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Practice Type: Model
Program Name: Men's Health League
Organization: Cambridge Public Health Department
Web site:
Overview: Men in the United States have been experiencing a silent health crisis for more than 50 years. Men’s life expectancy is shorter than women’s—women of all races now live 80.1 years, compared to men’s, who average 74.8 years. Men of color, in particular, are disproportionately affected by cardiovascular disease and type II diabetes, as well as many other chronic diseases. These men are also often reluctant to seek medical care unless they are very sick, and are twice as likely as women to report that they have no usual source of healthcare. Among men and women of different races and ethnicities in the U.S., black males also have the highest rate of cancer diagnoses and death, the highest death rate from heart disease and account for over two-thirds of deaths by homicide in the U.S. Objective 1: Engage men at high-risk for diabetes and heart disease in behavioral change by enrolling them in Fit for Life (FFL), a 10-week personalized, mentored exercise program based at the YMCA. Objective 2: Engage men in behavioral change by enrolling any man in the Community in the Fitness Brothers (FB) Program, a social support exercise promotion program. Objective 3: Engage Black men with diabetes and/or high blood pressure and high cholesterol in navigated care within the CHA system to improve access to care and enhance care coordination through a Navigated Care Program (NC). Preliminary evaluation results indicate the following changes in the health behaviors of program participants: I. Physical Activity Participation in physical activity increased among program participants. • 42% had an increase in self-reported activity levels before and after participation. • 49% increased the number of times per week they exercise. • 86% intend to increase or continue their current level of exercise. II. Diet/Nutrition Men’s Health League program participants improved diet over time. • 75% reported that they had developed healthier eating habits. • 40% reported having increased their daily consumption of fruits and vegetables. III. Clinical Indicators Clinical indicators improved among Men’s Health League program participants. • 50% of all participants lost weight. • On average, participants showed a decrease of 21 points in their total cholesterol reading. • On average, participants showed a decrease of 28 points in their blood sugar reading. IV. Access to Care Program participants reported greater access to health care. • For Navigated Care, 40% entered program with no medical home: at discharge, 100% had a primary care clinician. • For Fit for Life and the Men’s Health Team participants, the program saw a 13% increase in the percentage of men who reported having a primary care clinician.
Year Submitted: 2010
Responsiveness and Innovation: The age-adjusted death rate for Cambridge males is 34% higher than for Cambridge females. Within the city’s male population, black males have a death rate that is 9% higher than that of white males, 78% higher than that of Hispanic males, and 327% higher than that of Asian males. The health department collected and analyzed local and state data on heart disease, cancer, stroke, and diabetes, which are among the top 10 leading causes of death for American males. In addition, the department examined data on HIV/AIDS, a leading cause of death nationwide for black and Hispanic men age 20 to 65. The data revealed that Cambridge males have higher death rates than females for heart disease and cancer, and higher infection rates for HIV/AIDS. While both sexes experience a similar rate of death from stroke and diabetes, Cambridge males are hospitalized for these two diseases at a higher rate than females. Among males of different races and ethnicities, black males had the highest death rate for cancer, the highest hospitalization rate for Diabetes and the highest infection rate for HIV/AIDS. Some researchers have suggested that societal notions about male identity may be driving health disparities between the sexes. According to this theory, cultural beliefs about masculinity and manhood propel men to take actions that could harm their health and keep them from engaging in health-promoting behaviors and seeking medical care when necessary. Others propose a biological explanation for worse health outcomes. Still others assert that social determinants of health are a major factor, believing that the social conditions under which many men of color live make them sicker, and offer fewer opportunities for healthy living than those afforded other communities. Cambridge has had a focus on the health of men of color since 1993, stimulated by the findings of a community health assessment that was conducted in the early 1990’s which identified men’s health disparities as a major public health need in the area. The initiative has been guided by the community-based Men of Color Task Force composed of key stakeholders who make recommendations about programmatic directions and mobilize community participation in men’s health projects in the city. The primary success of this initiative has been establishing and institutionalizing the popular Hoops and Health event reaching about 1,000 black men annually. The event, which includes a mandatory health workshop, is designed to help youth and men of color learn about healthy behaviors, and to link them to health and social service resources throughout the city. Building on this history of community interest, and to gain a better understanding of gender, racial, and ethnic health disparities in Cambridge, the public health department examined disease and death data, surveyed Cambridge men about their health status, and asked men from culturally and racially diverse backgrounds to describe barriers to health and wellness in their communities. In 2007, the public health department surveyed 350 men in the greater Boston area, of whom 142 were Cambridge residents. Staff distributed questionnaires at local events and venues, including the 2007 Hoops n’ Health sports tournament, a Cambridge Health Alliance picnic, the Salvation Army meals program, two churches, and a gay pride event. The survey intentionally “oversampled” black and African-American men to better understand the health challenges facing this community. Among other finds, we discovered that a much smaller proportion of black respondents than white respondents reported currently having health insurance (75% vs. 91%). Following this, the Cambridge Public Health Department (CPHD) conducted a series of focus groups to help shape the men’s health programming. Two focus groups engaged men in designing the program now being proposed as a model in this application; the remaining four asked Ethiopian, Haitian, Spanish, and Portuguese-speaking men about their health behaviors. From these groups we gained critical insights about barriers to good health experienced by these men (lack of insurance, language barriers, not able to get time off from work); programmatic suggestions (include a competitive aspect) as well as input into marketing materials.We have attempted a multi-pronged strategy to create awareness and excitement about men’s health and to engage community members and institutions in improved health behaviors. More men of color in Cambridge are exercising. Over the course of two years, over 180 men have enrolled in Fitness Brothers, forming teams to encourage social support and competing with others for prizes and honor. Each Fitness Brothers cycle provides opportunities to exercise (for example, Men’s Health League-sponsored weekend bicycle rides) and three interactive educational workshops focused on fitness and nutrition. Seventy-six men at high-risk for diabetes or heart disease have enrolled in Fit for Life, a more intensive program that provides a free health club membership, personal trainers and a mentor to encourage and motivate regular exercise. We have built a core group of local health leaders through the Men’s Health Team (MHT), a group of community volunteers whose leadership skills and commitment to health promotion have increased over time. Team members took major responsibility to organize the 2009 Men’s Health Breakfast in June, recruiting over 100 men, arranging for the keynote speaker and organizing health screenings and follow-up for one-third of the attendees. Men’s Health Team members also supported over 30 Fit for Life participants, providing health and wellness information as well as working out regularly with their partner at the Cambridge YMCA. Seven out of the original 10 Men’s Health Team members have continued their involvement for at least two years. We have also provided Navigated Care to over 60 men, helping them overcome barriers to healthcare by obtaining health insurance, connecting with a primary care physician and accessing supportive services such as mental health or addictions treatment. We have provided education on men’s health issues and preventive health behavior to over 800 men, through large and small events co-hosted with community partners, many of which include a screening component. To date, over 20 events have been held, including collaborations with Harvard University, the American Heart Association and the city’s Department of Public Works. We have cultivated relationships with local barbershops, which serve as community centers for men of color, and worked with them to survey their customers on preventive health behaviors and provide education and screening Finally, we have focused on building capacity in other organizations who might be interested in beginning or expanding men’s health activities by developing a replication manual, soliciting proposals for mini-grants and blending Men’s Health League activities with the program offerings of other community agencies.Prior to developing the Men’s Health League initiative, we completed a literature review of current men’s health programs across the nation. The following are excerpts from the programs surveyed (complete literature review is available): Baltimore Men’s Health Center - Baltimore, MD The Men’s Health Center is the nation’s first health center created specifically for uninsured men between the ages of 19 and 64 living in Baltimore. Currently approximately 25-30 uninsured men receive services per day. The Center provides comprehensive services including primary care, dental referrals, substance abuse treatment, employment assistance, medication monitoring, housing assistance, medical assistance and smoking cessation classes. Barron Center for Men’s Health - Belmont, MA. The Barron Center for Men’s Health, located in Belmont, is part of Mount Auburn Hospital and has been in operation since 2004. It is privately and grant funded and the primary focus is on the prevention, diagnosis and treatment of prostate cancer. Boston Medical Center, Young Men’s Health Clinic – Boston, MA The Young Men’s Health Clinic at BMC established by Dr. John Rich was designed to provide necessary health services to young men transitioning to adulthood. Men serviced by the clinic are between the ages of 17 and 30. Free Care is available to those who do not have health insurance. The clinic does not have a physical location, but rather is a virtual referral to primary care. Men’s Health Network – Washington, DC Men's Health Network (MHN) is a non-profit educational organization comprised of physicians, researchers, public health workers, and other health professionals and is the sponsor and organizer of “Men’s Health Week”, a national awareness campaign. http://www.menshealthnetwork.org/stateofmenshealth/ Project Brotherhood - Chicago, IL Project Brotherhood (PB) is a clinic dedicated to improving the health and welfare of African American men which focuses on prevention and the promotion of emotional and physical health and wellness, not just treatment. The Center’s focus has shifted from exclusively providing preventative care and treatment of sexually transmitted diseases to combining prevention and treatment of acute medical conditions such as heart disease and diabetes. The staff has developed innovative strategies to recruit and retain black men in the clinic primary care system such as, providing free haircuts, food and transportation at every session. Thapelo Institute - Chicago, IL The Thapelo Institute is a local public health initiative that has been in operation for four years. It sponsors an annual event in Chicago, IL that combines health and fitness. The event targets men of color and attendees have opportunities to received blood draws, health screening and ask questions of medical professionals. Typical attendees of the health and fitness event are men between the ages of 40-60. The focus of the initiative is exclusively prevention and education. Whittier Street Health Center - Roxbury, MA The Edward Harris Men’s Health Clinic at the Whittier Street Health Center is an innovative and comprehensive outreach, education screening, and referral program. The Center uses a primary care model which offers health care, maintenance and disease prevention, risk assessments, walk-in blood pressure testing, prostate screening, fitness training, smoking cessation, an eight-week “Rap” discussion group, family planning and mental health counseling for men 18 and older. The Men’s Health League combines primary, secondary and tertiary prevention approaches with clinical care to address disparities in men’s health. By working across all these dimensions, we have been able to intervene in the lives of individual men suffering from disease, while engaging men who are at-risk of disease and those who, through healthier behaviors, can avoid a future of chronic disease. In addition, we have applied social marketing approaches to a community-wide campaign to engage all men of color to take a more active role in their health. In this way, all men have a place in “The League” and a way to become more active in their own health while encouraging their brothers (and fathers, sons, colleagues) to do the same. Our primary prevention efforts include education events at multiple community sites, ranging from small church-based men’s groups, to worksite wellness activities and large community athletic competitions attracting over one thousand participants. These events allow all men of color to participate in learning more about their health risks and recommended preventive screenings, while tailoring these opportunities to meet specific needs of particular sub-groups. Fitness Brothers, another primary prevention approach, allows all men, regardless of health status, to join in an exercise intervention that provides social support and education about men’s health. Almost 200 men have participated, ranging from those who regularly exercise and join mostly for the competition, to those who have never exercised before. The program allows men to choose their form of exercise, with a variety of options presented, thus tailoring the program to the individual’s preferences, schedule, previous activity level, etc. Fit for Life is an example of a secondary prevention initiative, targeting men at high risk of diabetes or heart disease. These men are largely overweight and sedentary, with family histories of diabetes, and require more motivation and support to succeed. This is provided by incentives like a free gym membership; free personal training sessions; and a mentoring relationship with a member of the Men’s Health Team. Regular group support is provided along with health education, and the opportunity to participate in other Men’s Health League activities. Tertiary prevention is provided through the Navigated Care program, which targets men who have had no access to primary care. Many of these men present with substantial medical concerns, including malnutrition, addictions and extremely high blood sugar levels. Many also have little or no job history, and often have prison records. By working with them to apply for health insurance and select and visit a primary care physician, we have opened up the possibility of healthier life. We have developed relationships with several male physicians within the Cambridge Health Alliance system, and are able to work closely with them to monitor client’s health and follow up on missed appointments through access to EPIC, the electronic medical record. In addition, we can engage them in the physical activity and education opportunities offered by the Men’s Health League. Finally, we use social marketing principles to inform our program design and, especially, our marketing materials. By taking the time to clearly define our target audience, engage them in the design of programs, pilot-test messages and materials, and use familiar images of local men in promoting our activities, we have captured the interest of community men who have not engaged in health promotion activities in the past. The Men’s Health League partners meet regularly to oversee program planning and implementation and to consider strategies for sustainability. Regular partnership surveys and interviews have provided ongoing feedback on the successes and barriers to effective partnership, and have helped us to improve communication, clarify roles and trouble-shoot difficulties before they impact the quality of our intervention. The health department also serves as the primary liaison to the clinical services provided by the Cambridge Health Alliance, identifying specific clinicians with an interest in health disparities and engaging them in program activities, e.g. teaching educational workshops. The health department has also leveraged its position as a City department to develop connections between the Men’s Health League and several city agencies. In particular, the Fire and Public Works Departments and the Senior Center have incorporated men’s health activities into their wellness efforts; the Peace Commission has proposed involving men in domestic violence prevention; the city’s recreational facility has served as a venue for program activities. Again, the health department’s unique position as a municipal department as well as a member of a health system has contributed to the success of The Men’s Health League. Capacity building support has also been offered to the community partners involved in the project, e.g. management consultation to the director of the Margaret Fuller Neighborhood House and grant-writing assistance to the Cambridge Family YMCA. In addition, the mini-grants provided to small community-based organizations has engaged new organizations in public health activities and offers ongoing opportunities for future collaborations. The Cambridge Public Health Department cultivates and depends on the relationships it builds with community partners in all aspects of our work. Regarding the Men's Health League, these relationships have earned us the trust of long-term residents and institutions who have provided a kind of "street credibility" upon which the success of the initiative relies. It would have been extremely difficult to "sell" improved health behaviors to men of color without the buy-in and support of our formal partners, as well as the many informal partners who have joined in The League's activities. In addition to building trust in the local health department, which of course extends to all our activities, we have also built capacity in many local agencies to add men's health programming in a more sustained way. Especially as we enter the final year of this pilot program, emphasis has been put on exporting capacity, program models and materials, and providing the requisite technical assistance that supports small, community-based organizations to begin to address the health issues of their members. The production of a formal Men's Health League Manual, which includes specific program materials, step by step instructions as well as evaluation instruments should help achieve this goal. We have found that MHL activities are easily understood and fit well into the program activities of a large variety of organizations. For instance, the local Dept. of Public Works has integrated our activities into their regular health promotion efforts, and Bally's Health Club has discussed integrating MHL models into its franchises nationwide.
Agency and Community Roles: The Cambridge Public Health Department has had the primary role in designing, staffing and implementing Men’s Health League activities. The program manager and care coordinator report directly to the department’s Director of Community Health Programs, and are supported by the Manger of Marketing and Health Promotion as well as epidemiology staff. Through a contractual agreement with the City of Cambridge, the public health department is part of a regional health system, The Cambridge Health Alliance, an integrated public healthcare system comprised of three community hospitals, over 25 primary care sites, the Cambridge Public Health Department, a managed Medicaid plan and the Institute for Community Health. Cambridge Health Alliance’s mission is to improve the health status of its communities through a commitment to quality, affordable, and accessible health care and public health initiatives. providing an extremely close connection with primary and ancillary care through the sharing of the electronic medical record. This unusual relationship between a local health department and a large health system has positioned us well to merge a community-wide health promotion intervention with clinical services at a hospital whose mission is to serve marginalized populations. The Public Health Department is also primarily responsible for data collection and program evaluation, working with the Institute for Community Health, a local organization focused on community-based participatory evaluation. The ongoing collaboration on this national demonstration project has allowed the Cambridge Public Health Department to focus on broader public health goals while attending to the core functions and essential services we are required to deliver. The health department developed relationships with three local organizations to form the partnership which guided this effort to reduce health disparities in men of color. Each has a long history of serving the Cambridge community, and substantive relationships with a broad range of community leaders and residents. The Margaret Fuller Neighborhood House is a small community settlement house that has been recognized for over a century as a catalyst for community involvement, activities and support. The MFNH serves as the lead fiscal agency for the Men’s Health League, and provides a close connection with the African-American population through its outreach staff. Its Outreach Connections Project targets young men between the ages of 18 and 35 who are at serious risk (recently incarcerated, addicted to drugs or alcohol, unemployed, homeless, or in need of health care or education. The street-worker leverages his long-standing relationships with local families to provide education, referral and case management support The Cambridge Family YMCA has served as the primary fitness facility for program activities. It is located close to the health department and the Margaret Fuller House, and offers an ideal setting to introduce program participants to opportunities for fitness, including a pool, weight room, martial arts classes and a brand new workout studio. The YMCA provides memberships for program participants, fitness trainers and has contributed to the design of the exercise components. An additional fitness facility, Bally’s Total Fitness, has now been added as a partner and hosts the Fitness Brothers components. The Men of Color Task Force is a group of community stakeholders whose mission is to improve the health of minority men by understanding and reducing barriers to health care and to provide health services and preventive care for Black and Latino men in Cambridge. Its primary success was in establishing and institutionalizing the popular Hoops and Health event reaching about 1,000 black men annually, and is now co-sponsored by the Men’s Health League. The Task Force also co-sponsors an annual Men’s Health Breakfast, which has become an annual signature event of The Men’s Health League. Leadership of this group includes current and former city politicians and community activists with long-standing connections to the African-American community. These connections have been invaluable to our marketing and outreach efforts. The Institute for Community Health provides has provided program evaluation, and has helped enormously in developing a logic model and guiding data collection efforts. Evaluation staff participates in all program aspects, helping us engage participants in program design and feedback which has resulted in ongoing modification and improvement of our activities.
Costs and Expenditures: The success of this program relies on engaging local partners to develop and implement wellness programs that engage and appeal to men of color. We established partnerships with a minority-serving community organization, a regional healthcare system and a local fitness center, as well as with The Men of Color Task Force, a group of community stakeholders with an interest in men’s health. Formal and informal leaders throughout the community were tapped to support and publicize the program, and men of color were hired as program staff. Grassroots health leadership was built by recruiting black men from the Cambridge, training them to be men’s health mentors and utilizing them in program activities. Men's Health Team members serves as liaisons to their community and to the specific community organizations to which they belong, and help with outreach, staff health fairs and mentoring program participants. As a way to engage all community men of color in The League, we developed the Fitness Brothers program, which utilizes social support to motivate teams of men to exercise in a 10-week competition. Group workouts taught by a personal trainer and three health promotion workshops conducted by the LHD are included in this intervention. Fit for Life is a more intensive program targeting men at high-risk for diabetes and heart disease. These men receive a free YMCA membership, six personal training sessions and are matched with a mentor from the Men’s Health Team. In addition, we have implemented a community-wide campaign for men’s health by providing health education and screening events in churches, community centers and worksites, and utilizing well-known men of color to provide motivation and inspiration to men of color wanting to improve their health. Activities include Hoops ‘n Health, an annual basketball tournament and health fair that attracts over 1000 participants; a yearly Men’s Health Breakfast; cooking workshops/demonstrations and a variety of faith-based activities for men. In an effort to stimulate local organizations to develop their own men’s health programming, a Men’s Health League replication manual has been created, and competitive mini-grants have been awarded to community-based groups for this purpose. The first six months were devoted to recruiting and hiring staff; conducting focus groups to inform the design and branding of the initiative; engaging local leadership; and developing a training curriculum and evaluation design. A logic model was developed, outcome indicators selected and evaluation instruments designed and tested. In-kind management consultation was provided by senior staff at the Cambridge Public Health Department, and program materials were designed and produced by the department’s Manager for Marketing and Health Promotion, using social marketing concepts to “pitch” improved health behaviors. Organizations, businesses, civic associations, and a broad spectrum of stakeholders engaged with the Men’s Health League to highlight health in a way that speaks to their constituents. Local leaders, including politicians and ministers, applied to participate as both mentors and participants. The local chapter of the NAACP highlighted the Men’s Health League at its annual Martin Luther King breakfast, and the Department of Public Works incorporated men’s health activities into its staff training schedule. When possible, activities were co-sponsored by community-based organizations, to assist with recruitment, and to build organizational capacity to carry on the work independently. In year three of the program’s operations, the Men’s Health League issued mini-grants to small, grassroots agencies interested in developing men’s health activities on site, and offered health promotion activities in an additional fitness facility, and piloted the Fitness Brothers model in the local high school. The federal Office of Minority Health provided three years of funding to develop and pilot the Men's Health League in Cambridge. This funding covered the costs of staff, incentives for participants, sponsored personal training and fitness facility memberships, and evaluation activities. In addition, the state Department of Public Health provided a small grant to develop the capacity of the Men of Color Task Force to provide leadership for men's health activities in Cambridge. In-kind resources were provided by the Cambridge Public Health Department for program supervision, and social marketing support. Other in-kind contributions were made by local fitness facilities interested in partnering with The Men's Health League, in the form of free memberships for participants in the Fitness Brothers program and access to personal trainers.
Implementation: The age-adjusted death rate for Cambridge males is 34% higher than for Cambridge females. Within the city’s male population, black males have a death rate that is 9% higher than that of white males, 78% higher than that of Hispanic males, and 327% higher than that of Asian males. The health department collected and analyzed local and state data on heart disease, cancer, stroke, and diabetes, which are among the top 10 leading causes of death for American males. In addition, the department examined data on HIV/AIDS, a leading cause of death nationwide for black and Hispanic men age 20 to 65. The data revealed that Cambridge males have higher death rates than females for heart disease and cancer, and higher infection rates for HIV/AIDS. While both sexes experience a similar rate of death from stroke and diabetes, Cambridge males are hospitalized for these two diseases at a higher rate than females. Among males of different races and ethnicities, black males had the highest death rate for cancer, the highest hospitalization rate for Diabetes and the highest infection rate for HIV/AIDS. Some researchers have suggested that societal notions about male identity may be driving health disparities between the sexes. According to this theory, cultural beliefs about masculinity and manhood propel men to take actions that could harm their health and keep them from engaging in health-promoting behaviors and seeking medical care when necessary. Others propose a biological explanation for worse health outcomes. Still others assert that social determinants of health are a major factor, believing that the social conditions under which many men of color live make them sicker, and offer fewer opportunities for healthy living than those afforded other communities. Cambridge has had a focus on the health of men of color since 1993, stimulated by the findings of a community health assessment that was conducted in the early 1990’s which identified men’s health disparities as a major public health need in the area. The initiative has been guided by the community-based Men of Color Task Force composed of key stakeholders who make recommendations about programmatic directions and mobilize community participation in men’s health projects in the city. The primary success of this initiative has been establishing and institutionalizing the popular Hoops and Health event reaching about 1,000 black men annually. The event, which includes a mandatory health workshop, is designed to help youth and men of color learn about healthy behaviors, and to link them to health and social service resources throughout the city. Building on this history of community interest, and to gain a better understanding of gender, racial, and ethnic health disparities in Cambridge, the public health department examined disease and death data, surveyed Cambridge men about their health status, and asked men from culturally and racially diverse backgrounds to describe barriers to health and wellness in their communities. In 2007, the public health department surveyed 350 men in the greater Boston area, of whom 142 were Cambridge residents. Staff distributed questionnaires at local events and venues, including the 2007 Hoops n’ Health sports tournament, a Cambridge Health Alliance picnic, the Salvation Army meals program, two churches, and a gay pride event. The survey intentionally “oversampled” black and African-American men to better understand the health challenges facing this community. Among other finds, we discovered that a much smaller proportion of black respondents than white respondents reported currently having health insurance (75% vs. 91%). Following this, the Cambridge Public Health Department (CPHD) conducted a series of focus groups to help shape the men’s health programming. Two focus groups engaged men in designing the program now being proposed as a model in this application; the remaining four asked Ethiopian, Haitian, Spanish, and Portuguese-speaking men about their health behaviors. From these groups we gained critical insights about barriers to good health experienced by these men (lack of insurance, language barriers, not able to get time off from work); programmatic suggestions (include a competitive aspect) as well as input into marketing materials.We have attempted a multi-pronged strategy to create awareness and excitement about men’s health and to engage community members and institutions in improved health behaviors. More men of color in Cambridge are exercising. Over the course of two years, over 180 men have enrolled in Fitness Brothers, forming teams to encourage social support and competing with others for prizes and honor. Each Fitness Brothers cycle provides opportunities to exercise (for example, Men’s Health League-sponsored weekend bicycle rides) and three interactive educational workshops focused on fitness and nutrition. Seventy-six men at high-risk for diabetes or heart disease have enrolled in Fit for Life, a more intensive program that provides a free health club membership, personal trainers and a mentor to encourage and motivate regular exercise. We have built a core group of local health leaders through the Men’s Health Team (MHT), a group of community volunteers whose leadership skills and commitment to health promotion have increased over time. Team members took major responsibility to organize the 2009 Men’s Health Breakfast in June, recruiting over 100 men, arranging for the keynote speaker and organizing health screenings and follow-up for one-third of the attendees. Men’s Health Team members also supported over 30 Fit for Life participants, providing health and wellness information as well as working out regularly with their partner at the Cambridge YMCA. Seven out of the original 10 Men’s Health Team members have continued their involvement for at least two years. We have also provided Navigated Care to over 60 men, helping them overcome barriers to healthcare by obtaining health insurance, connecting with a primary care physician and accessing supportive services such as mental health or addictions treatment. We have provided education on men’s health issues and preventive health behavior to over 800 men, through large and small events co-hosted with community partners, many of which include a screening component. To date, over 20 events have been held, including collaborations with Harvard University, the American Heart Association and the city’s Department of Public Works. We have cultivated relationships with local barbershops, which serve as community centers for men of color, and worked with them to survey their customers on preventive health behaviors and provide education and screening Finally, we have focused on building capacity in other organizations who might be interested in beginning or expanding men’s health activities by developing a replication manual, soliciting proposals for mini-grants and blending Men’s Health League activities with the program offerings of other community agencies.Prior to developing the Men’s Health League initiative, we completed a literature review of current men’s health programs across the nation. The following are excerpts from the programs surveyed (complete literature review is available): Baltimore Men’s Health Center - Baltimore, MD The Men’s Health Center is the nation’s first health center created specifically for uninsured men between the ages of 19 and 64 living in Baltimore. Currently approximately 25-30 uninsured men receive services per day. The Center provides comprehensive services including primary care, dental referrals, substance abuse treatment, employment assistance, medication monitoring, housing assistance, medical assistance and smoking cessation classes. Barron Center for Men’s Health - Belmont, MA. The Barron Center for Men’s Health, located in Belmont, is part of Mount Auburn Hospital and has been in operation since 2004. It is privately and grant funded and the primary focus is on the prevention, diagnosis and treatment of prostate cancer. Boston Medical Center, Young Men’s Health Clinic – Boston, MA The Young Men’s Health Clinic at BMC established by Dr. John Rich was designed to provide necessary health services to young men transitioning to adulthood. Men serviced by the clinic are between the ages of 17 and 30. Free Care is available to those who do not have health insurance. The clinic does not have a physical location, but rather is a virtual referral to primary care. Men’s Health Network – Washington, DC Men's Health Network (MHN) is a non-profit educational organization comprised of physicians, researchers, public health workers, and other health professionals and is the sponsor and organizer of “Men’s Health Week”, a national awareness campaign. http://www.menshealthnetwork.org/stateofmenshealth/ Project Brotherhood - Chicago, IL Project Brotherhood (PB) is a clinic dedicated to improving the health and welfare of African American men which focuses on prevention and the promotion of emotional and physical health and wellness, not just treatment. The Center’s focus has shifted from exclusively providing preventative care and treatment of sexually transmitted diseases to combining prevention and treatment of acute medical conditions such as heart disease and diabetes. The staff has developed innovative strategies to recruit and retain black men in the clinic primary care system such as, providing free haircuts, food and transportation at every session. Thapelo Institute - Chicago, IL The Thapelo Institute is a local public health initiative that has been in operation for four years. It sponsors an annual event in Chicago, IL that combines health and fitness. The event targets men of color and attendees have opportunities to received blood draws, health screening and ask questions of medical professionals. Typical attendees of the health and fitness event are men between the ages of 40-60. The focus of the initiative is exclusively prevention and education. Whittier Street Health Center - Roxbury, MA The Edward Harris Men’s Health Clinic at the Whittier Street Health Center is an innovative and comprehensive outreach, education screening, and referral program. The Center uses a primary care model which offers health care, maintenance and disease prevention, risk assessments, walk-in blood pressure testing, prostate screening, fitness training, smoking cessation, an eight-week “Rap” discussion group, family planning and mental health counseling for men 18 and older. The Men’s Health League combines primary, secondary and tertiary prevention approaches with clinical care to address disparities in men’s health. By working across all these dimensions, we have been able to intervene in the lives of individual men suffering from disease, while engaging men who are at-risk of disease and those who, through healthier behaviors, can avoid a future of chronic disease. In addition, we have applied social marketing approaches to a community-wide campaign to engage all men of color to take a more active role in their health. In this way, all men have a place in “The League” and a way to become more active in their own health while encouraging their brothers (and fathers, sons, colleagues) to do the same. Our primary prevention efforts include education events at multiple community sites, ranging from small church-based men’s groups, to worksite wellness activities and large community athletic competitions attracting over one thousand participants. These events allow all men of color to participate in learning more about their health risks and recommended preventive screenings, while tailoring these opportunities to meet specific needs of particular sub-groups. Fitness Brothers, another primary prevention approach, allows all men, regardless of health status, to join in an exercise intervention that provides social support and education about men’s health. Almost 200 men have participated, ranging from those who regularly exercise and join mostly for the competition, to those who have never exercised before. The program allows men to choose their form of exercise, with a variety of options presented, thus tailoring the program to the individual’s preferences, schedule, previous activity level, etc. Fit for Life is an example of a secondary prevention initiative, targeting men at high risk of diabetes or heart disease. These men are largely overweight and sedentary, with family histories of diabetes, and require more motivation and support to succeed. This is provided by incentives like a free gym membership; free personal training sessions; and a mentoring relationship with a member of the Men’s Health Team. Regular group support is provided along with health education, and the opportunity to participate in other Men’s Health League activities. Tertiary prevention is provided through the Navigated Care program, which targets men who have had no access to primary care. Many of these men present with substantial medical concerns, including malnutrition, addictions and extremely high blood sugar levels. Many also have little or no job history, and often have prison records. By working with them to apply for health insurance and select and visit a primary care physician, we have opened up the possibility of healthier life. We have developed relationships with several male physicians within the Cambridge Health Alliance system, and are able to work closely with them to monitor client’s health and follow up on missed appointments through access to EPIC, the electronic medical record. In addition, we can engage them in the physical activity and education opportunities offered by the Men’s Health League. Finally, we use social marketing principles to inform our program design and, especially, our marketing materials. By taking the time to clearly define our target audience, engage them in the design of programs, pilot-test messages and materials, and use familiar images of local men in promoting our activities, we have captured the interest of community men who have not engaged in health promotion activities in the past. The Men’s Health League partners meet regularly to oversee program planning and implementation and to consider strategies for sustainability. Regular partnership surveys and interviews have provided ongoing feedback on the successes and barriers to effective partnership, and have helped us to improve communication, clarify roles and trouble-shoot difficulties before they impact the quality of our intervention. The health department also serves as the primary liaison to the clinical services provided by the Cambridge Health Alliance, identifying specific clinicians with an interest in health disparities and engaging them in program activities, e.g. teaching educational workshops. The health department has also leveraged its position as a City department to develop connections between the Men’s Health League and several city agencies. In particular, the Fire and Public Works Departments and the Senior Center have incorporated men’s health activities into their wellness efforts; the Peace Commission has proposed involving men in domestic violence prevention; the city’s recreational facility has served as a venue for program activities. Again, the health department’s unique position as a municipal department as well as a member of a health system has contributed to the success of The Men’s Health League. Capacity building support has also been offered to the community partners involved in the project, e.g. management consultation to the director of the Margaret Fuller Neighborhood House and grant-writing assistance to the Cambridge Family YMCA. In addition, the mini-grants provided to small community-based organizations has engaged new organizations in public health activities and offers ongoing opportunities for future collaborations. The Cambridge Public Health Department cultivates and depends on the relationships it builds with community partners in all aspects of our work. Regarding the Men's Health League, these relationships have earned us the trust of long-term residents and institutions who have provided a kind of "street credibility" upon which the success of the initiative relies. It would have been extremely difficult to "sell" improved health behaviors to men of color without the buy-in and support of our formal partners, as well as the many informal partners who have joined in The League's activities. In addition to building trust in the local health department, which of course extends to all our activities, we have also built capacity in many local agencies to add men's health programming in a more sustained way. Especially as we enter the final year of this pilot program, emphasis has been put on exporting capacity, program models and materials, and providing the requisite technical assistance that supports small, community-based organizations to begin to address the health issues of their members. The production of a formal Men's Health League Manual, which includes specific program materials, step by step instructions as well as evaluation instruments should help achieve this goal. We have found that MHL activities are easily understood and fit well into the program activities of a large variety of organizations. For instance, the local Dept. of Public Works has integrated our activities into their regular health promotion efforts, and Bally's Health Club has discussed integrating MHL models into its franchises nationwide.
Sustainability: The committment of program partners has increased over time, and as organizational relationships have deepened and matured. The relationship of the LHD with the small, settlement house that is our primary partner in particular, has emerged as critical for both organizations, and has led to a variety of new collaborative initiatives. The resulting mutual gain in capacity will certainly be sustained over time. New partners have seen how integrating the MHL model into their current offerings attracts new members and is therefore an effective marketing tool for them. Many local athletic facilities and personal trainers have volunteered staff time and space with this in mind. As this program enters its third year of pilot funding, the question of sustainability is increasingly on our agenda. We are hopeful of continued federal and state funding for our efforts, and are implementing several additional strategies towards sustaining this successful intervention. All partners have expressed their commitment to sustaining program activities and integrating them into its ongoing menu of services. We believe the success of the Men’s Health League lies in its ability to raise the profile of men’s health in communities of color and spawn a range of new health promotion activities. Substantial effort has been made to build capacity in other organizations to implement health promotion programming for men of color. A program replication manual was developed and will be available to any interested institution to guide them through the implementation process. We have included health education materials targeting men, evaluation documents, and detailed curriculum for health education sessions. We have also implemented a mini-grant program to seed small health promotion initiatives in local community-based organizations. Fifteen applications were received from a diverse group of agencies including churches, fitness clubs, sports teams and municipal departments. Six grants were funded, and technical assistance will be provided to ensure success and to integrate funded activities into overall Men’s Health League activities. We have also begun to integrate program activities into schools and youth centers, modifying components for a younger cohort. The Fitness Posse, an iteration of Fitness Brothers which incorporates both boys and girls in a team competition, will kick off this spring in the local high school, targeting teens enrolled in special education classes. A local boxing program for high-risk teens involved in the judicial system has begun to incorporate health education workshops that were designed for Fitness Brothers as part of their regular program. The members of the Men’s Health Team, who have received three years of leadership education and support, will serve as ongoing carriers of important health information to their neighborhoods. These men are committed to improving their own health and that of others, and will continue to serve as models and motivators of good health practices.
Lessons Learned:

 

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