Title: Black Male Masculinity and Chronic Disease Prevention and Control: Closing the Gap Between Theory, R
1Black Male Masculinity and Chronic Disease
Prevention and Control Closing the Gap Between
Theory, Research and Practice
- Leonard Jack, Jr., PhD, MSc
- Jim Finks Endowed Chair of Health Promotion and
Professor - Behavioral and Community Health Science Program
- LSUHSC School of Public Health
- New Orleans, Louisiana
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3We Can Learn from the Womens Health Movement
- 25 Years ago-very little research specifically
targeting women - Except for reproductive health issues, women
were believe to have the same problems, needs and
solutions as men - Vigorous lobbying by women (over the world) lead
to more research on womens needs - Major study continue to generate evidence of
important differences between men and women - BMJ.The future of men and their health Are men
in danger of extinction?. BMJ, 3232, - 1013-1016.
4Mens Health Movement
- by default, the womens health movement has
revealed mens health requires more attention - Men, particularly Black men have higher mortality
rates for all 15 leading causes of death - Men are reluctant to embrace preventive
strategies - Moving beyond merely accepting that men catch
feel, dont want to feel and want ever show
emotion - Asking the question, Why?
- BMJ.The future of men and their health Are men
in danger of extinction?. BMJ, 3232, - 1013-1016.
5Major health concerns
- Alcohol and Drug Use
- Personal Fitness
- Body Image
- Anger Management
- Relationships
- STDs
- Mental Health
- Chronic Diseases
6- There is an urgent need to advertise and
promote mens health in a positive way - BMJ.The future of men and their health Are men
in danger of extinction?. BMJ, 3232, 1013- - 1016.
7Throw Into the Mix
8Masculinity refers to
- qualities and behaviors judged by a particular
culture to be ideally associated with or
especially appropriate to men and boys. Distinct
from maleness, which is a biological and
physiological classification concerned with the
reproductive system, masculinity principally
refers to socially acquired traits and secondary
sex characteristics.
9Black Masculinity?
- qualities and behaviors judged by a particular
culture to be ideally associated with or
especially appropriate to men and boys. Distinct
from maleness, which is a biological and
physiological classification concerned with the
reproductive system, masculinity principally
refers to socially acquired traits and secondary
sex characteristics - in the context of life, social determinants, and
black male experiences
10J Urban Health. 2003 80556-568, p. 559.
11 SOCIAL DETERMINANTS OF HEALTH
12Lets Look At
- Death Rate for Men by Race/Ethnicity, 2004
- Percent of African American Males Lacking
Insurance by Age and Region, 2000-2004 - Chronic Diseases U.S. and the Louisiana Report
Card
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15A National Perspective on Diabetes!
- From 1980 to 2003, the age-adjusted prevalence of
diagnosed diabetes increased 50 for men and 37
for women - In 2003, 7.0 of African-American men had
diagnosed diabetes compared with 5.1 of white
men - African-American men experience poorer levels of
glycemic control and higher rates of
diabetes-related complications, such as
lower-extremity disease, visual impairment and
end stage renal disease
16Louisiana Health Ranking
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19Views from within and beyondIllness narratives
of African American Men with type 2 diabetes
- Leandris C. Liburd, MPH, MA
- Apophia Namageyo-Funa, MPH
- Leonard Jack, Jr., PhD, MS
- Edward Gregg, PhD
20Research Objectives
- To explore the meanings, symbols, and personal
and interpersonal significance of diabetes as
experienced by African American men living in
southeast Raleigh - To use the findings from this project to enhance
diabetes care and improve outcomes for African
American men
21Kleinmans anthropological illness narratives
framework
- Life history
- Patient and family explanatory models
- Symptom symbols
- Personal and interpersonal significance
- Culturally marked disorder
22Mr. Guns story
23Findings
- Heredity and diet were linked to the development
of type 2 diabetes, but there was little
consciousness about prevention - In spite of the high prevalence of diabetes in
the African American community, it is a
stigmatized condition among black men
24Findings
- Diabetes is an interruption of the normal and
codes a man sick - Seeking medical care was only precipitated by the
inability to work, to perform sexually, or weight
loss - Considerable self-diagnosing and the use
self-prescribed medications characterized the
illness behaviors of these men
25Comments
- no guy I know would want to say he is seeing a
counselor - I think going to see a counselor is a sign of
weakness and you dont want to appear weak in
front of your colleagues
26Key themes Captured from Other Studies
- 1. Support
- Mostly from female partners
- Little from male friends
- Indirect
- 2. Help seeking influenced by
- Perceived vulnerability
- Fear
- Denial
27Key themes
- 3. Personal barriers - related to traditional
male social role viz - Immunity from disease
- Immortality
- Difficulty in relinquishing control
- Help seeking unacceptable
- Not interested in prevention
28- 4. Systemic barriers
- Lack of time
- Long waits
- Access
- Having to state reason for visit
- Lack of male provider
29Themes
- 5. Health promotion is female. So being a man
means being denied a self monitoring role. - 6. Prostate problems present a threat to the
masculine self. - 7. Men cope less well because they fear losing
control. - 8. Men tend to see the body as a machine.
- 9. Men make bad patients (eg DRE)
30Why dont men seek help?
31Barriers to seeking help
- Need to conceal vulnerability and appear
independent. - Lack of knowledge/misinformation about services,
lack of understanding of counseling process. - Lack of time. /Not susceptible to health concerns
- Lack of credibility of adviser/ health care
provider. - Cost
- Insensitivity to minority groups.
32The Driving Questions
- Can social constructions of masculinity change?
Can men change? - What evaluation data exists for programs engaging
men and boys within a gender perspective? - Do some kinds of interventions show more evidence
of effectiveness? - Does applying a gender perspective to work with
men lead to greater effectiveness?
Source Gary Barker. Men, Boys and HIV
Examining the Evidence Base, Instituto Promundo
Rio de Janeiro, Brasil. Collaboration World
Health Organization and Instituto Promundo.
www.promundo.org.br.
33Theories to explain help seeking behaviour.
- Psychological/behvioural
- Sociological/cultural
34Psychological/behavioural(P/B)
- 1. Health belief model ( Beche MH 1974).
Likelihood that action will be taken about a
health problem is dependent up - Suspicion
- Susceptibility
- Severity
- Solution
35P/B
- 2. Theory of reasoned action( Fishbein M, Aizen
I, 1995) - Intention to change behaviour is a function of
perceived norms about an act. The more someone
evaluates an act as positive and believes that
others favour it, the greater is the chance that
he/she will perform it.
36Sociological/cultural (S/C)
- Hegemonic masculinity( Connell RW 1987)
- Ideological construction of masculinity to serve
interests of male groups.Males are dominant
group. Role of men is to dominate women and other
men - Need to be different to women( none of that
womens stuff), to be superior ( big shot , big
wheel), independent and self reliant(solid
citizen), powerful, even violent( give em hell) - Ethnicity and culture may overemphasize HM
37S/C
- 2. Multiple and multidimensional masculinities(
Connell RW 1987). - This allows for variability within individual and
group experiences, both at any one time and
longitudinally. - Fits a post modernist view.
38S/C..
- 3. Negotiated gender ( Cornwall A, Lindisfarne N
1994) - Gender is a social construct which is constantly
being renegotiated and defined in the
relationship and in the family eg following
childbirth, during chronic illness.
39Lets Not Forget History
40Tuskegee Syphilis Study 1932-1972
http//hsc.virginia.edu/hs-library/historical/apol
ogy/
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42The subject pool of the study was comprised of
illiterate sharecroppers from one of Alabamas
most impoverished counties. All of the subjects
were black men. These black men were never told
they had syphilis. They were told that they were
being treated for bad blood.
Flyer recruiting subjects for the experiment.
43Example of the deception used to coerce subjects
in the study
By the end of the study, only 74 of the test
subjects were still alive. Twenty-eight of the
men had died directly of syphilis, 100 were dead
of related complications, 40 of their wives had
been infected, and 19 of their children had been
born with congenital syphilis.
44Possible Futures in Theory, Research and
Practice?
- Include discussion in program description of
gender norms, social constructions of gender and
how these influence the behavior of men and
women - Include deliberate public debate, critical
reflection or explicit discussion of gender
norms and/or - Attempt to measure changes (eitther qualitatively
or quantitatively) in gender structures,
generally measured via mens and womens
attitudes toward gender norms.
Source Gary Barker. Men, Boys and HIV
Examining the Evidence Base, Instituto Promundo
Rio de Janeiro, Brasil. Collaboration World
Health Organization and Instituto Promundo.
www.promundo.org.br.
45Emerging Reflections about Promising Approaches
- Movement toward integrated models engage
individual men but within the social context - Many of the interventions one-time or pilot
sustainability of efforts, staffing needs seldom
discussed - Studies typically last a couple of years What
happens to boys and men over the lifecycle? - Few interventions engage men and boys women and
girls
Source Gary Barker. Men, Boys and HIV
Examining the Evidence Base, Instituto Promundo
Rio de Janeiro, Brasil. Collaboration World
Health Organization and Instituto Promundo.
www.promundo.org.br.
46Common Elements of Promising or Effective
Approaches
- Explicit inclusion of discussions of
manhood/masculinities in face to face or
community-based educational activities - Creating an enabling environment (peers, social
group that support change) - Alliance-building (using an ecological
perspective to reinforce messages) - Addressing mens vulnerabilities engaging men
to redress gender inequalities that women and
girls face
Source Gary Barker. Men, Boys and HIV
Examining the Evidence Base, Instituto Promundo
Rio de Janeiro, Brasil. Collaboration World
Health Organization and Instituto Promundo.
www.promundo.org.br.
47Finally Where to from here?
- Scaling up? How, who, where?
- Need to question the negative views about men
that still prevail in some settings - Need to measure, understand and promote changes
in men and masculinities at higher and multiple
levels - Engage men for their own well-being, for the
well-being of women and for the well-being of
children
Source Gary Barker. Men, Boys and HIV
Examining the Evidence Base, Instituto Promundo
Rio de Janeiro, Brasil. Collaboration World
Health Organization and Instituto Promundo.
www.promundo.org.br