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Priorities for Global Prostate Cancer Intervention:An Advocate/Survivor Perspective: Taking Health into Our Own Hands
Presented by Virgil H. Simons, MPA:3rd Annual Educational Symposium
29 October 2011
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“Health is an indirect measure of a society’s
collective democracy.”
-Rudolf Virchow
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Healthcare Costs represent an increasing
% of GDP- $650B more for Cancer
Treatment
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National Healthcare Quality Report - 2007
“Preventive healthcare lags significantly behind other gains in healthcare.”“Access to care and information varied widely between racial/ethnic groups
and by socio-economic status”Source: www.ahrq.gov
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Understanding the Risk…
Of dying after being physically attacked - 1:7,336,000Of being struck by lightning - 1:835,500Of dying in a plane/train/car accident - 1:6,279Of having a heart attack - 1:53Of dying from prostate cancer - 1:36Of getting prostate cancer - 1:6
If you’re African-American:- 1 in every 4 Black men get Prostate Cancer- Black men die at a rate 240% higher than whites- Blacks diagnosed at advanced disease stages at a
144% greater rate
Source: The Book of Odds; American Cancer Society
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Pathways to Cancer
AwarenessAccessEnvironmentLifestyleCultureGeneticsEvery cancer is different
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Research Partnerships
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We Don’t Know What We Don’t Know!
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Communicating the Problem
Patient/Professional dialogue divergenceLack of clear-cut risk communicationsRisk of advanced stage first diagnosisNeed for actionable patient information
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Defining Barriers to Men’s Participation in HealthcareClinical Barriers
- Awareness- Access- Financial
Attitudinal Barriers-Gender Role Stoicism -Work Role Stoicism-Distrust of the Health Care System-Fatalism: “you’ve got to die of something.”-Maladaptive Self-Reliance: “A ‘man’ takes care
of his own problems.”
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Barriers to Early Detection
U.S. vs European conflict on screening
No consensus among U.S. agencies
Lack of “Risk” determination
Clinical Barriers
Decline in doctors in Primary Care Medicine
Closing of ER’s
Continuing shortage of nurses
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Treatment ImpactConflicting preventive therapeutic
recommendationsSELECTFinasteridePLCO Study
Skeletal impacts of ADTCardiovascular issues related to hormone therapyEmerging technologies with minimal curative
benefitRobotic surgeryProton radiotherapy
Mixed benefit of emerging drug therapiesTargeted disease managementLimited therapeutic impactCost of care
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Evaluating Public Ed34% do not use evidence-based strategies
85% of activities not informed by needs assessment
50% of activities not evaluatedPublic education strategies are perceived as costly
Programs are concerned about meeting demand generated by public education
There is a comfort level with usual strategies (e.g., small media)
Source: (2009) Inventory and Assessment of NBCCEDP Interventions
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Regional Symposium Series
2011 Program Sites:March 19 - Vienna, AustriaMay 21 - New OrleansAugust 27 - University of MichiganSeptember 10- Northwestern SPORESeptember 17 - Karmanos October 29 - New York UniversityNovember 29 - Cairo/AORTIC
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Neutralize Media Negatives
Utilizing current network to develop “Proof of Concept” educational module
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Raising Consumer Awareness
• Sexual Intimacy & Cancer
• Nutrition for Prevention and Progression
• Maximize “Edutainment”
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Social Network Integration
•Credible peer-to-peer communications
• “New” Prostate Cancer Infolink
• “Pints for Prostate”• Prostate Cancer Internet Alliance
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Broadening Outreach: La Prostata Red
• Latino/Hispanic men have 3rd highest incidence
• Poorer 5 year survival
• Cultural barriers to prostate health
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Broadening Outreach:Korean-Americans
• High Cholesterol Levels
• Strong association with Pca
• Need for whole body initiative
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Complicating the Issue
Gender/Disease Inequity
Research funds - 3X for BRca vs Pca
Public health funding - inconsistent for Pca
Public health agencies - none dedicated to Pca
Federal focus - no agencies for men’s health
Women more likely to utilize health services
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Women Often Serve as the “Health Police” in the Family
• Men do best when they have motivated partners
• Women are usually more experienced and knowledgeable in health matters
• Appeals to responsibility, taking care of family.• Reduce his fear: early diagnosis = best
outcomes.• Challenge him to take control: “Your blood
pressure was high. What are you going to do about it?”
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The Family Connection
• Shared risk concept
• Enhance Family responsibility
• Builds on genetic similarities
• Promotes personal communication
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The CoalitionImpact
Empowering community stakeholders to address community problems
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Why the Barber / Barbershop
Model has been proven in several public health programs in the U.S. and internationally
Traditional role as opinion shaper in the community
Continuing source of information and place for verbal interaction
Emerging function as outreach center for community health information
Important new role as lay health facilitator and liaison with local healthcare providers
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The Benefits of Positive Men’s Health to the Community
• Reducing or controlling rising health care costs through preventing costly, advanced disease
• Reducing economic costs of preventable male illness, including lost time from work, disability, diminished income, and reduced work productivity
• Increased attention to men’s health ultimately holds the potential to bolster and uplift the health status of both genders
• Gender health is not either/or, It’s both or neither• Jean Bonhomme, M.D. - Men’s Health Network
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The “Iron Triangle”
• Building Health Empowerment• Community/Patient Interest
Groups• Government enabling agencies• Congress
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Conclusions / ObservationsFederally funded Pca early detection
dependent on policy conflict / disease funding inequity resolutions
FQHC/CEED programs coordination needed to better serve medically underserved communities
Consistency in community facilitator programs must be maintained
Third-Party providers are necessary to fulfill government missions in public health
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The real voyage of discovery consists not in seeking new landscapes but in having new eyes.
• - Marcel Proust
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Thank You!