Men’s Health in Puerto Rico

November is National Men’s Health Awareness Month. No matter when you read this, though, the topic of men’s health in Puerto Rico is yet another piece of evidence that Puerto Rico’s territorial status causes inequity that can have very serious consequences in the lives of the U.S. citizens living in Puerto Rico.

Prostate cancer

Prostate cancer is a particular focus of Men’s Health Awareness Month. It is also the deadliest cancer in Puerto Rico. Studies show that Puerto Rican men tend to see poorer outcomes from treatment than other men, including other Hispanic men in the states.

Given equal access to care, according to an academic study published in Cancer Medicine, Puerto Rican men had better pathology results after radical prostatectomy surgery. That is, when looking at things like lymph node metastasis, Puerto Rican men were healthier after the surgery than the average in the study.

Even so, the researchers had to conclude that “they had significantly worse post‐treatment outcomes than men from the Continental US, regardless of race.” The study examined more than 8,000 men at VA hospitals across the country, including the one in San Juan. VA hospitals were chosen because they provide equal access, at least in theory, and comparable care. Though testing after the surgery showed better results for the men in Puerto Rico, they did not live as long as the Continental group and they were more likely to suffer relapse and tended to do so sooner. Researchers were expecting to see that Puerto Rico patients had worse pathologies, but that was not the case.

Other studies looked for genetic explanations and lifestyle differences including higher incidences of obesity or lower rates of physical activity. These studies typically include that more study is needed. Recently, however, examinations of toxic chemicals on the Island have shown stronger correlations with the elevated prostate cancer rates and higher likelihood of death.

Since Puerto Rico is subject to federal laws about environmental contamination, it’s usual to assume that toxicity is no higher in Puerto Rico than in the states. In fact, Puerto Rico’s air quality is often better than that in states. However, lack of funding and outdated infrastructure causes high levels of water contamination and chemical emissions in parts of the Island. Knowing that the standards for water quality and manufacturing emissions are the same in Puerto Rico and in the states can cause people to overlook the fact that Puerto Rico’s municipalities often cannot meet those standards.

Suicide

Another focus of National men’s Health Awareness Month is the growing problem of suicide among American men. Puerto Rico does not have a suicide rate as high as the numbers in the states now, but the proportion of men is much higher. Nearly 80% of suicides in Puerto Rico are among men.

Researchers suggest that traditional gender roles in Puerto Rico contribute to the gender disparity on the Island. Economic hardship combined with the traditional importance of the male provider role creates pressure on men. At the same time, stigma around mental illness, particularly for men, discourages some men from getting help when they need it.

Apart from men’s particular experiences, Puerto Rico’s economic problems and austerity measures have severely cut support for mental health care. This, together with the trauma of repeated natural disasters and energy crises, has increased stress on the Island, though not the rate of psychiatric disorders.

Heart health

The third focus for National Men’s Health Awareness Month is cardiac or heart health. Heart disease is the #1 cause of death for men in Puerto Rico and in the U.S. as a whole. In Puerto Rico, men have higher levels of hypertension (44.7%) and diabetes (17.2%) than women. Both of these percentages are significantly higher than in the U.S. overall. Even young men in Puerto Rico have heart health problems — more than three quarters of men 18-25 in one study showed less than perfect scores.

Again, the stress of life in poverty is a factor in Puerto Rico, where the poverty rate is more than double that in even the poorest states. The fragility of the healthcare system and limited access because of inadequate federal funding prevent early intervention which could reduce the rate of heart disease among Puerto Rican men.

Heart disease risk can be reduced by good lifestyle choices, including physical activity and healthy eating as well as stress management. Personal responsibility is always part of the equation, and this is one of the reasons for devoting the month of November to men’s health awareness.

Still, we can’t ignore the fact that inequality in Puerto Rico affects people’s health. And we should not ignore the fact that statehood would bring equality with the states. Reach out to your legislators and let them know that this matters to you.