Men's Health

In general, men have less awareness about their overall health, and there are poorer and fewer health education and health programs that focus on men than women. This is important because in the 1920s life expectancy for men and women was about the same, but over the years this has changed – men’s life expectancy is now more than 10% lower than that of women. Moreover, men have an earlier and higher death rate for each of the top ten leading causes of death including cancer, stroke, heart disease, and suicide.1,2,3

National Men’s Health Week

To promote awareness of issues surrounding men’s health, the National Men’s Health Week Act was passed by Congress and signed into law by President Clinton on May 31, 1994. This year National Men’s Health Week will be observed from June 14-20, with men’s health screenings being offered on Capitol Hill. To set an example for the rest of the country, more than 700 members, staffers, and employees are screened each year for prostate cancer, high blood pressure, diabetes, and cholesterol.4

The Men’s Health Act

To further strengthen the focus on men’s health issues, the Men’s Health Act was introduced in 2003 by Representative Randy Cunningham (R-CA) and Senator Michael Crapo (R-ID) to establish an Office of Men’s Health at the U.S. Department of Health and Human Resources. If passed, this Office will mirror the work of the Office of Women’s Health (established in 1991) by developing strategies, coordinating research activities, recommending public policies, as well as promoting awareness and early detection of diseases that adversely affect men.

Early Detection

Early detection is critical to good health outcomes, especially regarding cancer treatment. However, expenditures for outreach and screening at the Centers for Disease Control (CDC) in 2000 show that while $185,000,000 was spent on breast and cervical cancer programs, $11,000,000 was spent on prostate cancer programs. Moreover, expenditures for cancer research by the National Cancer Institute show that $424,900,000 was spent on breast cancer research compared to $190,000,000 spent on prostate cancer research.2 It is expected that 230,000 American men will be diagnosed with prostate cancer this year.5

VA Focuses on Men’s Health

Because the veteran population is mostly male, the Veterans Health Administration (VHA) is primarily focused on men’s health care issues. With an annual budget of more than $25 billion, VHA is the nation’s largest integrated health care system, employing more than 180,000 health care professionals and operating more than 1,300 sites of care, including hospitals, community and facility-based clinics, nursing homes, and various other facilities.

HSR&D Research

As part of VHA’s Office of Research & Development, HSR&D conducts research on many health issues related to men’s health, such as prostate cancer, smoking interventions, depression, and hypertension. In addition, the Quality Enhancement Research Initiative (QUERI) was created to target diseases and conditions that are highly prevalent and burdensome among the veteran population. The current veteran population is mostly male and these diseases and conditions are particularly burdensome for men, their families and the VA health care system as a whole. Below are some specific examples of HSR&D research projects and findings.

Lower Cost Interventions for Prostate Cancer Screening

Evidence is inconclusive about whether mass screening and early treatment for prostate cancer can reduce mortality, but due to cost concerns it is important to know whether more resource intensive interventions also have greater impact. Investigators in this HSR&D study assessed the relative effectiveness of a video versus a lower-cost mailed pamphlet intervention for increasing patients’ knowledge about prostate screening. They also examined the impact of the interventions on screening preferences, testing rates, and decision-making participation. Both the pamphlet and video described prostate cancer, the potential risks and benefits of PSA testing, and explained that the decision to undergo screening should be discussed with a physician. In addition, the video depicted patients discussing their differing opinions about the value of PSA testing. Results of the study showed that patients who received the pamphlet or video were more knowledgeable about prostate cancer and screening. Further, patients who received the pamphlet were more likely to discuss screening with their provider.

Lower Screening Rates for Colorectal Versus Prostate Cancer

While some believe PSA screening may reduce deaths due to prostate cancer, others believe that widespread screening will lead to more prostate cancer diagnoses and potentially harmful therapy, without any improvement in outcomes. On the other hand, colorectal cancer screening for people 50 and older is widely advocated, and has proven to substantially reduce mortality among those who receive periodic screening. Researchers compared the prevalence of PSA and colorectal cancer screening among men in the United States. Using data from a large telephone survey conducted by the Centers for Disease Control and Prevention (n = 49,315), they found that 75% of men aged 50 and older had undergone PSA testing at least once, compared to 63% of men aged 50 and older who had undergone colorectal cancer screening. Further, men were more likely to be up-to-date on prostate screening than colorectal cancer screening. This suggests that despite widespread efforts to improve adherence to colorectal cancer screening guidelines, it is still considerably less common than prostate cancer screening. Investigators recommend that physicians inform patients about the known mortality benefit of colorectal cancer screening, as well as the uncertainty about screening for prostate cancer. 7

VA Physicians Refer Depressed Patients More Often then Private Sector Counterparts

Depression is the second leading cause of disability worldwide, yet this condition is markedly under-treated in the private sector despite clinical guidelines that encourage aggressive treatment with antidepressant medications and/or mental health referral. Theorizing that greater availability of mental health services in VA would result in better adherence to depression management guidelines, this study compared management recommendations of VA versus non-VA physicians who viewed videotapes portraying a standardized case of major depressive disorder (MDD) in an elderly patient. All physicians viewed a videotape vignette (professionally produced with actors) of an elderly patient presenting to a physician for a hypertension follow-up. During the visit, the patient describes specific symptoms that meet MDD criteria. After viewing the tape, physicians answered questions about diagnosis, treatment, and follow-up recommendations. Randomly selected participating physicians included 115 practicing in an outpatient VA setting and 128 practicing in non-VA medical settings in the Northeastern U.S. Results showed that VA physicians were twice as likely to recommend treatment for depression and half as likely to recommend monitoring within 2 weeks than non-VA physicians.8

Lower Mortality in Black vs. White Veteran Patients with Congestive Heart Failure

Blacks have a higher prevalence of congestive heart failure (CHF) than whites, in addition to higher rates of hospitalization and readmissions that may be linked to disparities in access to care. Investigators in this CHF QUERI study sought to determine any racial differences in short-term and intermediate-term mortality in VHA patients (99% male) hospitalized for CHF, and to examine racial differences in the patterns of health care utilization following the initial hospitalization. Investigators conducted a retrospective cohort study of 4,901 black and 17,093 white patients hospitalized with heart failure at 153 acute care VA hospitals nationwide between October 1997 and September 1999. Results of this study showed that overall black patients had lower short-term (within 30 days of admission) and intermediate-term (measured at 1 and 2 years following discharge) mortality rates than white patients.9

Lack of Lipid Testing Associated with Increased Morbidity and Mortality

A large number of patients with coronary heart disease (CHD) do not have a current measurement of their low-density lipoprotein (LDL) levels. IHD-QUERI investigators sought to identify patients at risk for not undergoing lipid measurement and determine whether they had higher risk-adjusted morbidity and mortality compared to patients with a lipid measurement. Using an existing database, investigators extracted data on all active primary care and cardiology patients with CHD from 8 VA hospitals (n = 12,135). They assessed information on patient demographics, outpatient and inpatient diagnoses, pharmacy data, and laboratory data. Findings showed that 40.7% of the patients did not have an LDL measurement during the 15-month baseline period, and those without an LDL measurement had a 5% higher hospitalization rate and a 36% worse survival rate. Findings also show that CHD patients less likely to have a lipid measurement included: older patients, African-Americans, those with a history of chronic obstructive pulmonary disease or depress, and those living more than 25 miles from a medical center.


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