No Canadian men's health policy: Does it mean obscure pathways for research on masculinities and men's health?

1. Margareth Zanchetta, PhD, RN Ryerson University, Faculty of Community Services-Daphne Cockwell School of Nursing No Canadian men's health policy: Does it mean obscure pathways for research on masculinities and men's health?

2. Profile of medical consultations Critical period 0 50 65+ 95 12 Regular medical visits initiated by mothers Medical long term goals: Nourish good relationships with HCPs Men’s behaviours: self-medication, alcohol/drugs, suicide (successful!) Medical short term goals: Evaluate the health condition of occasional clients • Colon cancer • High cholesterol • Diabetes • Hypertension • Eventual consultations: Private health insurance & check-up Increase of medical consultations due to chronic diseases

3. Canadian situation... • Restricted access and less men’s health & social services (Galand, 2001) • Immigrant men present high risk for chronic diseases (Hyman, 2007) • Lack of conceptual models and frameworks to inspire health policy respecting the diversity of men’s population (Doyal, 2000) • Lack of men’s health policy = Use of Health Canada sex & gender based analysis policy as a conceptual framework to explore health variations, health and illness experiences, within social sub-groups to better understand life diversity, and its impact on men’s health • Future should observe issues of domination and marginalization among sub-groups of men (Spitzer, 2005) • British Columbia’s Expanded Chronic Care Model (BC-ECCM) has inspired the conception of provincial plans (prevention & self-management of chronic diseases) that may support the development of men’s health programs.

4. Men health x health inequities in Canada= ? • complex social / economic inequities • vulnerabilities • barriers to access health care • cultural differences between immigrant population / host society • health disparities endured by Francophone men when living as linguistic minority • sexual orientation diversity • aboriginal men • Re-conceptualization of masculine gender as a social determinant of health (or as vulnerability) is needed

5. Investigation team • Margareth Zanchetta, PhD, RN- Daphne Cockwell School of Nursing (DCSON)-Ryerson University • Christine Maheu, PhD, RN- School of Nursing, York University • SepaliGuruge, PhD, RN- DCSON • JalilaJbilou, PhD- University of Moncton • Roger Pilon, PhD cand, RN- Laurentian University Research Assistants: • Mohamed Mohamed, BScN, RN • Melissa Stevenson, BScN, RN-Anishnawbe Health Toronto • OlesyaKolinsyk, MN, RN- University Health Network- Toronto General Hospital & Centennial College • Terry Sizto, BScN student • Carole LinaSanJose, BScN • DianaKinslikh, MA, RPT- West Park Healthcare Centre

6. Most common mental and physical chronic diseases • Cancers (prostate, lung, and colorectal) • Circulatory diseases (high blood pressure) • Respiratory diseases (chronic obstructive pulmonary disease and asthma) • Diabetes • Mental diseases & major depression episodes • Substance abuse & alcohol dependence • Source: Haydon, E. Roerecke, M., Giesbrecht, N., Rehm, J., & Kobus-Matthews, M. (2006). Chronic disease in Ontario and Canada: Determinants, risks factors and prevention priorities-Summary of Full Report. Available: http://www.ocdpa.on.ca/docs/CDP-SummaryReport-Mar06.pdf

7. Major methodological threats • In several qualitative studies, findings reported were not differentiated between men and women. • Less methodological rigor to compose a minimal sample of 3 men participants to allow internal comparison among them

8. Common themes on findings • Barriers imposed by social vulnerabilities and health inequities over personal intentions to adopt self-management strategies • The use of humour to speak of diseases was important to manage the impact of threats to their masculinity

9. Gaps in findings • Many studies target different cultural and ethnic men, however, there is no concrete comparison of whether one group is more adaptive than another • Little is explored about the influence of social and health services using a men-friendly approach to seek health care, and engagement in primary health care initiatives

10. Implications for Research • Research should aim to make explicit the issues men face within health care • Areas to be explored: • Preventative strategies • Comparison between cultural and ethnic groups • The influence of social and health services using a men-friendly approach to seek health care, and engagement in primary health care initiatives • Creation of a Canadian research group that includes Francophone and Anglophone researchers in the area of men’s health

11. Implications for Practice • Men usually do not articulate what their communication needs are = Creation of innovative ways to communicate and respond to men’s interest in prompt action • It is not masculine to speak about emotions = Eliminate barriers that are formed through masculinity and gender shaped dialogue • Religion, culture, ethno-cultural background, SES, and sexual orientation diversity might affect perceived competence, safety and appropriateness of preventative and self-management behaviours= Cautions about gender overgeneralization • Create accessible and inclusive environments

12. Pro-active approach X Reactive approach • Health Research: • Evaluate population based initiative to address social and biological risk factors • Compare effects of medical treatments • Appraise the determination of health behaviours according to concepts of masculinities • Include in studies the places of social interactions and masculine territories in health promotion campaigns • Expand partnerships with community groups to reach out to groups of men who are not exposed to ideas of health promotion and prevention • Investigate ways to mobilize men’s sensitivity and its effect in social relations

13. Concluding remarks • Findings remain inconclusive regarding the following: • Health prevention strategies men find helpful to practice • Self-management barriers they face in their daily lives • The context men live in and how they manage their conditions • Needs of different men’s groups (e.g. age, culture, religion) are not addressed • Multicultural society  cultural, religious, cohort, gender identity, and socio-economic factors