Mens issues in CVD risk management and CVD prevention Feisul Idzwan - - PowerPoint PPT Presentation

Men’s issues in CVD risk management and CVD prevention

Feisul Idzwan Mustapha

Consultant Public Health Physician (NCD) Disease Control Division Ministry of Health Malaysia First Malaysian Men’s Health Conference 2018 Kuala Lumpur, 13 August 2018

There are Four Major Groups of Non-Communicable Diseases (NCDs); Four major lifestyles related risk factors

Modifiable causative risk factors Tobacco use Unhealthy diets Physical inactivity Harmful use of alcohol Noncommunicable diseases Heart disease and stroke

✓ ✓ ✓ ✓

Diabetes

✓ ✓ ✓ ✓

Cancers

✓ ✓ ✓ ✓

Chronic lung disease

✓

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Presentation outline

• Men’s Health Status

– Mortality Rates and Trends – NCDs in Men and Risk Factors

• Characteristics of Men

– Health Seeking Behaviour – Health Literacy – Risk Taking and Masculinity

• Role of Sex and Gender in NCDs
• Benefits of Improved Men’s Health
• Mainstreaming Gender in NCD Policies

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Male mortality

• Men are known to have a shorter life expectancy and higher

mortality compared to women.

• Mortality rate in men versus women

– Asia – Malaysia

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Premature mortality due to NCDs, Malaysia

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19.4% 15.7% 8.5% 7.3% 7.0% 5.0% 2.3% 0.2% 0.1% 22.8% 1.2% 9.1% 8.1% 8.2% 7.1% 0.3% 0.2% 0.1% 25% 20% 15% 10% 5% 0% 5% 10% 15% 20% 25% High BP Tobacco Diabetes Mellitus High Cholesterol High BMI Physical Inactivity Alcohol Underweight Poor Water & Sanitation Male Female

Deaths attributable to risk factors, Malaysia

7 Burden of Disease Study Malaysia 2008, slide courtesy of Dr Mohd. Azahadi Omar, Institute for Public Health

DALYs attributable to risk factors, Malaysia

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10.8% 10.7% 9.0% 8.3% 5.2% 4.3% 3.1% 0.7% 0.1% 10.8% 0.7% 11.4% 12.1% 5.1% 0.9% 4.3% 0.7% 0.1% 15.0% 10.0% 5.0% 0.0% 5.0% 10.0% 15.0% High BP Tobacco Diabetes Mellitus High BMI High Cholesterol Alcohol Physical Inactivity Underweight Poor Water & Sanitation Male Female

Burden of Disease Study Malaysia 2008, slide courtesy of Dr Mohd. Azahadi Omar, Institute for Public Health

Prevalence of Selected NCD Risk Factors

Based on NHMS 2015, amongst the Malaysian adult population (≥18 years):

• 63.6% of men, and 64.5% of women are either overweight or
• bese
• 43% of men smoke; 59% of men ages 21-30 smoke
• 43.5% of men, and 52.2% of women have hypercholesterolemia
• 30.8% of men, and 29.7% of women have hypertension
• 16.7% of men, and 18.3% of women have diabetes mellitus

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Health seeking behaviour and utilisation of health services

• Under-utilisation of primary care services
• Structural barriers

– Primary care services available when men at work

• Health awareness fail to engage men

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Health literacy

Health literacy is dependent on individual and systemic factors:

– Communication skills of lay persons and professionals – Lay and professional knowledge of health topics – Culture – Demands of the healthcare and public health systems – Demands of the situation/context

Men has less knowledgeable than women about specific diseases, risk factors and health in general

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Risk taking and masculinity

• Men’s risk taking behaviours and under utilisation of health

services largely linked to male role norms.

– e.g. use of tobacco linked to their perception that a real man should be daring, courageous, confident and able to demonstrate manliness

• Heavy drinking
• Promoting positive models of manhood

– e.g. caring and involved fatherhood can improve men’s health seeking behaviour

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Sex and gender in NCDs

• Tackling men’s health is NOT more important than addressing

women’s health;

– Not binary choice or zero-sum game – In certain areas, women’s outcome worse than men – In some countries, gender power dynamics mean women lack autonomy in health

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Benefits of improved Men’s health

• Lower male premature mortality and morbidity rates

– Also benefit women and families who depend on men’s incomes

• Lower levels of alcohol consumption

– Help reduce inter-personal violence

• Reduce economic costs of lost productivity and health

treatments

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National Strategic Plan for Non-Communicable Diseases (NSP-NCD) 2016-2025

• Approved by MOH on 10 April 2017

– Continuation from NSP-NCD 2010-2014

• In-line with Malaysia’s commitment at the global

level for NCD prevention and control

– Including Sustainable Development Goals (SDGs)

• Governance: Cabinet Committee for a Health

Promoting Environment

– Chaired by Deputy Prime Minister – Membership: 12 ministers

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Implementation of NSP-NCD 2016-2025

1. National Plan of Action for Nutrition of Malaysia III 2016-2025 2. National Strategic Plan for Tobacco Control 2015-2020 3. Policy Options to Combat Obesity in Malaysia 4. Salt Reduction Strategy for Malaysia 2015-2020 5. National Strategic Plan for Active Living 2016-2025 6. Malaysia’s Alcohol Action Plan 2013-2020 7. National Strategic Plan for Cancer Control Program 2016-2020 8. Enhanced Primary Healthcare (EnPHC) initiative 9. Komuniti Sihat, Pembina Negara (KOSPEN) initiative

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Steps in mainstreaming gender in NCD policies

• Disaggregation by sex/gender in NCDs research, intervention,

monitoring and evaluation

• Shift mindsets to appreciate that gender norms affect

everyone’s health

• Gender in global health is a political issue, in that specific

interests perpetuate gender norms and thus, specific interests are needed to address these interests

Hawkes, S., & Buse, K. (2013). Gender and global health: evidence, policy, and inconvenient truths. The Lancet, 381(9879), 1783-1787 17

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Next steps for us…

• Life-course approach
• Gender responsiveness
• Address gender and other social determinants

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Main references

• Gender and Global Health: Evidence, Policy and Inconvenient

Truths 2013

• Men’s Health: Time for a New Approach to Policy and Practise

2017

• Gender, Health and Sustainable Development Goals 2015

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Thank you

dr.feisul@moh.gov.my

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