Dennis J. Barbour examines why boys and men aren’t getting the health care they need.
I was a chubby kid. Clothing manufacturers still euphemistically label what had been my size as “husky”. I was chubby, that is, until I was nine. That’s the year I visited the pediatrician for the last time. After he weighed me and poked and prodded my thicker areas he announced with dripping disdain that at 92 pounds I was ten pounds overweight. He was brutal. He said things to shame me that to this day make me shiver. But his tactic worked. Within two months I had shed the ten pounds and I’ve been on a diet ever since.
That experience as a child was transformative because it set the stage for a lifetime habit, if not an obsession, of keeping my weight in check. As I have grown older the logical extension has been regular cardiovascular exercise, coupled with mild gym rat behavior, which has led to a healthy examination of the foods I eat. The fact is, when it comes to health and behavior, lifestyle patterns are set very early in life. In my case the stage may have been set for a lifetime obsession when it comes to my weight and fitness, but I am thankful that my parents took me to a pediatrician who at least recognized that I was on a trajectory to become an overweight, if not obese, adult, with all of the attendant health consequences.
Today we have an adolescent obesity epidemic in this country, and it isn’t just an issue for girls and young women. We have an adolescent suicide problem, and it’s pronounced with adolescent males, who complete suicide at four times the rate of adolescent females. Homicide among adolescent males is four times that of adolescent females. Adolescent males have an unintended injury rate that is double that of females, and adolescent males have an ADHD diagnosis rate that is three times that of adolescent females. The diagnosis rate of epilepsy among young males is twice that of young females, and the incidence rates of syphilis among males age 15-24 is from twice to five times that of females.
Yet, like me on that fateful day when I was nine, once most young males leave their pediatrician’s office for the last time they do not return to a health care provider for regular visits until their mid-thirties, if then. And, while this lack of continuous care may be exacerbated by poverty and other factors, it affects young men who come from affluent backgrounds as well. It is often observed that men “do not go to the doctor” because of misplaced notions of masculinity or because their female partners (as an extension of their mothers) watch over their health. It is just as likely that men do not go to the doctor regularly because by their thirties a visit to the doctor has become a very foreign encounter, fraught with unpleasant childhood memories.
The situation with females is quite the opposite. Once they have their first period and become sexually active they have more incentive to seek continuous medical care, if for no other reason than simply because they can become pregnant. Their ob/gyn’s office, in essence, becomes their medical home for life. Young males do not have the equivalent, and because their health needs are not apparent in any visible way they seem to do just fine.
But they aren’t doing just fine. They are half the equation in unintended and unwanted pregnancies. They acquire STIs that, if left undiagnosed and/or untreated, can spread to their sexual partners and have severe long term consequences for their own overall health. They suffer from depression that goes unnoticed by our educational and health care systems, leading at times to substance abuse and those suicide rates that are higher than females’. They are not taught what it means to be biologically male and the things that males should learn in adolescence to protect their health as adults, like testicular self-exams (testicular cancer is the top cancer among males 18-34). They are not engaged in conversation about the very meaning of masculinity, leading to risky behaviors and, among some gay male youth, shame and bullying.
If young males had a place, a home, or even a welcoming place to go within our health care system that focused on these needs in a coherent and comprehensive fashion we would be much healthier as a society.
We must, we can and we are doing something about this. It begins by recognizing that each sector of our health care system has a role to play and that they must work together to address this growing problem.
For the past year The Boys Initiative, working with physicians at the Johns Hopkins School of Medicine, Columbia University School of Public Health, Boston’s Children’s Hospital, other medical institutions and major health organizations, has researched this issue and has found that work is beginning to be done to address the unique health needs of adolescent and young adult males. Unfortunately, this work is being conducted in a siloed fashion and the services that are emerging are not being provided in a comprehensive fashion. For example, school clinics may provide counseling on sexual and reproductive health matters but not conduct screening for mental health disorders, substance abuse or risky behaviors. Emergency room physicians may treat young males for concussions but there may be inadequate coordination with another provider for follow-up visits. Some adolescent and young adult males may never have reason to visit a physician or an ER but may still be at risk. The fact is that most disorders do not occur in a vacuum and may be related to others.
After consulting with a broad range of over 60 health care providers and health care organizations, government agencies, youth organizations and other stakeholders in the health of adolescent and young adult males, we have perceived an emerging consensus that we can, and should, begin to tackle this issue in a coordinated fashion. To that end we have assembled a cross-specialty and cross-disciplinary coalition of nationally known experts to forge a path forward. In the near future we will release a checklist for adolescent and young adult male health, to be followed by a range of activities leading up to formal medical guidelines. It will be a long slog, but the effort will be worth the result if we are successful. As we move closer and closer to the reality of “medical homes” and as the Affordable Care Act rolls out in the coming years we will have many opportunities to make a difference for our male youth. The stars are aligned for success in this endeavor, which has been long overdue.