NAME:MOHD FAIRUZ BIN ADDNAN
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In the last few decades, men’s health has becoming a significant public health concern. What does it mean to be a healthy man? The WHO (1946) defines health as ‘a state of complete physical, mental, and social well-being and not merely the absence of disease, or infirmity’. This broad definition can be applied equally to both genders. In the past, men’s health has been narrowly defined by those diseases uniquely affecting the male genitourinary tract. However, defining men’s health as diseases of the male reproductive system ignores holistic nature of health. There is no concrete definition for Men’s Health. Tan et al. (2013) define Men’s Health as a discipline that promotes physical, mental and social well-being of men throughout their life cycle (from boyhood to manhood) and addressing health problems related to men.
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In many parts of the world including in Asia, health outcomes among men persistently worse compared to women. Men have shorter life expectancy and higher mortality rates compared to women (Ng et al. 2014).
In Malaysia, life expectancy at birth for men is 72.6 years compared to 77.2 years for women. Death rate for men in 2011 was 5.2 per 1,000 population compared to women which was 4.0 per 1,000 population. In 2006, the most common causes of death in men were ischaemic heart disease, which constituted 13.3% of total certified death followed by motor vehicle accidents (7.9%), septicaemia (6.3%), cerebrovascular disease (6.3%) and pneumonia (5.2%).
Recent National Health and Morbidity Survey (NHMS) 2011 (Institute of Public Health 2011) reported that about 8.8% of men having undiagnosed Diabetes Mellitus (DM) and 21.8% of men having undiagnosed Hypertension, which were higher compared to women. This is a worrying trend as many men unaware that they have these conditions. Undiagnosed DM and hypertension may lead to premature death as the leading cause of premature mortality in Malaysia is ischemic heart disease (Ummi Nadiah et al. 2013). These silent risk factors and disorders can only be diagnosed and treated if men attend health screening.
If we exclude sex-specific cancer types, the incidence rates of common cancers were higher in men than in women. The most common cancer in males was colorectal cancer, which accounted for 14.5% of the total incidence of cancer. This was followed by lung cancer (12.2%), nasopharyngeal cancer (7.8%; mainly among Chinese), prostate cancer (7.3%) and leukaemia (6.5%) (Tong et al. 2011).
For psychological health, based on NHMS IV, most mental health problems such as depression, suicidal attempt and anxiety disorders were more prevalent among women compared to men. Other than that, erectile dysfunction (ED) is the most commonly studied male sexual health condition in Malaysia (Tong et al. 2011). Study by Khoo et al. (2008) among aging men in urban area in Malaysia found that the prevalence of ED was 70.1% (mild ED 32.8%, mild to moderate ED 17.7%, moderate ED 5.1%, and severe ED 14.5%). Premature ejaculation (PE) is another male sexual health condition that has been studied. The prevalence of PE was four to five times higher among men with anxiety and depression compared to men without these disorders (Quek et al. 2008).
Until recent years, there are no specific public health care services for men. In general, public health clinics in Malaysia in terms of delivery services can be divided into Outpatient Department (OPD) and Maternal and Child Health (MCH) clinic with support from other units such as pharmacy, laboratory and others. Health services for men are only available at OPD but the services are meant for general population. There is no specific clinic for men even though all the services provided such as health screening and treatment of illness are related to men. Other programmes include quit smoking services, methadone replacement therapy services and some clinics have occupational health services.
At OPD, men able to have a screening for risk factors of cardiovascular diseases and also sexual and urological conditions by using self-administered questionnaires. There are several obstacles exist in the implementation of the screening programmes. Participations from men were low and there is a lack of opportunity to have an effective consultation with health care providers due to shortage of manpower and resources. In 2001, screening programme for colorectal cancer has been introduced but it was fully implemented in health clinics after 2010. Screening through faecal occult blood test (FOBT) done annually for those in high risk group. Study by Yusoff et al. (2012) found that participation in colorectal cancer screening in Malaysia especially among men was extremely low.
Ministry of Health under the Division of Family Health Development has come out with some objectives to promote health for both men and women. However, many activities in the past until now had prioritised women and child health due to high maternal and infant mortality, which has improved tremendously over the years. Nonetheless, the Ministry of Health, through its various departments, has been addressing many issues related to men such as non-communicable diseases and healthy lifestyles. These programmes were mostly targeting general population rather than men. An example is Komuniti Sihat Perkasa Negara (KOSPEN) programme started in July 2013 in effort to deal with increasing burden of non-communicable diseases (NCD) (Ministry of Health 2013). This programme aims to improve health of Malaysia citizen by empowering the community and increase their involvement in health programmes. Similar to previous healthy lifestyle campaigns or programmes, it cannot be denied that all these health programmes touched on many issues related to men’s health. However, important factors associated with poor health among men such as unwillingness of men to engage in healthy lifestyle, appropriate health seeking behaviour, accessibility to men’s health services, are not being addressed.
There was actually an attempt by the Ministry of Health to draft a men’s health policy. Previous Minister of Health in his opening address at the First National Men’s Health and Aging Conference 2005 affirmed the importance of promoting men’s health in Malaysia (Chua 2007). However, the policy has still not materialised for various reasons. Health policy is important to serve as a framework to advocate and promote men’s health.
Some developed countries have already had their own national men’s health policy. An example is National Male Health Policy in Australia. The Policy is for male of all ages focusing on engaging males about their health, raising awareness about preventable health problems affecting males, improving the use of existing health resources by males by reducing access barriers, and targeting males with poorer health outcomes (Ministry for Indigenous Health Rural and Regional Health and Regional Services Delivery Australia 2010).
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Our government support for men’s health has been integrated into general health care delivery and appears somewhat fragmented. It is still very much disease-oriented rather than focus on men. We need to develop a comprehensive male health policy which is both sensitive to boys and men’s needs as well as addressing the health seeking behaviour of men.
To develop a successful policy, we need to integrate and cooperate with various stakeholders, working at different levels such as local, regional and national and also integrate within other policy areas such as education and human resource. We need to have specific plans and resources for evaluation of the policy and action plan of implementation. Evaluation outcomes should be set in the context of realistic expectation. The policy shall focus on key men’s health issues such as NCD risk factors and health seeking behaviour.
Currently, the health status of Malaysia men is rather worrying. The approach in men’s health in Malaysia is still predominantly organ-specific and fragmented as it falls under the responsibility of a variety of specialties and subspecialties. There is still considerable lack of awareness among the general public and healthcare professionals alike. There is also lack of close collaboration across health disciplines as well as governmental and non-governmental agencies in the approach to men’s health issues. The importance of health screening and healthy lifestyle should be stressed to all men and their families. There is also an urgent need to develop an effective service delivery system sensitive to men’s needs. National health policy on men’s health, based on good local and international research encompassing physical and psychosocial dimensions, will certainly encourage men in Malaysia to seek early professional advice and treatment to improve both their quality and quantity of life. It will also help to create awareness of the concept of men’s health to the healthcare professionals and other stakeholders.
Chua, S. L. 2007. The first national men’s health & aging conference in conjunction with Universiti Malaya’s 100th anniversary. Ministry of Health, www.moh.gov.my/MohPortal/speechDetail.jsp?action=view&id=369 (Accessed Nov 5).
Quek, K. F., A. A. Sallam, C. H. Ng & C. B. Chua 2008. Prevalence of Sexual Problems and Its Association with Social, Psychological and Physical Factors among Men in a Malaysian Population: A Crossâ€Sectional Study. The journal of sexual medicine 5(1): 70-76.
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