Eva Brams, a Manhattan social worker, had tried wifely persuasion to get her husband to stop smoking: She told him how much she loved him and how she was afraid cigarettes would snuff out his life. She noted how smoking seemed to isolate him socially. She showed him research about secondhand smoke and said she worried that his habit would hurt their infant son.
Finally, she tried to cut a deal: "I really, really care about you quitting smoking. Is there anything I could do in exchange to get you to do this?" As a matter of fact, there was: Steven really hated the fact that she let newspapers pile up, covering every surface of their apartment. He wanted her to throw out each paper by the end of the day, whether she had finished reading it or not.
They made a pact. Steven has been nicotine free for almost 30 years -- and the risk of both cancer and fires in the Brams household has been slashed dramatically.
Convincing a man to make his health a priority is kind of like cracking a safe: It's easiest if you know the right combination, but if your first efforts don't work, keep trying different approaches.
"Men want to be better men," explains Jean Bonhomme, MD, spokesman for the Men's Health Network and president of the National Black Men's Health Network. The problem, he says, is that from childhood they've been socialized to deny pain, minimize health risks, and reject any suggestion that they are vulnerable or mortal.
Women: The Health Police
Ignorance of health risks, failing to see the doctor, and terrible health habits are major reasons why men live almost six years less than their wives and sisters. Women live on average 79.4 years, but men only make it to 73.6 years. Black men fare the worst, barely living long enough to collect Social Security. According to 1997 figures in the National Vital Statistics Report, they live an average of 67.2 years. Black women live to an average age of 74.7 years.
The major causes of death for men -- heart disease, cancer, stroke, diabetes, suicide, accidents, and violence -- are partly or entirely preventable by making lifestyle changes.
Getting their patients to commit to lifestyle changes and then carry them out is the most formidable and frustrating treatment problem facing doctors, but in this respect, a woman can save the day -- and the patient.
Married men live longer than bachelors in part because they have women - the historic nurturers and health police -- looking after them.
"The men I see who do the best are those who have partners who are motivated," says Ken Goldberg, MD, a Dallas urologist and men's health advocate. "Women are more experienced and more knowledgeable when it comes to health care, and they're likely to ask more questions. The woman is the decision maker in the household and she can really do a lot to help," he says.
How to Change Him
As Brams's story illustrates, a woman has to customize her pitch to appeal to her mate's personality if it's going to have the desired effect. A vain, narcissistic man might diet after his wife pokes her finger at his spare tire and declares the flab decidedly unsexy. Do this to a depressed guy with poor self-esteem, though, and he's likely to eat his way into an even larger pair of pants.
Here are some strategies to help you get your mate to go in for regular checkups, follow doctor's orders, and take better care of himself.
First, try a tactful, nonblaming message of love and care that appeals to his sense of responsibility: "It's really important to me that you exercise and eat right and get your blood pressure under control. I read these stories about young men dying of heart attacks and would feel so relieved if you just got checked out. Would you please make an appointment so I don't have to worry?"
If a man is afraid of a diagnosis, calmly talk through the worst-case scenarios and point out how early detection can prevent the very consequences he fears. Take your cue from him about whether he'd like your help in making an appointment and going to the doctor with him.
If a man who likes to be in charge complains of pain, ask innocently, "What are you going to do about it?" Such an approach allows him to conclude on his own that he needs to see a doctor. This makes it more likely he'll follow through because it's his idea.
One of the best ways to kindle a behavior change is "to motivate people to want for themselves what you want for them," says Brams. By refusing responsibility, you give him more reason to take responsibility himself.
What About Bribes?
Bribery has its place, notes Alvin Baraff, MD, a clinical psychologist and the founder and director of MenCenter in Washington. Tell him when he brings back the results of his prostate cancer screening (recommended for all men after age 50) he's in for a wonderful meal, tickets to the playoffs, or a sexual surprise.
Speaking of sex: Keep the lights on and pay attention. Men are more likely to get skin cancer on their backs, where they can't see it, than women. Testicular cancer, usually found by a telltale lump, is the leading cancer killer of men in their 20s and 30s, but is cured in 90% of all cases after initial treatment.
Steer tech-heads to the Web to research the risks of obesity, high cholesterol, and high blood pressure. One warning, though: Don't recommend the Web if your mate has a problem with marijuana or steroids. "Too many of the sites are promotional," notes Brams.
You might also try raising his anxiety level: "Gee, honey, look at this: The typical impotent man is a heavy smoker over 40!" Or, "Did you read about that actor who died of alcoholism?" Addictions, incidentally, are some of the trickiest things to deal with, but gathering together everyone an addict cares about and trusts for an intervention can work well.
Figure out whose opinion counts the most to him. If he won't listen to your rap that a colorectal cancer screening is the thing to do after age 50 (or earlier if colon cancer runs in his family), recruit one of his pals -- or even one of the kids -- to help convince him.