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Title: Black Male Masculinity and Chronic Disease Prevention and Control: Closing the Gap Between Theory, R


1
Black 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

2
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3
We 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.

4
Mens 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.

5
Major 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.

7
Throw Into the Mix
  • Masculinity

8
Masculinity 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.

9
Black 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

10
J Urban Health. 2003 80556-568, p. 559.
11
SOCIAL DETERMINANTS OF HEALTH
12
Lets 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

13
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14
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15
A 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

16
Louisiana Health Ranking
17
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18
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19
Views 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

20
Research 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























21
Kleinmans anthropological illness narratives
framework
  • Life history
  • Patient and family explanatory models
  • Symptom symbols
  • Personal and interpersonal significance
  • Culturally marked disorder

22
Mr. Guns story
23
Findings
  • 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

24
Findings
  • 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

25
Comments
  • 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

26
Key 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

27
Key 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

29
Themes
  • 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)

30
Why dont men seek help?
31
Barriers 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.

32
The 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.
33
Theories to explain help seeking behaviour.
  • Psychological/behvioural
  • Sociological/cultural

34
Psychological/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

35
P/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.

36
Sociological/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

37
S/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.

38
S/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.

39
Lets Not Forget History
40
Tuskegee Syphilis Study 1932-1972
http//hsc.virginia.edu/hs-library/historical/apol
ogy/
41
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42
The 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.
43
Example 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.
44
Possible 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.
45
Emerging 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.
46
Common 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.
47
Finally 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
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