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

“Health is an indirect measure of a society’s

collective democracy.”

-Rudolf Virchow

Healthcare Costs represent an increasing

% of GDP- $650B more for Cancer

Treatment

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

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

Pathways to Cancer

AwarenessAccessEnvironmentLifestyleCultureGeneticsEvery cancer is different

Research Partnerships

We Don’t Know What We Don’t Know!

Communicating the Problem

Patient/Professional dialogue divergenceLack of clear-cut risk communicationsRisk of advanced stage first diagnosisNeed for actionable patient information

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.”

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

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

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

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

Neutralize Media Negatives

Utilizing current network to develop “Proof of Concept” educational module

Raising Consumer Awareness

• Sexual Intimacy & Cancer

• Nutrition for Prevention and Progression

• Maximize “Edutainment”

Social Network Integration

•Credible peer-to-peer communications

• “New” Prostate Cancer Infolink

• “Pints for Prostate”• Prostate Cancer Internet Alliance

• FaceBook

Broadening Outreach: La Prostata Red

• Latino/Hispanic men have 3rd highest incidence

• Poorer 5 year survival

• Cultural barriers to prostate health

Broadening Outreach:Korean-Americans

• High Cholesterol Levels

• Strong association with Pca

• Need for whole body initiative

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

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?”

The Family Connection

• Shared risk concept

• Enhance Family responsibility

• Builds on genetic similarities

• Promotes personal communication

The CoalitionImpact

Empowering community stakeholders to address community problems

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

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

The “Iron Triangle”

• Building Health Empowerment• Community/Patient Interest

Groups• Government enabling agencies• Congress

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

The real voyage of discovery consists not in seeking new landscapes but in having new eyes.

• - Marcel Proust

Thank You!