Sri Lanka´s public health services have lately switched their focus from battling communicable diseases to scaling down health issues of the population caused due to various non-communicable diseases (NCDs). This latest change in focus is due to the recent shift of the disease burden towards NCDs, which are also more popularly known as ´lifestyle diseases´ caused due to rapid urbanization and lifestyle transformations.
According to the Ministry of Health (MOH) while Sri Lanka has come a long way from controlling communicable diseases, in improving maternal and child health as well as nearly eliminating vaccine preventable diseases, chronic non-communicable diseases are the leading cause of mortality, morbidity and disability among the population with NCDs accounting to almost 71 per cent of deaths in the country.
However, while health services in Sri Lanka have for several years been working towards preventing and controlling non-communicable diseases, and introducing national policies as well as strengthening the health system, authorities today continue to grapple with luring Sri Lankan men to seek medical help, especially, for NCDs.Today, heart attacks and other cardiovascular diseases rank as the number one killer disease among males while NCDs in general cause premature deaths and negatively affect the quality of life.
According to Additional Director General (Statistics) of the Department of Census and Statistics I.R. Bandara, the reluctance of men to seek medical help is one of the main reasons for the recorded dismal numbers related to life expectancy of men in Sri Lanka. Recent statistics collected by the Department show that an average male in Sri Lanka has a life expectancy of 72 years as opposed to the 78.6 years enjoyed by women, while in districts such as Mullaitivu the life expectancy of males hover around a lamentable 60.9. Experts claim that improved life expectancy of women has been achieved by providing accessible and free healthcare to women during critical health junctures in their lives through hospitals, a dedicated cadre of public health midwives and programs such as the ´Well Woman´ program.
Life expectancy
However, with no dedicated program by the MOH to promote better health among males, and instead, conducting independent programs focused on various NCDs individually, experts have now found the reluctance to seek medical help plays a key role in the life expectancy of males in the country despite health care being free and accessible. While admitting that there are no focused programs aimed at promoting male health, Director of the National Health Education Bureau Dr. R.D.F.C Kanthi says under the healthy lifestyle campaign conducted by the MOH free health checkups and services are available to the public to promote better health awareness and provide quality healthcare. However clearly, the majority of the male population appears to not utilize the services.
¨Through our surveys we have found that males in Sri Lanka live 6.6 years less than females,¨ says Bandara adding that according to data collected males have a shorter life expectancy than females in every district across the island.
According to Bandara it was revealed that males have an inherent reluctance to seek medical help and when they did it was much later than females, and in serious stages of the disease, a fact the Director of the Non-communicable Diseases Unit at the Ministry of Health, Dr. Thilak Siriwardhana can attest to.
“For example if we attempt to conduct awareness programs about NCDs or provide checkups to gather information on diseases suffered by the public, we notice men largely tend to avoid the program citing various excuses,” he says, adding that not having enough time to attend is a popular excuse among many. According to him while females tend to actively participate, officials continue to struggle in reaching out to the male population.
Dr. Siriwardhana says, while health officials have conducted smaller research programs on the issue, a mass scale research is needed to correctly identify the reason behind the unwillingness of men to seek medical help.
Global
¨We have requested several researchers to conduct such a program so that we can address the problem better,¨ he said, adding that however such requests have gone unheeded.
However the issue is not one limited to Sri Lanka, but global. A survey conducted in the United Kingdom through the Everyman Male Cancer Campaign revealed that twice as many men as women had not visited their general practitioner in the past year with evidence also suggesting that even fewer men visit a dentist or ask pharmacists for advice or information. Research done has also confirmed that men are more likely to be hospitalized as they tend to delay visiting health care officials.
According to Bandara one of the main reasons for such reluctance in seeking medical help appear to be prevalent attitudes among men. ¨Women remain healthy as they are active throughout their lives but after a certain age men remain idle,¨ she says adding that this is due to the attitude that men should not participate in household chores.
Experts also put down such reluctance to similar cultural reasons. While women are seen as custodians of family and health due to being carers for the children, health care remains a concept alien to men with many unable to decide on the next step once symptoms of some sort emerge. Another possible reason according to experts is the inherent unwillingness of men to accept help or admit they have a problem and thinking nothing bad will happen.
Vipuli Perera´s husband died 10 years ago due to a stomach cancer. ¨He was 47 at the time and had various symptoms such as appetite loss and severe weight loss including bad stomach pains¨ she recalls, adding that however, for a long time he refused to seek medical help. ¨We would try local remedies to improve his appetite but in time things only got worse,¨ she says. According to Vipuli her husband passed away just several days after being admitted to hospital as the cancer had spread beyond any medical help. ¨He was adamant that nothing was wrong but I wish we had sought help for him sooner,¨ she says.
However despite being in the dark on reasons related to the reluctance shown particularly by Sri Lankan men the NCD unit too has tried to reach out to the public in various methods to encourage them to seek treatment. ¨We used to run television advertisements in the past and hope to resume it in the near future,¨ Dr. Siriwardhana says. According to him currently advertisements in all national languages are also being broadcast through the Sri Lankan Broadcasting Corporation to encourage people to get medical help for NCDs. ¨We hope to expand this to private channels as well,¨ he says further adding that short life expectancy of men due to avoiding health care is an issue taken seriously by the unit.
According to Dr. Siriwardene in a unique approach the MOH along with the Ministry of Education will provide a book regarding NCDs to children of Grade 6 to Grade 9 in schools at the start of the next academic year. ¨Through the book we intend to educate them on such diseases and also teach children to notice any symptoms of NCDs shown by parents in order to encourage adults to seek medical help,.¨ he says. The Unit has also been carrying out similar programs targeting youth councils and clubs in order to change attitudes of the younger generation about health awareness.
While today Mullaitivu district has the worst life expectancy for males in the country at 60.9 behind the comparatively high 72.91 for females of the district , the lack of awareness and low levels of education have been attributed to males avoiding health care.
Visible shift of attitude
The Medical Superintendent of the Mullaitivu District General Hospital, Dr. K. Thayanandaruban however claims there is now a visible shift of attitude in males towards coming in for health checkups and seeking healthcare at early stages of a disease. ¨War was one reason for low life expectancy and medical care was not accessible to these people for a long time,¨ he says adding that however, now the quality of life is seen increasing gradually so is the attitude of males towards health care. ¨There is a natural change in their attitudes so the hospital has not had to reach out to them to encourage to seek help,¨ he says adding that while numbers may not show an improvement of life expectancy even in the next several years, change is certainly afoot among the male population in the district.
However Additional Director General (Statistics) of the Department of Census and Statistics I.R Bandara emphasizes the need for a much cohesive plan to reach out to the male population.
¨This is a must if we are to increase the life expectancy of males in Sri Lanka,¨ she says adding that addressing the lack of such a plan is in fact the need of the hour to ensure continuous economic and social development of the country.
