Report to Congress
MEN’S HEALTH PROGRAMS LAG BY A 5:1 MARGIN AT DHHS
A Report By:
Edward E. Bartlett
January 25, 2001
- Executive Summary
Each year, 30,000 American men lose in their struggle for an equal chance at life. As a result, tens of thousands of women become widows. When these women reach their 70s and 80s, they face a four-times greater risk of being placed in a nursing home. As a result of this social and public health problem, Healthy People 2010, the nation’s blueprint for health, singled out men’s health as a national health priority.
This annual Report to Congress tracks the nation’s progress in achieving the goal of elimination of gender health disparities by the year 2010. This Report also compiles information on the following DHHS men’s health programs with a definable budget: 1. Centers for Disease Control and Prevention—Prostate Cancer Screening Program 2. National Institutes of Health—Prostate Cancer Research Initiative and Urology Program 3. Office of Population Affairs—Male Involvement in Family Planning
The budget allocation of the DHHS men’s health programs is $963.6 million. In comparison, the DHHS allocates approximately $5 billion to women’s health research and education. Despite the fact that the health of men is worse than the health of women on virtually every indicator, men’s health programs lag by a 5:1 margin in terms of budget allocations within the Department of Health and Human Services.
An additional area of concern lies in the DHHS Initiative to Eliminate Racial and Ethnic Disparities. Given the long-standing existence of racial disparities in our society, it is understandable why the Initiative emphasizes racial disparities. But absent any defined focus on men’s health, the Initiative may actually result in a deterioration of gender disparities, as explained in Appendix A.
The DHHS can be justifiably proud of a number of exemplary men’s health programs mounted by a number of dedicated public health professionals. Nonetheless, the DHHS has a long way to go until its programs and policies are consistent with the priorities outlined in Healthy People 2010. If we are to succeed in achieving the goal of eliminating sex-specific health disparities within 9 years, the Department of Health and Human Services will need to give far greater attention to the health of men.
- Introduction
On January 25, 2000, the Department of Health and Human Service (DHHS) released Healthy People 2010. For the first time, men’s health was identified as a national priority. Healthy People 2010 states:
“The second goal of Healthy People 2010 is to eliminate health disparities among segments of the population, including differences that occur by gender, race or ethnicity. . . Overall, men have a life expectancy that is 6 years less than that of women and have higher death rates for each of the 10 leading causes of death.”
Responding to the challenge of Healthy People, Rep. “Duke” Cunningham and Sen. Strom Thurmond introduced the Men’s Health Act in Congress in 2000. The purpose of the bill is to establish an Office of Men’s Health in the DHHS. Currently, there are offices of women’s health in the DHHS, National Institutes of Health, Centers for Disease Control, Food and Drug Administration, and Health Resources and Services Administration. To date, none of these agencies have an office devoted to the needs of men’s health.
We are now one year into the decade, and it is time to take stock of our progress. The purpose of this Report to Congress is three-fold: 1. Highlight information on the health status of men. 2. Catalog all the DHHS programs that are specific to men’s health. 3. Provide an overall comparison of gender-specific programs within DHHS.
We used several strategies to assure the information in this Report was accurate and complete:
- Communications with the persons in each DHHS agency participating on the Healthy People Steering Committee
- Search of the DHHS Web search engine: www.hhs.gov/topics/men.html
- Review of various DHHS reports and web sites
Draft program descriptions were sent to agency contacts, who were provided the opportunity to review and comment on the program summaries.
III. Key Indicators of Men’s Health Status
Each year the National Center for Health Statistics releases Health, United States, 2000, a compilation of health statistics. The following statistics provide the most recent summary of the health status of American men. All statistics are age-adjusted and apply to 1998:
- On average, American men live 73.8 years, and women live 79.5 years, a 5.7 year life span gender gap (Table 28).
- Men have a higher death rate for every one of the top 10 leading causes of death (Table 30):
Cause of Death Men Women
Heart disease 166.9 93.3
Cancer 147.7 105.5
Injuries 43.0 17.8
Stroke 26.6 23.6
Chronic lung dis. 25.9 18.1
Suicide 17.2 4.0
Pneumonia/flu 16.3 11.0
Diabetes 15.2 12.3
Homicide 11.3 3.2
HIV infection 7.2 2.2
Rates per 100,000 population
- Comparing all racial, ethnic, and gender groups, Black males had by far the highest mortality rates (Table 36):
Racial/Ethnic Group Men Women
Overall 605 376
Black 921 549
White 576 358
American Indian 568 364
Hispanic 455 262
Asian/Pacific Islander 347 212
Rates per 100,000 population
- Males under 65 years of age were more likely to have no health insurance, compared to females: 18.5% vs. 16.2% in 1997 (Table 128).
- Among males, 23.2% had no usual source of health care, compared to 11.9% of females (Table 78).
- Program Descriptions
The following are descriptions of the programs in the Department of Health and Human Services that are specific to men’s health:
Administration on Aging
No men’s health programs identified.
Administration for Children and Families
The Office of Child Support Enforcement at ACF sponsors a Fatherhood Initiative, but it has no defined relationship to reducing the health disparities facing men.
Agency for Healthcare Research and Quality
The Agency for Healthcare Research and Quality has no defined men’s health program. It has, however, funded several research projects on prostate health. The largest was the Prostate Patient Outcomes Research Team (PORT). The original PORT grant was awarded to Dartmouth University in 1990 (www.ahrq.gov/research/nov95/feature.htm). PORT-II continued the work of PORT-I, and recently concluded in 2000.
AHRQ has published a number of practice guidelines on prostate health, and continued to support several research projects specific to prostate health. Information on these projects can be found at: www.ahrq.gov/research/may00/0500ra10.htm
www.ahrq.gov/research/jun00/0600ra6.htm
www.ahrq.gov/news/press/pr2000/prospr.htm
www.ahrq.gov/research/nov00/1100ra7.htm
Budget: Unknown.
Contact:
Karen Migdail
AHRQ Public Affairs
2101 E. Jefferson St.
Rockville, MD 20852
301-594-6120
kmigdail@ahrq.gov
Centers for Disease Control and Prevention
CDC sponsors several prostate cancer control initiatives, which are summarized in Appendix B. Overall, CDC is working to build the science base for prostate cancer to deliver appropriate messages that will allow people to make informed decisions about prostate cancer screening and follow-up. The CDC also maintains a database of federal and state legislation related to cancer: www.cdc.gov/cancer/legislat.htm.
Budget: $9.2 million
URL: www.cdc.gov/cancer/prostate
Contact:
Karen Richard, MPA
Public Health Advisor
National Center for Chronic Disease Prevention and Health Promotion 4770 Buford Highway, NE, MS K64 Atlanta, GA 30341?3717 770-488-4737 kmr4@cdc.gov
Food and Drug Administration
No men’s health programs identified.
Health Care Financing Administration
No men’s health programs identified.
Health Resources and Services Administration
No men’s health programs identified.
Indian Health Service
No men’s health programs identified.
National Institutes of Health
The National Institutes of Health is the only DHHS agency that provides breakdowns of overall funding patterns by sex. According to the General Accounting Office report on Women’s Health (GAO/HEHS-00-96, May 2000), the 1999 budget allocation for men’s health research was 6.4%. This percentage formed the basis of the calculation of the NIH men’s health budget, reported below. In contrast, 15.5% was allocated for women’s health in that same year. The GAO report also revealed that since 1988, men’s health research has been funded less than half the amount allocated to women’s health.
Since 1994, the NIH has tracked sex-specific participation in extramural research projects. These percentages are reported in an annual report issued by the NIH Office of Research on Women’s Health, “Implementation of the NIH Guidelines on the Inclusion of Women and Minorities as Subjects in Clinical Research.” In Fiscal Year 1994, male participation was 44.9%. By 1998, that percentage had fallen to 32.2%.
The NIH has well-defined men’s health programs at the National Cancer Institute (see Appendix C) and the National Institute of Diabetes and Digestive and Kidney Diseases (see Appendix D).
Budget: $949.7 million (FY 1999)
Contact:
NIH Information Office
National Institutes of Health
Building 1, Room 344
Bethesda, MD 20892
301-496-2535
Office of the Assistant Secretary for Planning and Evaluation
The Assistant Secretary for Planning and Evaluation (ASPE) is the principal advisor to the Secretary of the U.S. Department of Health and Human Services on policy development. The ASPE supports the DHHS Fatherhood Initiative, a loosely-coordinated coalition of federal programs concerned with a range of fatherhood issues (http://fatherhood.hhs.gov/).
The Fatherhood Initiative has no defined relationship to reducing the health disparities facing men.
Office of Minority Health
No men’s health programs identified.
Office of Population Affairs
In 1997, the OPA/OFP began an initiative to involve community-based health and social service organizations to improve family planning/reproductive health education and services to men. The OPA/OFP projects are intended to integrate family planning service and education into programs where young males are already receiving other health, education, and social services. In FY 1999, grants were awarded to 24 community-based organization for these projects.
Through HHS regional offices, approximately 30 small grants were awarded to Title X family planning clinics for employing male high school students as interns. This program is designed to provide participants with information about allied health professions and job-skill training, as well as education about family planning, reproductive health, and responsible sexual behavior.
In FY 2000, OPA/OFP established the Title X Training Center for Male Reproductive Health at Morehouse Research Institute at Morehouse College in Atlanta, GA. This Training Center provides science-based information and training to Title X projects that provide family planning/reproductive health information and services to men.
Budget: $4.7 million
URL: www.hhs.gov/opa/titlex/ofp-male-grantees.html
Contact:
Kathy Woodall
Office of Population Affairs
U.S. Department of Health and Human Services
4350 East-West Highway, Suite 200
Bethesda, MD 20814
301-594-7608
KWoodall@osophs.dhhs.gov
Office of Disease Prevention and Health Promotion
The Office of Disease Prevention and Health Promotion sponsors a web-based HealthFinder, which includes information on men’s health. The men’s health page includes information on hot topics, news, smart choices, tools for you, and men’s health in the community.
Budget: Unknown
URL: www.healthfinder.gov/justforyou/men/Default.htm
Contact:
Mary Jo Deering, PhD
Office for Disease Prevention and Health Promotion
738-G Humphrey Bldg.
200 Independence Ave., SW
Washington, DC 20201
202-205-8611
MDeering@osophs.dhhs.gov
Office of Women’s Health
The DHHS Office of Women’s Health sponsors the National Women’s Health Information Center (NWHIC). The Center’s website includes a page on “What About Men’s Health?” The purpose of the website is to help women learn more about the leading health concerns of men.
“What About Men’s Health?” includes sections on alcohol and drug abuse, cancer, diabetes, fitness and nutrition, heart disease and stroke, HIV and AIDS, mental health, men with disabilities, prostate health, reproductive health, smoking, and violence prevention.
Budget: Unknown.
URL: www.4woman.gov/mens/
Contact:
Valerie Scardino, MPA, Program Manager
HHS Office on Women’s Health
200 Independence Ave., S.W., Room 712E
Washington, DC 20201
202-205-0270
vscardino@osophs.dhhs.gov
President’s Council on Physical Fitness and Sports
No men’s health programs identified.
Substance Abuse and Mental Health Services Administration
No men’s health programs identified.
- DHHS Budget for Men’s Health
The following summarizes the budget allocation for men’s health programs in the Department of Health and Human Services:
Centers for Disease Control and Prevention:
Prostate Cancer Screening Program $9.2 million
National Institutes of Health:
Prostate Cancer Research Initiative $141.5 million
NIDDK Urology Program $7.0 million
Other male-specific research $801.2 million
Office of Population Affairs:
Male Involvement in Family Planning $4.7 million
TOTAL $963.6 million
In comparison, women’s health is allocated approximately $5 billion, according to the DHHS Office of Women’s Health.
+++++++++++++++++++++++
Appendix A
DHHS Initiative to Eliminate Racial and Ethnic Disparities
The DHHS Initiative to Eliminate Racial and Ethnic Disparities outlines 5 disparity-reduction goals: infant mortality, cancer, cardiovascular disease, diabetes, and HIV infection/AIDS. The absence of a defined focus on men’s health has raised concerns in two of these areas.
- Cancer
Goal 2 of the Initiative addresses Cancer Screening and Management. Basic public health principles dictate that attention should be directed to persons at highest risk. Overall, men’s age-adjusted cancer mortality risk is 147.7/100,000, compared to 105.5/100,000 for women (Health, United States, 2000, Table 30). Thus, men currently have a 40% greater risk of dying from cancer than women.
But according to information posted on the DHHS website, the strategy for achieving the cancer goal focuses only on breast and cervical cancer. The conclusion that no attention should be directed to cancer in men, especially African-American men, is difficult justify.
- HIV Infection
Goal 5 of the Initiative addresses HIV Infection. The DHHS plan makes this statement: “We will establish educational outreach to all major medical providers to promote the current standard of clinical care for all persons living with HIV/AIDS, including Medicaid-eligible women and children with HIV” (emphasis added).
Medicaid eligibility rules in most states give preference to custodial parents, who are usually mothers. But many non-custodial fathers are under a court order to pay child support to the mother. If these men become ill and are unable to work, they may be incarcerated due to aggressive enforcement of child support orders.
URL: http://raceandhealth.hhs.gov
Appendix B
Centers for Disease Control
Prostate Cancer Control Initiatives
- Support six comprehensive cancer control projects that include activities targeting prostate cancer. The six projects are located in in Colorado, Massachusetts, Michigan, North Carolina, Texas, and the Northwest Portland Indian Health Board.
- Collaborate with the Association of State and Territorial Health Officials to ensure that health departments provide accurate and useful information to the public about the benefits and risks associated with PSA screening tests.
- Develop communications tools in Oklahoma, Texas, and the District of Columbia to help men decide whether to be screened for prostate cancer.
- Analyze print media messages to determine what prostate cancer information is currently being provided to the public in general and to the African-American community in particular.
- Work to increase the recruitment of African-American men into the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trials. These trials are designed to answer the critical question of whether screening for prostate cancer prevents deaths.
- Examine clinical and demographic factors among African-American and white men that may explain increased risk for prostate cancer.
- Conduct a study with the Alliance of Community Health Plans to compare the medical records of patients with their own report of whether they received a PSA test.
- Study the effectiveness of PSA and digital rectal exam (DRE) screening in the managed care setting by examining medical histories of men who died of prostate cancer.
URL: www.cdc.gov/cancer/prostate
Appendix C
National Cancer Institute
Prostate Cancer Research
In 1997, the NIH established the Prostate Cancer Progress Review Group, charged with helping the National Cancer Institute sharpen its focus on the prostate cancer agenda. In its 1998 report, “Defeating Prostate Cancer: Crucial Directions for Research” (http://osp.nci.nih.gov/PRGReports/PPRGReport/toc.htm), the Group identified about 500 NCI-funded projects supporting prostate cancer research.
At the request of Congress, NIH then developed a 5-year plan for a coordinated, NIH-wide prostate cancer research initiative. “Planning for Prostate Cancer Research: Expanding the Scientific Framework”
(http://www.nci.nih.gov/prostateplan.html) was submitted in July 1999. Current research projects include the following:
- 246 clinical trials in prostate cancer, including 80 Phase III studies and 37 Phase II studies. • The Prostate Cancer Prevention Trial (PCPT) to determine if the drug finasteride can prevent prostate cancer. • The Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial
(PLCO) to assess the efficacy of prostate cancer screening.
- The Surveillance and End Results (SEER) Program to identify differing patterns of care among black and white men with prostate cancer.
Budget: $96 million (FY 1999)
URL: www.nci.nih.gov/disease-initiatives/prostatecancer/index.html
Contact:
Barry Portnoy, PhD
National Cancer Institute
Building 31, Room 10A49
31 Center Drive, MSC 2580
Bethesda, MD 20892-2580
301-496-9569
bp22z@nih.gov
Appendix D
NIDDK Urology Program
The National Institute of Diabetes and Digestive and Kidney Diseases
(NIDDK) Urology Program supports basic and clinical research on the normal and abnormal development, structure, and function of the genitourinary tract and studies on the genitourinary effects of diabetes mellitus and other diseases. The NIDDK is especially interested in research on these urological conditions: • Benign prostatic hyperplasia • Erectile impotence • Other sexual dysfunctions • Chronic inflammatory disorders of the genitourinary tract, such as prostatitis, epididymitis, and orchitis.
The NIDDK currently has several large-scale men’s health studies
underway:
- Minimally-Invasive Surgical Therapies Treatment Consortium for Benign Prostatic Hyperplasia
The NIDDK recently announced the establishment of a 5-year multi-center trial to study the effectiveness of minimally invasive surgical therapies for the treatment of benign prostatic hyperplasia (BPH). The study will be known as MIST: Minimially Invasive Surgical Therapies Treatment Consortium for Benign Prostatic Hyperplasia. The purpose of this project is to conduct randomized clinical trials of the long-term efficacy and safety of the major “minimally-invasive” approaches for the treatment of symptomatic BPH.
Budget: Year 1: $3 million. Years 2-5: $6 million/year.
Contact:
Dr. John Kusek, Deputy Director for Clinical Program Administration 6707 Democracy Blvd., Rm. 617, MSC 5458 Bethesda, MD 20892-5458 301-594-7717 kusekj@ep.niddk.nih.gov http://grants.nih.gov/grants/guide/rfa-files/RFA-DK-01-024.html
- Alternative and Complementary Therapies for Symptomatic BPH
Alternative medicine approaches to the treatment of disease are often used for many urological conditions that affect quality of life. Alternative therapeutic agents are often used to treat BPH symptoms. This initiative will assess the efficacy of widely used alternative strategies for treatment of BPH, and compare these agents with FDA-approved drugs for the treatment of this condition.
Budget: $3.0 million.
- Innovative Therapeutic Interventions for Chronic Prostatitis
The purpose of this initiative is to expand the Chronic Prostatitis Collaborative Network, a consortium of six clinical centers and a data coordinating center. The purpose of the Chronic Prostatitis Collaborative Research Network is to define the epidemiology of this condition and start clinical trials of therapeutic interventions for men with Chronic Prostatitis.
Budget: $0.5 million.
- Minority Recruitment in Chronic Prostatitis Cohort Study
The Chronic Prostatitis Collaborative Research Network will be expanded by addition of new clinical facilities to strengthen the recruitment of African-American men with chronic prostatitis.
Budget: $0.5 million.
Contact:
Leroy M. Nyberg, MD, PhD, Clinical Urology Program Director 6707 Democracy Blvd., Room 654, MSC 5458 Bethesda, MD 20892-5458 301-594-7717 nybergl@ep.niddk.nih.gov