MIGUEL'S JOURNEY

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Miguel is 38 years old. He lives in Tumbes, a Pacific coastal region in northern Peru, where he runs a fishing business and lives with his young family.
Tumbes has one of the highest number of hypertension cases in the country.1
If it’s a fact Miguel’s aware of, he doesn’t give it much thought. He’s more concerned about how climate change and adverse weather are affecting his daily catch.
The impact of increasing rainfall and warmer waters on seafood stocks means longer hours at sea and higher fuel costs.2
The fear of failure weighs heavily on men like Miguel, who from childhood see their role as a provider, protector and leader set out for them.
His wife is about to tell him she’s pregnant again. Another mouth to feed will add to his worries.
Miguel’s stress is a silent burden, as is his rising blood-pressure.
As with the majority of men his age, Miguel’s hypertension is likely to remain undetected and untreated. Possibly until it’s too late.
Only 1.5 in 10 Peruvian men aged 30-44 with hypertension are diagnosed.
While many more women are diagnosed, still more than half fall under the radar.
Miguel smokes to settle his mind. He often drinks after work, too, either in celebration or commiseration depending on the yield of his boats.
Although habits among young men in Peru are changing, smoking and drinking heavily have long been woven into the fabric of daily life, with advertising targeting male adults especially.
Smoking is more prevalent among men than women in South America.3
A South American study shows that advertising bans, plain packaging, higher taxes and smoke-free environments could save hundreds of thousands of lives and reduce healthcare spending.4
Miguel unknowingly consumes quite a bit of salt in the food he eats, mainly due to how that food is produced and promoted.
Salt intakes in Latin America currently double the World Health Organisation’s (WHO) recommended limit of 5g per day. WHO’s global targets to reduce sodium in the food supply call for life-saving changes in public health policy and food production.5
Studies carried out in Tumbes by the Peruvian University in Lima have shown a salt substitute can halve new cases of hypertension.6
Medical checks, making changes to his diet, and cutting out tobacco could help put Miguel on a healthier pathway.
In Peru, many more women than men with hypertension are successfully treated.
Better awareness of self-care and also access to care through maternity may be factors.
Could Miguel be encouraged to do a medical check while in hospital for his partner’s maternity care?
But self-care and seeking support are not naturally encouraged in a traditionally masculine culture. ‘Toughen up’ is the mantra Miguel and his peers were likely to hear growing up.
Just a tenth of men with hypertension at Miguel’s age receive treatment.
Poverty compounds the issue. Many men in the Tumbes region have little or no access to antihypertensive drugs.7
The loss of human life to hypertension-related illness levies an untold cost on families, communities and wider society. Not only in Peru, but also worldwide.
Of people aged 30-44 with hypertension in Peru, only 7% of men see their condition successfully managed, compared with 31% of women.
More than twice as many men than women in that age group die from hypertension-related illness.
Unless action is taken to reduce Miguel’s blood pressure, it’s increasingly likely he won’t live to see his children grow into adults.

Why do men’s and women’s journeys through hypertension differ so much?

How does gender influence their lives? And what systemic and structural imbalances present barriers or benefits to their health?

With a more gender-responsive approach to health policy, what could be done differently to manage the risks and make the right treatment more accessible to all? Already we’re seeing how targeted interventions are reducing cases of hypertension; but there’s much more we can do.

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References
1 SciELO - Scientific Electronic Library Online — Prevalence and incidence of arterial hypertension in Peru, October-December 2021
2 Dialogue.Earth — Impact of climate change on fishing in Peru, February 2024
3 Frontiers in Public Health — Exploring gender disparities in the disease and economic tobacco-attributable burden in Latin America, February 2024
4 BMJ Group — Health, economic and social burden of tobacco in Latin America and the expected gains of fully implementing taxes, plain packaging, advertising bans and smoke-free environments control measures: a modelling study, 2024
5 WHO — Global report on sodium intake reduction, March 2023
6, 7 National Heart, Lung and Blood Institute — Building a better salt substitute: New formula helps reduce high blood pressure, December 2023

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