foundation will be important for those connections and opportunities long term. As far as groups like the Illinois Cancer Partnership, Illinois Suicide Prevention Alliance, and Illinois Partnership for Safety, these are all affiliated programs with IDPH, and I've had the opportunity to speak and be involved and provide that men's health lens that I spoke with earlier on how we can incorporate men into their current programs and their strategies.

Andrew Lerch: Another big part of the program and this role is developing an annual report on men's health. So, this was something that you'll find on our website each year, and it compiles as much recent data as possible across all of these categories for Illinois men, and then also includes recommendations for policy changes, services, and what do Illinois men need. So, this is where I hope to gather as much input as possible from individual residents to large organizations to academic professionals maybe studying men’s health on what they feel would be best in this area.

Andrew Lerch: Looking towards the future, the goal would be to take all of this data and start to administer and promote grant-funded opportunities and find ways to partner with organizations and these academic institutions to spread awareness, make recommendations, and overall influence men's health for the for the better.

Jim Leach: Finally, Andrew, you've given us a lot to think about here, and there are a lot of resources, a lot of sources of information, that we would encourage men and really everyone to check out on this issue. So, what are some ways that listeners can keep up with men's health issues and activities in our state and in general?

Andrew Lerch: I would recommend visiting our website first and foremost. So, we are going through a pretty big update on the men's health webpage, so you'll see that here soon which it compiles a lot of male-focused data for these conditions, like mental health, chronic disease, those publications like the men's health report I mentioned, different infographics, info-sheets if you're an organization or just an interested person looking to help spread awareness at the local level, and then links to different resources that you might find interesting as well.

Andrew Lerch: Additionally, I've mentioned a few different organizations today that are men's health-focused nationally, and I'd recommend maybe following them and also programs with IDPH. So, our Violence and Injury Prevention Section and our Chronic Disease Division have active programs out there and resources available for topics like suicide prevention or prostate cancer, so that's all available too.

Jim Leach: Great place to start is the IDPH website. That is dph.illinois.gov. You can search for men's health, and you will find a lot of valuable information there. I want to again thank our guest Andrew Lerch, Men's Health Section Chief at IDPH, during this Men's Health Awareness Month. Thank you all for joining us and join us next time for another edition of This Is Public Health with the Illinois Department of Public Health.