Priorities for Global Prostate Cancer Intervention: An Advocate/Survivor Perspective: Taking Health into Our Own Hands Presented by Virgil H. Simons, MPA: 3rd Annual Educational Symposium 29 October 2011

“Health is an indirect measure of a society’s collective democracy. ” - Rudolf Virchow

Healthcare Costs represent an increasing % of GDP - $650B more for Cancer Treatment

National Healthcare Quality Report “Preventive healthcare lags significantly behind other gains in healthcare.” “Access to care and information varied widely between racial/ethnic groups and by socio-economic status” Source:

Understanding the Risk… Of dying after being physically attacked - 1:7,336,000 Of being struck by lightning - 1:835,500 Of dying in a plane/train/car accident - 1:6,279 Of having a heart attack - 1:53 Of dying from prostate cancer - 1:36 Of getting prostate cancer - 1:6 If you’re African-American: - 1 in every 4 Black men get Prostate Cancer - Black men die at a rate 240% higher than whites - Blacks diagnosed at advanced disease stages at a 144% greater rate Source: The Book of Odds; American Cancer Society

Pathways to Cancer Awareness Access Environment Lifestyle Culture Genetics Every cancer is different

Research Partnerships

We Don’t Know What We Don’t Know!

Communicating the Problem Patient/Professional dialogue divergence Lack of clear-cut risk communications Risk of advanced stage first diagnosis Need for actionable patient information

Defining Barriers to Men’s Participation in Healthcare Clinical Barriers - Awareness - Access - Financial Attitudinal Barriers -Gender Role Stoicism -Work Role Stoicism -Distrust of the Health Care System -Fatalism: “you’ve got to die of something.” -Maladaptive Self-Reliance: “A ‘man’ takes care of his own problems.”

Barriers to Early Detection U.S. vs European conflict on screening No consensus among U.S. agencies Lack of “Risk” determination Clinical Barriers Decline in doctors in Primary Care Medicine Closing of ER’s Continuing shortage of nurses

Treatment Impact Conflicting preventive therapeutic recommendations SELECT Finasteride PLCO Study Skeletal impacts of ADT Cardiovascular issues related to hormone therapy Emerging technologies with minimal curative benefit Robotic surgery Proton radiotherapy Mixed benefit of emerging drug therapies Targeted disease management Limited therapeutic impact Cost of care

Evaluating Public Ed 34% do not use evidence-based strategies 85% of activities not informed by needs assessment 50% of activities not evaluated Public education strategies are perceived as costly Programs are concerned about meeting demand generated by public education There is a comfort level with usual strategies (e.g., small media) Source: (2009) Inventory and Assessment of NBCCEDP Interventions

Regional Symposium Series 2011 Program Sites: March 19 - Vienna, Austria May 21 - New Orleans August 27 - University of Michigan September 10- Northwestern SPORE September 17 - Karmanos October 29 - New York University November 29 - Cairo/AORTIC

Neutralize Media Negatives Utilizing current network to develop “Proof of Concept” educational module

Raising Consumer Awareness Sexual Intimacy & Cancer Nutrition for Prevention and Progression Maximize “Edutainment”

Social Network Integration Credible peer-to-peer communications “New” Prostate Cancer Infolink “Pints for Prostate” Prostate Cancer Internet Alliance FaceBook

Broadening Outreach: La Prostata Red Latino/Hispani c men have 3rd highest incidence Poorer 5 year survival Cultural barriers to prostate health

Broadening Outreach: Korean-Americans High Cholesterol Levels Strong association with Pca Need for whole body initiative

Complicating the Issue Gender/Disease Inequity Research funds - 3X for BRca vs Pca Public health funding - inconsistent for Pca Public health agencies - none dedicated to Pca Federal focus - no agencies for men’s health Women more likely to utilize health services

Women Often Serve as the “Health Police” in the Family Men do best when they have motivated partners Women are usually more experienced and knowledgeable in health matters Appeals to responsibility, taking care of family. Reduce his fear: early diagnosis = best outcomes. Challenge him to take control: “Your blood pressure was high. What are you going to do about it?”

The Family Connection Shared risk concept Enhance Family responsibility Builds on genetic similarities Promotes personal communication

The Coalition Impact Empowering community stakeholders to address community problems

Why the Barber / Barbershop Model has been proven in several public health programs in the U.S. and internationally Traditional role as opinion shaper in the community Continuing source of information and place for verbal interaction Emerging function as outreach center for community health information Important new role as lay health facilitator and liaison with local healthcare providers

The Benefits of Positive Men’s Health to the Community Reducing or controlling rising health care costs through preventing costly, advanced disease Reducing economic costs of preventable male illness, including lost time from work, disability, diminished income, and reduced work productivity Increased attention to men’s health ultimately holds the potential to bolster and uplift the health status of both genders Gender health is not either/or, It’s both or neither Jean Bonhomme, M.D. - Men’s Health Network

The “Iron Triangle” Building Health Empowerment Community/Patient Interest Groups Government enabling agencies Congress

Conclusions / Observations Federally funded Pca early detection dependent on policy conflict / disease funding inequity resolutions FQHC/CEED programs coordination needed to better serve medically underserved communities Consistency in community facilitator programs must be maintained Third-Party providers are necessary to fulfill government missions in public health

The real voyage of discovery consists not in seeking new landscapes but in having new eyes. - Marcel Proust

Thank You!