Developing a Health Advocacy Campaign

As advocacy reaches its zenith with billions of US dollars being raised and spent in philanthropic programs all over the world, the ordinary man has been forgotten. Most programs involve women and children with men only being remembered under extreme circumstances such as old age, critical injury or for being a war veteran. The ordinary man has been completely ignored in this equation with his particular needs and requirements not featuring in the advocacy scene (Bailey, Wallace & Mishel, 2007). Yet, man faces one of the biggest challenges of our times in the name and style of prostate cancer. According to the American Cancer Association, this is the most common form of cancer among men in the world with over 180,000 cases reported annually leading to over twenty six thousands deaths (American Cancer Society, 2016). Despite these mind-boggling statistics, prostate cancer remains generally misunderstood, understudied, and under researched hence ensuring that the issue only gets worse with time.

The only certain facts about this aliment is that it generally attacks men and is predominant from the age of forty and above with the prevalence increasing with age (Carter et al., 2013). It is, therefore, important for men who have attained this age to go for regular check-ups since the best way to curb its exacerbation is early detection. Among the two common means of assessment are the Prostate-Specific Antigen (PSA) and Digital Rectal Exam (DRE) (Carter et al., 2013). Unfortunately, most people in the United States fall under the lower social class with the social ladder becoming narrower as it goes up; this leaves the common man lacking essential funds and/or insurance cover to facilitate continuous check-ups which are fundamental for early detection (Epstein, Fiscella, Lesser & Stange, 2010; Knickman & Kovner, 2015) . 

Most prostate cancer detection involve procedures that delve into the anal region which most people will find embarrassing and shy away from especially as they approach they mid-age when they are not very comfortable with their aging bodies (Epstein, Fiscella, Lesser & Stange, 2010). The totality of the foregoing has ensured that most men will only realize the onset of cancer upon detection of symptoms, but at this stage, it is almost always fatal. 

Whereas an ailment that affects one in every seven men according to the America Cancer Association can rightfully be considered as a pandemic, very little is known about this form of cancer; indeed, contemporary bibliography on prostate cancer reeks of paradoxes (Bailey, Wallace & Mishel, 2007; Kuhlmann & Annandale, 2012). Some research considers prostate cancer’s prevalence to be increased by lifestyle issues such as obesity while others have found to the contrary. Some associate it with smoking and other issues while others have found no other relationship, yet other have indicated racial, geographic or even height factors as elements that increase its prevalence (World Cancer Research Fund International, 2014) . 

This begs the question on how very little can be known about such a dangerous condition yet so little is being done towards research thereof. The initial step in resolving this impasse is research, hence the fundamental aspect of this advocacy being the creation of a prostate cancer research center in every university to facilitate widespread study on this ailment in an attempt to better understand its causes, come up with simpler, cheaper, and less embarrassing testing regimens as well as better treatments so as to reduce its carnage (Epstein, Fiscella, Lesser & Stange, 2010). Research is both expensive and time consuming, it also requires specialized training which is rare or otherwise engaged and this makes this advocacy element more crucial.

The second element of the advocacy after research is detection and treatment, a factor that generally involves money and/or health insurance. Health insurance ought to be a fundamental right guaranteed to every citizen by the government preferably under the constitution (Knickman & Kovner, 2015). Unfortunately, the American constitution began with the Declaration of independence, a document that was specifically designed to end colonialist tied with the United Kingdom and not concentrate on the fundamental rights of Americans albeit it contends that all men have "unalienable Rights, that among these are Life, Liberty and the quest for Happiness," as well as indicating in the preamble the underlying objective to "advance the general welfare" of the general population (Knickman & Kovner, 2015). 

However, when the fundamental rights were being grafted into the constitution, its followed the dimension of fixing issues as and when they arose which resulted in the leaving out of critical issues such as the right to life and the right to proper healthcare as fundamental and inalienable rights. This has created a legal vacuum where albeit the nation is thriving and reputed around the world as a super power buoyed by military superiority, many of its citizens continue to suffer from the maladies including prostate cancer that are more expensive to detect and treat (Knickman & Kovner, 2015). This calls for advocacy geared towards the passing of laws for the provision of mandatory and good quality healthcare for all members of society to enable early detection and proper treatment of prostate cancer sufferers (Knickman & Kovner, 2015).

Finally, when a patient is diagnosed with prostate cancer, there is need for proper nursing and care, whether or not the condition will result in a fatality, which is the norm rather than exception. A sick and suffering individual is still a human being who deserves dignity and proper caregiving. They also need to be persistently and relentlessly treated equally well despite their financial capacities and be accorded an opportunity to lessen their suffering. All these are elements of nursing essential to all prostate cancer sufferers especially among the lower echelons of the social ladder. Its achievement will necessitate funding, availability of institutions and necessary apparatus as well as skilled and companionate labor.

National Alliance of State Prostate Cancer Coalitions (NASPCC) is the current champion against prostate cancer with a multipronged approach that involves all the aforementioned elements and areas from research, diagnosis, treatment to nursing as well as availability of funds and health insurance for the affected. Being the umbrella body, it would be vital for the advocacy to rhyme with the ideals of NASPCC and also adhere to its guidelines for prostate cancer advocacy. It will also be necessary to align with the said NASPCC for legality purposes.

Among the duties being carried out by the NASPCC is the preparing and providing coalition agents as well as equipping their trainers in a bid to increase the team working towards prostate cancer management. Further, to create a unified front NASPCC requires creating a list of issues and items to be handled and advocated for by requesting issues from its member bodies, sorting them out, amending and polishing them. The obtained issues would then be prioritized and dispersed for handling in the form of a menu of issues and proposals. As an immense amount of assistance in varying forms is necessary, NASPCC has adopted an open policy towards assistance and created a master department to liaise with the members as well as government arms to unsure the same. Finally, to create a smoothly functioning apparatus, NASPCC has created executive teams for specific areas of interest to increase the chances of success through professionalism and proper liaison. 

One of the biggest ethical dilemmas involved emanating from this advocacy program lies in its necessity. Most advocacy and humanitarian programs involve the clearly marginalized and less advantaged populace including children, mothers, and the aged. Prostate cancer affects men in their prime age, after they have supposedly had at least two decades of working life and who should be in a position to both know and understand the need for medication and be able to pay for it. On issues such as funding, it is difficult to have monies taken away from a children’s hospital or hospice and committed to prostate cancer that caters for 40 or 50 year olds. It is difficult to request volunteers who could have worked in a maternity related project for teenage African American mothers, some of whom are as old as thirteen and will almost always be maimed or even die during delivery and have then cater for middle-aged men with prostate. 

According to Turale (2014), one of the major ways to deal with ethical dilemmas is looking at the bigger picture; prostate cancer is responsible for tens of thousands of deaths annually, predominantly among the working poor and the underclass. For macroeconomic reasons, this group has been condemned to a continuous cycle of poverty that also includes death through prostate cancer. A scenario where a man who has been working in a factory since his teenage years and has managed to raise a family of 5 children while living in the projects then gets prostate cancer at the age of 50 can be very sobering and would be one of the ways to resolve the ethical impasse (Turale, 2014).

The advocacy acts envisaged herein fall under the two categories of working as a nurse thus adhering to the American Nursing Association (ANA) code of the ethics as well as working as a lobbying since there is the fundamental issue of amendment of the law. In the United States, lobbying issues fall under the Lobbying Disclosure Act of 1995 as read together with and/or amended by the Honest Leadership and Open Government Act of 2007. With regard to the nursing aspect, the relevant provisions of the ANA code of ethics fundamental to this advocacy are Provisions 7, 8 and 9. 

Provision 7 commits the nursing professional to advance the nursing profession through research, scholarly enquiry, professional standards development and the creation and perfection of nursing and health policy. These are among the fundamental premises for the advocacy specifically with regard to the issue of prostate cancer. This gives a cover and impetus in the performance of this advocacy as well as setting proper professional premises. 

Provision 8 also relates with a fundamental aspect of this advocacy as it involves collaboration with other members of the health related professions as well as the general public in the protection of human rights, promotion of health diplomacy. It also helps in reduction of health disparity, in this part among both the less financially endowed as well as the less informed about prostate cancer. Finally, Provision 9 entails how to conduct any and all obligations pertaining to the nursing profession under which the advocacy falls. The provision provides for the incorporation of nursing values, integrity and social justice into the nursing and health policy. These are fundamental guidelines and basic rules to be adhered to in the pursuance of the advocacy and carrying out of its duties. 

With regard to the legal provisions as under the Lobbying Disclosure Act of 1995 as read together with and/or amended by the Honest Leadership and Open Government Act of 2007, the lobby must be registered as under the provisions of these laws as lack of registration would attract a fine of up to US$ 50,000.00. Further, under these laws, a clear disclosure must be given to any and all persons who shall give any kind of support to the advocacy, pecuniary or otherwise regarding the particulars of the lobby, its operations, mandate, and scope. Any finances derived from the advocacy must also be spent precisely as outlined in the terms of the advocacy and in a transparent manner. The law also limits the amounts of gifts that may be bequeathed to politicians in order to push for the legislative elements of the advocacy’s scope. 

Whereas the main ethical dilemma involves why one should assist prostate cancer victims knowing that they are seemingly in a good position to assist themselves, the main ethical challenges involved in this lobby lies in the question of how to assists and cope with the very specific set of persons who often suffer from prostate cancer, to wit men from the age of 40 years. Whereas the nursing profession involves the ethical issue of serving individuals in need who make the nurse uncomfortable or is even displaying violent tendencies, a good example being persons of unsound mind or juveniles, the prostate cancer issue crease a whole new scenario of current and previous patients who are too proud to allow for advice or even assistance when sick (Turale, 2014).

The current generation of men under 40 belong to the culture of machismo where men considered themselves to be superior beings and would therefore be reluctant to accept help since they consider it as a weakness to be in need of help in the first case. Further, there is a damaging myth that prostate cancer is more prevalent among men who have not been having enough sex; this laughable myth is very damaging in effect since very little is known about prostate cancer. Finally, the tests currently available for prostate cancer involve a penetrative procedure that involves the insertion of an object into the rectum, an act that a man with machismo will find repulsive. 

The totality of the foregoing is that the lobby, apart from facing all the other challenges and difficulties outlined above or otherwise, will also face animosity and opposition from the target group itself. It is the nurses’ fundamental element of doing good as defined by Turale (2014) that will assist one in performing under these unfriendly circumstances. Although there exists this feeling that the target group is the biggest hindrance to the operation of an advocacy that is seeking to save the prostate cancer victims, they are human lives and they matter, so the advocacy is worth it (Turale, 2014). This ethical challenge is perhaps one of the many reasons that very little have so far been done with regard to prostate cancer.

Generally, prostate cancer is a form of cancer that affects the prostate gland, an organ that forms part of the male reproductive system and produces part of the fluid which alkalizes ejaculatory fluids to neutralize the predominantly alkaline vagina and allow sperms to live longer therein. Whereas majority of suffers of prostate cancer are over the age of 50, the America Cancer Association places the high risk group to begin at the age of 40. It is also a serious pandemic with over 180,000 cases reported annually leading to over 26,000 deaths. With all issues relating to sex and sexual organs, people with prostate cancer will live with myths including a damaging one that attributes it to lack of enough sex by the sufferers in their prime age. This seemingly innocent jibe creates a serious challenge in combating of this ailment due to an underlying stigmatization of those affected and their spouses. 

Further, the prostate cancer testing which ought to be a routine once an individual attains the age of 40 is commonly conducted through the insertion of a finger into the rectum of the person being tested; most men this age are very sensitive about their bodies, having only realized that they are growing old and are therefore reluctant to take the test. The sensitive and almost embarrassing nature of the test is also the subject of jibes with Lavell Maurice Crawford, a popular comedian once relating it with homosexual intercourse, another reason that would create testing reluctance. For these reasons, most people defer testing until it is too late.  

There is very little research being conducted regarding prostate cancer, which couples with the fact that most of the research that has already been conducted is contradictory at best. The causes of cancer, accurate testing and treatment are still a mystery in this day and age of advanced medical knowledge and enlightenment. Finally, nursing and catering for those who suffer from prostate is a complex affair as their age and the prevalent stigmatization create an underlying hostility from the patients themselves. The machismo culture also creates a feeling that these sufferers do not need anyone’s help, a situation that exacerbates the predicament (Bailey, Wallace & Mishel, 2007; Kuhlmann & Annandale, 2012) .  

It is because of these reasons that this advocacy programme has been proposed to operate under the auspices of and in conjunction with the National Alliance of State Prostate Cancer Coalitions (NASPCC) to mitigate the crisis that prostate cancer has become among the populace. This will be done by advocating for continued testing, more research, better health insurance laws as well as better nursing for those already suffering from the ailment. Albeit most patients would not even admit to be suffering from prostate cancer, it has become a major killer that must be thwarted.

References

American Cancer Society. (2016).  Prostate Cancer Prevention and Early Detection . (1st ed.). Retrieved from <https://www.cancer.org/prostate-cancer-early-detection-pdf/>

Bailey, D. E., Wallace, M., & Mishel, M. H. (2007). Watching, waiting and uncertainty in prostate cancer. Journal of clinical nursing, 16 (4), 734-741.

Carter et al.. (2013). American Urological Association (AUA) Guideline. Early detection of prostate cancer: Aua Guideline ,  1 (1), 4-20. 

Epstein, R. M., Fiscella, K., Lesser, C. S., & Stange, K. C. (2010). Why the nation needs a policy push on patient-centered health care. Health Affairs, 29 (8), 1489-1495. 

Knickman, J.R., & Kovner, A.R. (Eds). (2015). Health care delivery in the united states (11th ed.). New Tork, NY. Springer Publishing. 

Kuhlmann, E., & Annandale, E. (2012). Researching transformations in healthcare services and policy in international perspective: An introduction. Current Sociology, 60 (4), 401-414. 

Turale, S. (2014), Ethical dilemmas: the challenge of advocating for human rights. Int Nurs Rev, 61 (3), 299–300. 

World Cancer Research Fund International. (2014).  Diet, nutrition, physical activity and prostate cancer . (1st ed.). London: World Cancer Research Fund International.