The Challenges of Men’s Health.
Moderator, friends, I am most grateful to Rev Peter Kaniah and Rev Henry Kaira and colleagues for their kind invitations, both to attend this historic meeting and also to be able to share my thoughts on the Challenges to Men’s Health in Sub- Saharan Africa.
It is a great privilege to listen and learn from friends in Africa; and indeed the recent General Assembly of the Church of Scotland meeting in May 2016 requires our own World Mission Council to investigate and share some of the lessons of your experience and success in Africa.
Around 40years ago I spent almost six years working in the Presbyterian Joint Hospital Uburu, in south eastern Nigeria before a career in Scotland as a consultant physician specialising in medicine of older people. Latterly I was a Medical Director responsible for hospital and community services. I learned a huge amount from my Nigerian friends and experience which strengthened my passionate belief that our great commission includes sharing the Gospel or Good News of Health: that, relying on God’s Grace, much can be done to improve our own health and that those of our neighbours and communities.
I recognise that major progress is being made and that there is great variation between countries and even within the same nation. I have looked at recent medical research and especially publications from the World Health Organisation. It is clear that there are common challenges worldwide and especially in Sub Saharan Africaa number of vital issues which affect each and every one of us today. Not least of these is the indisputable fact that, on average, men in every continent have more health problems and live shorter lives than our female sisters in our population. We are the sicker and weaker sex.
Today I will outline some of the Biblical basis for us as Christians to address some of the challenges to men’s health. I will then talk about the different components of health, before discussing the most common causes of death and disease and suggest what all of us can do, within our own families, communities and churches, to improve the situation.
As recorded in John ch10 verse 10,Jesus,who is of course the Great Physician, said “I have come that they may have life, and have it to the full”. God’s desire is that we live life to the full. We are created in God’s image and as Paul said to the Corinthians in his first letter and chapter 6, “You were bought at a price- therefore honour God with your bodies”.
We should do what we can to look after our health. Of course Ill-health and disease is no respecter of persons – rich and poor righteous and unrighteous Even Paul had an affliction, a thorn in his side that he repeatedly prayed to the Lord to relieve. We should have no truck with those who say that those suffering must have sinned or their predecessors failed or blame evil spirits or spells. Even when previous action or life-style may have contributed to ill-health, Judge not that we be not Judged and remember that all have sinned and fallen short. Our response must be Care and compassion following the example of our Lord and suffering Saviour, practical action like the Good Samaritan and remembering the Story of the sheep and the goats in Matthew’s Gospel: “When did we do these things for you?” And the King’s reply- “Whatever you did for one of the least of my brothers and sisters, you did for me”.
What is health? The components of health.
The word health comes from an old word meaning wholeness, being whole, sound or well. Health is defined as not just the absence of disease or infirmity but much more than that.
The World Health Organisation when set up in 1948 considered health to “A state of complete physical mental and social well-being”. In recent years there is more and more evidence of the positive benefit of faith. There are 4 main dimensions contributing to health- physical, psychological, social and spiritual well-being which we should bear in mind and in keeping with Life in all its fullness.People of faith can and should work together with health professionals and others in partnership to improve health.
Why are men sicker?
Men in almost every country in every continent have a lower life expectancy (over 5 years on average). The commonest explanation relates to typical expectations and attitudes to masculinity. In most societies men are expected to be physically stronger and their status is often linked with certain jobs or roles. In general, boys and men often have more risky behaviour, are less concerned about their health, more reluctant to admit to health problems as they think this a sign of weakness, or to seek medical attention or take medical treatments. I will give examples of this when discussing the main causes of death and illness,
Top Killers- the World Health Organisation(WHO) groups causes of death into three main categories-
- Group 1- accounting for almost 6 million deaths and over 60% deaths in sub-Saharan Africa in 2012, were communicable diseases or infections as well as deaths associated with pregnancy and poor nutrition.
- Group 2- accounting for 2.7million deaths and almost 30% of deaths in the region were non- communicable and lifestyle diseases such as heart disease, stroke, epilepsy, cancer and diabetes.
- Group 3- almost 1 million deaths 10% of the total in the region are due to injury accidental or intentional.
In general most of the mortality and suffering in pregnancy and in young children is preventable and treatable by good care of pregnant mothers and young children. Child deaths between 2000-2010 fell by two thirds due to immunisations. Diseases such as polio, measles, tetanus and diphtheriacan be completely prevented by vaccinations.
I cannot emphasise strongly enough the value of good antenatal care and immunisations as well as improved nutrition for this group. There is clear evidence that involvement and support of fathers in this improves not only the health of mothers and children but also that of the young men and fathers. Some countries e.g.Ghana have hugely improved survival by this strategy.
Group 1: Communicable disease
According to the WHO, the five top killers in Africa in 2012 were HIV and TB, lower respiratory tract or chest infections, diarrhoeal illness, malaria and cerebro- vascular accidents (stroke). All of these apart from stroke are infections, and I will briefly mention how best to reduce each of them.
- a) Malaria- In 2012, about 600,000 people in Sub-Saharan Africa died of malaria- 92% of all worldwide deaths from the disease and over 40% are in children under 5years. Nigeria, Demographic Republic of Congo, Tanzania, Uganda, Mozambique and the Ivory Coast account for about half of the cases. An increase in malaria interventions such as provision of insect repellent mosquito nets and indoor spraying with insecticides as well as anti-malarial drugs in pregnancy and infants have helped reduce deaths by 30% in 10 years and so are worthwhile, but much more could be done.
- b) Diarrhoeal illnesses- caused about 650,000 deaths in sub-Saharan Africa in 2012 through dehydration. Almost 90% of these deaths are due to unsafe water and inadequate sanitation and hygiene which must be top priorities
- c) HIV- In 2012 over 1 million people in the region died from HIV related disease and 25million – one in every 22 adults, were living with HIV which makes them more prone to other infections. Southern Africa is most affected.
Several recent studies in Malawi, South Africa, Uganda, and Zimbabwe suggest that notions of masculinity e.g. reluctance to use condomsincreases the risk of infection with HIV and also inhibits men from getting tested for HIV, coming to terms with their HIV positive status , taking instruction from nurses and engaging in health enabling behaviours. Voluntary medical male circumcision has also be shown to reduce HIV by up to 80%
75% of people living with HIV in West and central Africa and 59% of people living with HIV in East and Southern Africa who would benefit from treatment are not getting access to adequate treatment. Children are even less likely to receive necessary treatment than adults. Disproportionately fewer men than women access treatment; they start treatment later and are more likely to stop treatment. Discrimination against people known to have HIV is an important factor in this situation, but many with HIV do not know they have the condition until late and some may not have knowingly engaged in risky behaviour.
Relationshipsof oldermen with youngerwomen are associated with unsafe sexual behaviour and low condom use which increases the spread of HIV. Gender based violence, drug abuse and homosexual relationships all increase risk.
- d) Tuberculosis(often referred to as “TB”) is acoughing disease most often associated with persistent cough, fever and loss of weight is still a major killer. It is associated with poor nutrition and poor housing, and may also complicate HIV, but can affect anyone. My own twin brother who is now a church minster had TB when aged 5years and needed treatment for 18 months but fully recovered with this. TB is largely prevented by BCG vaccination and is usually treatable and curable if caught early with oral medicines which need to be taken for up to a year.
- e) Other Chest Infections- include pneumonia, influenza and bronchitis. They caused over 1 million deaths in Sub Saharan Africa in 2012 and are a leading cause of death in children. They are caused by viral or bacterial infections, more common if there is poor housing or nutrition, but potentially treatable with full courses of antibiotics.
Group 2 Non Communicable Diseases
These accounted for 3 out of every 10 deaths in 2012: but the numbers and proportion are rising especially in men and where standards of living are increasing.In many of these conditions, lifestyle especially tobacco smoking are important causes and the United Nations has a goal of by 2030 reducing by one third the premature mortality from these diseases by prevention and treatment. I will briefly mention some of these conditions.
- Chronic Respiratory Problems including COPD- are an increasing cause of death especially likely if smoking cigarettes or other pollution. Three times as many men as women die of tobacco related disease. Improving the atmosphere we breathe and live in is essential but medicines may improve symptoms of cough, wheeze and breathlessness.
- High Blood Pressure, Heart Disease and “Stroke”are increasingly common in middle and older age. Stroke which is due to problems with circulation to the brain now accounts for almost one in twenty deaths in sub-Saharan Africa. Coronary heart disease accounts for one in twenty five deaths. The likelihood of such diseases can be more than halved by changes in lifestyle, stopping smoking, cutting or reducing alcohol and salt intake, reducing weight if overweight and ensuring regular physical activity if having a sedentary occupation. Traditional diets with plenty vegetables are generally better than lots of refined salty foods. Reducing high blood pressure with medicine reduces the chance of heart disease and stroke.
- Diabetes- in this condition high blood sugar level may cause problems with circulation. Many cases arising in adults are related to being overweight and taking too much sugar or sweet food.
- Epilepsy – Epilepsy or seizures can usually be controlled well with the right medication.
- Cancer– is increasingly common as people get older and causes almost 450,000 deaths per year in Sub-Saharan Africa. The risk of cancer especially lung cancer is reduced but not abolished by healthy lifestyle choices. Older men may have increasing problems passing urine – sometime this is due to cancer of the prostate, a small kola nut like organ near the base of the bladder. If you have such symptoms it is worth seeing a doctor because treatments may help.
- Mental Illness- is increasingly common especially in men, who are reluctant to seek help because of unjustifiable stigma. Such illnessesare often due to chemical imbalances in the brain and may be readily treatable with medicine, as well as benefitting from understanding, support and prayer.
- Older People- As more people age, we can expect increasing numbers of very old who are more likely to be frail and have memory problems or dementia. Some people are remarkably fit in their eighties whilst others are physically old in their fifties.Separation from families and loneliness may be challenges – the church community has a lot to contribute to care as well as ensuring the wisdom of elders is shared with younger generations.
Palliative Care- Recent surveys have shown that dying patients in Nairobi are often more content than Scottish counterparts due to better attention to spiritual and social support but we must also ensure that necessary medical care such as adequate pain relief is also provided.
Group 3-Accidents and Injuries
Road Traffic Accidents cause over 200,000 premature deaths each year and 90% victims are men. Safer driving, better maintenance of vehicles and stopping driving whilst under the influence of alcohol and other drugs are all crucial to reducing this. 90% of fatal occupational injuries and exposures to toxic fumes in dangerous workplaces affect men and are all preventable.
Violence -Inter personaland collective violence was estimated to cause 132,000 and 14,000 deaths in 2012. The church has a major role in promoting peace, justice and reconciliation.
What can reduce the tragic Deficit in Men’s Health?
Healthresearch suggests that action should have three targets. The first is schools where stereotypes about masculinity can be challenged. The second is education of young and older men regarding health promotion and lifestyle factors which can have huge benefit in reducing non communicable and lifestyle disease and accidents. Involvement of young men can greatly improve the health of the whole family. Finally action should be targeted to marginalised men, such as refugees, those from minority populations and those at especial risk,such as prisoners and those with HIV, to ensure they are not forgotten and miss out. I am aware of great benefits from church initiatives in prisons and for HIV in Malawi, but am sure that you all have many examples of church led projects which should be shared and celebrated.
What we as individuals and faith communities do?
These health challenges are much too pressing to leave to governments and the relatively small number of health professionals alone. All of you as church leaders have important roles and a responsibility to support the drive to improve the health of African men and women in terms of –
- Awareness of the challenges and opportunities-
- Education and Myth busting especially with teenagers and also older men
- Encouragement of men especially younger men to engage- Prevention, promotion of healthy lifestyles , and early detection and treatment of illness – Be Role Models
- Practical Support, Care and Compassion.
- A Holistic Whole- person approach.
I have attempted to give a very speedy summary of the challenges to the Health of our brothers, have given some explanations as to why on average they live shorter and sicker lives, what some of the main causes of death and disease in men are; and also , thanks be to God, how much of this suffering can be prevented or relieved. I am happy to try to answer any questions now or later on, but before I do, I appreciate that most of you are the real practical experts; and I am keen to learn from your experience and perspective especially in two main questions-
- Are our members and communities aware of what we, as individuals and within our churches, can do to prevent many of these causes of death?
- What successes and examples of good practice can we share, and how can we best address the challenge of Men’s Health?
Before I try to answer any questions now or later on, I would close by thanking you for this opportunity to share the Gospel or Good News of potentially better Health for all including African men, and I pray that you will have God’s Blessing as we try to put this into practical action.