Introduction

Have you ever wondered why men die on average six years before women?  According to researchers, differences in death rate among infants, teen and young adults, and middle-agers all reflect greater female survival.  For the ten top causes of death in this country the death rate for males is higher than females.  When examining the major causes of death one will find that not only do men die younger, but the causes are most often lifestyle related.  For those that work in the area of worksite health promotion this is encouraging, because health related behaviors are often controllable.  Much could be done to reduce morbidity and mortality among men if worksite health professionals were cognizant of the incidence and etiology of health problems specific to males.  The selected list of Websites included on Optimal Health Concepts Men's Health Links Page offer a collection of some of the best men's health information sites available on the Internet.

Men: The Endangered Minority

Understanding gender differences in health behaviors and health outcomes is the first step to planning effective programs.  A number of researchers have surmised that males are less interested in health matters than females, are less knowledgeable, and thus are not as attentive to self care practices.  The lack of emphasis which males may put on healthy lifestyles in turn increases rates of serious illness and decreases life span in males.  Some aspects of gender based morbidity and mortality differences include the following:

• American men ages 45-64 years old suffer an estimated 424,000 heart attacks a year; women in the same age group suffer 136,000 heart attacks annually.
• An estimated 3.6 million men, or half of all men with diabetes, don't even know they have the disease.
• Death due to motor vehicles accidents are responsible for a three to one ratio of males to females.
• In the United States alone, 1 in 5 men will develop prostate cancer in their lifetime.
• The death rate of men from prostate cancer has increased by 25 percent since 1971.
• In 1996, the bulk of government funding for breast cancer research was estimated at $337 million; for prostate cancer, $71 million.
• Men represent 85 percent of all AIDS cases in the United  States.
•  80% of those who have serious drug addictions are men.
• Cirrhosis of the liver and alcoholism maintain a 4:1 ratio
• Nearly 90 percent of all driving under the influence charges filed in 1994 were against men
• 80% of the Homeless on America's streets are men and 35% of those are Vietnam Veterans.
• The ratio of males to females suicide is a four to one .
• Nearly 80% of all homicide victims are male.
• Fifty percent of domestic homicides are committed against men.
• Men are 43 times more likely than women to be admitted to Psychiatric Hospitals and 25 times as likely to end up in Prison.
• Women visit doctors almost four times as often as men. Even when reproductive related physician visits are controlled for, females tend to utilize the medical care system to a much greater extent than males.
• Men are less knowledgeable and less interested in health than females.

Societal expectations may play a role in discouraging men to seek medical care or mental health care.  Females are twice as likely to report mental health problems than males.  Female cases of neuroses outnumber males two to one and yet when we look at the most debilitating mental illnesses, most psychiatric beds are filled by males.  Men may have more to lose in self esteem and the esteem of others, if they can not cope or admit to psychological disturbances. A societal message given to males is that it is unmanly to express emotion or admit to pain. In the case of emotional depression, women are more likely to seek counseling or be prescribed an anti-depressant.  Depressed men are more likely to self medicate themselves with alcohol or some form of illicit and potentially addicting drug.

Ideas for Effective Intervention and Programming at the Worksite

Examining the condition of men's health described above and comparing them to available Websites one will find that these sites are wonderful sources of information regarding specific diseases and illnesses (e.g. prostate cancer).  One will also find that these sites are less useful in suggesting how to encourage healthy lifestyles among men. From a health promotion perspective these sites are a valuable resource for male employees.  Men still outnumber women as Internet users and it would behoove professionals to advertise the availability of these sites.  While these Web pages may be effective in increasing awareness, it is important that men also feel empowered to make behavioral changes which are health enhancing.  As an example, it is important to include information regarding local screening opportunities along with information about a prostate health Website.

Developing and marketing culturally appropriate interventions is another way to increase the effectiveness of health promotion efforts.  Programs are most effective when they are marketed to specific segments of the male population and are designed to address male characteristics.  Men are often under represented in worksite health promotion programs and in part, this may be due to an unintentional emphasis on programs and activities that are attractive to women.  If no men are enrolled in a lunchtime walking program, maybe noon basketball or an indoor golf driving range would encourage greater participation.  When developing a weight control program, one may want to ask if a separate program (with a name like Gut Busters) needs to be offered for men only.  On the occasions when men do attend worksite fitness programs they are usually found pumping weights, if men are shunning aerobic dance classes, it may be time to try a martial arts based aerobics program.

The key is to determine the needs of a specific market segment and then market the program in a way that is appropriate for men.  As another example, in some areas of the country deer hunting is a popular recreational activity where unfit men put severe stress on their cardiovascular systems trying to drag a large deer uphill.  A worksite in such an area could offer pre-hunting season workout sessions to introduce these men to scientifically sound exercise programming.

It may be more difficult to develop emotional health programs that are attractive to males.  An emphasis on wellness with attention to increased performance, will be a more effective strategy for many men.  If males are socialized to be more competitive then health education should provide information on how a guy can be the best he can be.  For instance, a stress management program should not emphasize preventing symptoms and poor health, but on how to handle high levels of stress and enjoy it.

Programs focussing on skills to reduce anger and hostility would be very useful for many men, if we could get them to attend.  Because women have greater interests in health than men, another successful strategy may be to address men's health through support that can be provided by spouses and significant others.  A program can be offered for women entitled "How to help your partner deal with anger in a healthy way".  As a more effective strategy to increase male involvement, this same concept can be used to encourage regular medical exams, improve male dietary patterns, or to improve other health habits.  This approache has been used in rural farming areas as a means of getting men to practice safety when working with farm machinery.  From an epidemiological perspective, one of the healthiest things a guy can do is get married.  Married men take less health risks, eat better and are involved in more health enhancing behaviors.

Other sources of social support for male health behaviors should not be overlooked.  Much of the research on health behavior has focused on the importance of social reinforcements for positive and negative health behaviors (e.g. Social learning theory, Reciprocal determinism, Reinforcing factors).  Health promotion professionals must assess the culture of the workplaces to examine how healthy it is and what must be changed in order to reinforce preventive health behaviors as the norm.

One last approach to successful health promotion programming involves the manipulation of men's egos.  Research indicates that men are more narcissistic that females.  Evidence of this is provided through the success of Men's Health Magazine.  If one looks at the titles of sections of this magazine or its online version, examples of very effective marketing to a specific segment of men can be found.  One can certainly see that sex sells. Based upon this approach a general theme for all men's worksite health promotion programs should be: "How to be the Strongest, Sexiest, Toughest, Healthiest Employee".  Give men what they need by packaging in what they want.  Disease avoidance is not a significant motivation for most men.  Prevention of illness is not as exciting as the quest for optimal health so use this to encourage male employees to be the best they can be.
 

References:

The Men's Health Network of Washington, D.C. http://www.vix.com/pub/men/orgs/writeups/menshealthnetwork.html

Zoske, J., (1998). Men's health & wellness: 50 health promotion ideas of educators, practitioners & planners.P.O.Box 8852, Academy Station, Albany, NY.