Men’s Health Month: CBH Director of Primary Care Behavioral Health Dr. Frank Johnson Discusses Addressing Men’s Barriers to Care
In recognition of Men’s Health Month, Frank Johnson, PhD, MPH, LCSW, Director of Primary Care Behavioral Health at CBH, discusses the unique health challenges men face and the importance of addressing longstanding barriers that often prevent men from seeking care.
The health status of Philadelphia’s men is alarming. Across the lifespan, in every age group, the risk of death for men is higher than it is for women. The national average life expectancy for men is 75.8 years, but in Philadelphia, the life expectancy for men is just 73 years. Considering race and the neighborhoods where men live, Philadelphia’s Black men have a life expectancy of 65 years—the lowest for any one group in the city. In sections of North and Southwest Philadelphia, the life expectancy is lower than it is in any other part of the city. Men have worse outcomes than women for almost all health conditions, including cancer, diabetes, hypertension, HIV, hepatitis, and obesity. Even during the COVID-19 pandemic, more men died from the virus than women.
The status of men’s mental health is arguably more troubling. In Philadelphia, an estimated 300,000 individuals experience some form of mental illness yearly, ranging from mild depression to severe mental illnesses such as bipolar disorder and schizophrenia. While women are diagnosed with anxiety and depression at higher rates than men, higher rates of alcohol dependence, tobacco use, and opioid overdoses can be found among men. The Centers for Disease Control reports that nationwide, every 11 minutes, someone dies by suicide. Roughly eighty percent of those are men. In Philadelphia, men die by suicide three times more often than women, with middle-aged White men having the highest death-by-suicide rate.
More attention needs to be given to gender and racial disparities. As health systems strategize to achieve equity, the specific needs of men need to be integrated into those plans. This includes understanding the social determinants of health that are specifically correlated with men’s health. For example, men are socialized around traditional masculine norms such as being financial “breadwinners” for their families. For many men, their identity may be driven by the ability to achieve financial success and also tied to the type of work they do—and won’t do. For unemployed or underemployed men, obtaining an adequately paying job in a declining job market and adapting to a multigenerational workforce with diverse gender identities can be a significant stressor. Men may also struggle with the financial stress of providing care or support for an elderly family member, along with the responsibilities that come with maintaining a successful career. Other stressors men frequently report include relationship struggles with family, spouses/significant others, and their children. Many men of color and men who identify as gay, bisexual, or transgender also report trauma from negative racial and violent experiences.
Stress can trigger depression or other mood disorders that go undiagnosed in many men. There are several reasons for this. For one, most health systems lack the cultural competence that would make them sensitive to differences beyond racial and ethnic categories. Therefore, developing interventions and patient/member engagement efforts that could be culturally tailored and gender-specific are not considered. Also, men who cling to traditional masculine norms that encourage self-reliance, emotional toughness, and avoidance of any type of engagement associated with feminine values will usually avoid seeking help. When men do seek help, their depression is often missed because common screening questions used to assess depression do not always hold the same meaning for both men and women. With depressive symptoms unrecognized, many men resort to unhealthy behaviors to self-medicate, including substance use and risky sexual behavior.
What can be done? Helping men understand the difference between stress and depression, innovatively using digital tools and online platforms to improve their health literacy, and addressing the social determinants of their health are some action items that healthcare systems should consider. Indeed, a healthy man is tied to the well-being of families, communities, and society at large. Using psychoeducation to promote open dialogue can be empowering and help guide men toward healthy decision-making. Culturally competent gender interventions and programming could help shrink disparities that have been stubbornly resistant to change. It’s certainly a heavy lift, but moving forward with incremental action is a start—and can also result in some great success stories to share.
The information provided in this blog post is for general educational purposes only and does not constitute professional medical advice or treatment for a medical condition. Please consult your healthcare provider about any questions or concerns you may have regarding a medical condition.
