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Help minority men

AMERICAN MEN of many colors are risking their lives in Iraq because they have chosen to serve their country. But if they are black or Latino, they may statistically be safer in Baghdad than in Baltimore.

In Iraq, there has been about one death per 1,000 soldiers. In the United States, African-American men die of heart disease at about twice that rate.

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While health professionals and researchers are finally paying attention to the need to reduce overall racial and ethnic disparities in health, men of color have been underrepresented in proposed solutions. It is an issue that ripples through the rest of a society that values equal opportunity. But without the most basic of all rights -- the right to live, learn, work and play as long and as well as possible -- there can be no opportunities to take advantage of.

When addiction runs rampant, when HIV/AIDS is epidemic, when crime kills bystanders, the health of minority men becomes a public health issue. When insurance dollars are spent disproportionately treating preventable chronic conditions and when the minority work force will soon constitute 41.5 percent of the total, the health of minority men becomes a business issue. When one group of Americans is so starkly more at risk of dying than any other, the health of minority men becomes a moral issue.

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It is, indeed, an issue of national urgency that:

Life expectancy for African-American men is 7.1 years less than for white men, 7.5 years less than for African-American women and 12.7 years less than for white women.

Stroke is twice as likely to kill African-American men as it is to kill white men or women. Cancer kills African-American men at more than twice the rate as for white women. African-American and Latino men are less likely than white men to see a doctor, even when they are in poor health.

Men of color are less likely to receive timely preventive services and more likely to suffer the consequences of delayed attention, such as limb amputations and radical cancer surgery.

How did this happen? The most obvious answer is what researchers call "socioeconomic status," the fact that access to care and quality of care are higher and stress is lower among those with higher income and education. Access to resources to improve one's health are limited for poor men compared with those at the higher end of the scale.

Some of the disparity, to be sure, has to do with the peculiarity of men in general and black and Latino men in particular. They simply don't go to doctors or even complain when they are ill. They see themselves as providers, and when they can't play that role, their lives and health are affected.

Men are overrepresented among the homeless, the prison population, substance abusers and people with severe mental illness. And when public programs do provide assistance to the poor, it is almost always to children and the mothers who take care of them.

Without diminishing the special health care needs of women and children, steps can be taken to recognize and deal with the health status of men.

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The W.K. Kellogg Foundation is funding an innovative Men's Health Initiative that has enlisted actor Danny Glover in a public service campaign to get men to finally start thinking about their health. This pilot project in six cities, including Baltimore, has already yielded important information about myths and perception, outreach and counseling, provision of health services and training of culturally competent staff.

Private philanthropy cannot bear the entire cost, though, and a public commitment to the health of the forgotten requires some public resources. One way to start would be to establish an Office of Men's Health within the National Institutes of Health, comparable to the existing Office of Women's Health.

Another way would be to improve health insurance, if not universally, then at least by extending Medicaid eligibility without regard to gender or family status. Finally, we ought to extend the hugely successful Family and Medical Leave Act to include men.

America's attention today is on events in the Middle East, where a shooting war concentrates public awareness on needless suffering, privation and death. But today's other war -- against heart disease, high blood pressure, diabetes, cancer and addiction -- must not be ignored simply because the victims are not dying on television or being buried in flag-draped coffins.

Barbara Krimgold is senior project director of the Men's Health Initiative at the Center for the Advancement of Health in Washington. Dean Robinson is associate professor of political science at the University of Massachusetts and program director of the Initiative.


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