Men's Health: Men Are far from being the 'Stronger Sex', they are Actually the Opposite
Introduction: Gender-based Health Disparities
While the study of gender in health has allowed for tremendous strides, there has been little benefit to advancing the understanding of men's health (Habben, 2005). While the majority of social, political, legal, and religious systems favor men, this favoritism has not served to improve men's health status (Lantz, Fullerton & Harshburger, 2001, p. 189). Generally, men suffer more life-threatening and chronic illnesses such as heart and cardiovascular disease, cerebrovascular disease, certain cancers, and emphysema (Lantz, Fullerton & Harshburger, 2001, p. 189). Men have higher age-adjusted mortality rates for the 15 leading causes of death than do women (Williams 2003, p. 724). Furthermore, they have at least two times higher death rates than women for suicide, homicide, accidents and cirrhosis of the liver (p. 724).
The two leading causes of death for men in the U.K. are circulatory disease (including heart disease and stroke) and cancer (NSO, 2004a). Numerous health statistics illustrate the increased vulnerability of men to certain illnesses. In 2001, almost half of men were considered overweight compared to one-third of women (NSO, 2004b), men are twice as likely as women to exceed the daily benchmark for alcohol consumption (NSO 2004b), and life expectancy at birth is lower for males than for females at 75.7 vs. 80.4 years (NSO 2004c). In the United States, men have a higher incidence of seven out of the ten most common infectious diseases, and three quarters of deaths from myocardial infarction occur in men (Courtenay, 2000, p. 1385). Cancer is a prime example of the effects of male gender on health (Nicholas, 2000). Cancers of the larynx, oral cavity, pharynx, bladder, and liver occur highly disproportionately in men (Nicholas, 2000, p. 27). Further, men are more likely to die from cancer than are women.
Biology vs. Gender Socialization
Differences in health between men and women are not merely biological, but also include lifestyle differences and gender socialization factors (Peate, 2004). Gender differences in health and longevity can be explained partly by health behaviors (Courtenay, 2000, p. 1386), and recent discussions of men's health have emphasized the importance of masculine gender role socialization (e.g., Nicholas, 2000, p. 27). Men's concepts of maleness or masculinity guide their decisions about accepted behaviors. For example, risk-taking behaviors such as excessive alcohol or tobacco use are influenced by beliefs about masculinity (Nicholas, 2000, p. 28). The study of men's health goes beyond an emphasis on physiological structure and biological sex to include a broader analysis of social, cultural, and psychological issues pertaining to the traits, norms, stereotypes and roles associated with male gender (Brooks, 2001, p. 285). Men, in their quest to embody a strong masculine role, may predispose themselves to psychological, emotional, and behavioral disorders (Brooks, 2001, p. 287).
Gender may be defined as the expectations and behaviors that individuals learn about femininity and masculinity (Sabo, 2000, p. 133). Gender socialization influences health-risk behavior, men's perceptions of and use of their bodies, and their psychosocial adjustment to illness (Sabo, 2000, p. 133). While establishing his braveness or manliness to others, a man who conforms rigidly to the masculine ideal by ignoring pain and other illness symptoms is at increased risk of developing chronic diseases (Sabo, 2000, pp. 135-136).
Beliefs about masculinity play a role in the health of men, and may lead them to engage in harmful behaviors or to refrain from health-protective actions (Williams, 2003, p. 727). Male-like qualities such as individuality, autonomy, stoicism, and physical aggression, as well as avoidance of showing emotion or displaying weakness may combine to lead to poorer health in men (Williams, 2003, p. 726). In addition, gender roles can help explain men's reluctance to seek medical care, their avoidance of expressing emotions, engagement in unsafe sexual behaviors, drug use, crime, and dangerous sports (Lee & Owens, 2002). Further, men may be more likely to identify themselves with their work and to spend less time with family (Lee & Owens, 2002).
While men who are socialized to have more feminine attributes may be more likely to be aware of and concerned about their health and health-compromising behaviors (Kaplan & Marks, 1995), men who step outside the gender boundary may be perceived as deviant (Seymour-Smith, Wetherell & Pheonix, 2002). Gender socialization may influence the extent to which boys adopt masculine behaviors. Boys are encouraged to play like other boys and discouraged from playing with or like girls. To do otherwise could lead to rejection. Parents often instill in boys that they are strong and that big boys don't cry'ideas which help form the boy's personality. The masculinization process may make men have difficulty asking for help (Peate, 2004). Society places great value on the stereotypical image of the male as strong and silent, contributing to the idea that men are invulnerable (Fleming, Spiers, McElwee & O'Gorman, 2001, p.337). While women value interdependence (e.g., consulting others and accepting help), men value independence and avoid acknowledging a need for help (Lantz, Fullerton & Harshburger, 2001, p. 190).
Strict adherence to idealized masculinity may lead to a number of mental and physical health problems. This may be due not only to strict adherence to a rigid masculine role, but also to a sense of failure when men fail to live up to this role (Nicholas, 2000, p. 31). Such failure may lead to increased anxiety, psychological distress, poor relationships, cardiovascular reactivity, anger, decreased self-esteem, and unwillingness to seek health services (p. 31).
Men are more likely than women to engage in risky behaviors and to hold risky beliefs (Courtenay, McCreary & Merighi 2002). They are more inclined than women to engage in behaviors that increase morbidity and mortality such as smoking and alcohol abuse (Williams, 2003, p. 727). Men and boys are socially pressured to endorse gendered societal prescriptions such as beliefs that men are strong, independent, self-reliant, and tough (Courtenay, 2000, p. 1387).
As a reflection of such gender stereotypes, men often exhibit risk-taking behaviors such as smoking, poor diet and exercise habits, drinking to excess, and overworking (Lantz et al., 2001, p. 191). While men tend to know less about health than women, they also perceive themselves as less vulnerable to illness than do women (Nicholas, 2000, p. 29). As a result, men may be less aware of recommended screening and common symptoms of disease. More men than women smoke cigarettes and use excess alcohol. These behaviors often occur together, thereby increasing the incidence of oral and throat cancers (Nicholas, 2000, p. 28). Excess alcohol and tobacco use is a risk factor in 80% of cases of head and neck cancers (p. 28).
The causes of death that affect the most men'compared to women'are those most influenced by behavior or personal choice (e.g., suicide, homicide, accidents, and cirrhosis of the liver; Habben, 2005). Alcohol and illicit drug abuse are largely male problems in which the social construction of masculinity plays a significant role (Brooks, 2001, p. 290). Alcohol abuse is a major contributor to mortality from liver cirrhosis, accidents, suicide, and homicide'these being the four causes of death where men double the rate of women (Williams, 2003, p. 727). Further, men are more likely to believe that high-risk behaviors will not impair their performance (e.g., drinking and driving; Williams, 2003, p. 727).
Throughout life, men are at a higher risk of dying than are women. Lifestyle factors related to this include an increased likeliness of having accidents, having a dangerous occupation, and experiencing higher risks when at work (Peate, 2004). Men tend to underestimate the risks involved in physically dangerous activities and may feel that enduring physical punishment and pain are part of being male (Nicholas, 2000, p. 29). Men are more likely than women to work in hazardous occupations such as construction, agriculture, oil, transportation, and forestry'occupations that increase men's exposure to known carcinogens such as asbestos, benzene, chromium, and vinyl chloride (Nicholas, 2000, p. 28).
In addition, risk-taking may include playing of dangerous sports (e.g., football or rugby), or engaging in high-risk sexual behavior. Taking risks confirms a man's masculinity to himself and to others. Further, gender is related to power, and the pursuit of power may lead men to engage in harmful behaviors (Courtenay, 2000, p. 1388). Behaviors such as refusing to take sick time off from work, insisting that they need little sleep, and boasting that alcohol or drug use does not impair their driving serve to demonstrate the dominant norms of masculinity (Courtenay, 2000, p. 1389).
Under-utilization of Health Care Services
Since illness is seen as a threat to masculinity, men are less likely to seek help when ill (Fleming, et al., 2001, p. 337). This may be related to the male tendency to suppress the expression of need and to minimize pain (Williams, 2003 p. 728). Men tend to reinforce social beliefs that they are less vulnerable than women, that their bodies are stronger than those of women, and that caring for one's health is feminine (Courtenay, 2000, p. 1389). In fact, utilization of health care and exhibiting positive health behaviors or beliefs are constructed as part of idealized femininity, and must be resisted in the expression of masculinity (p. 1389).
Men's reluctance to discuss personal concerns may extend into the patient-provider relationship, where men may be less likely to fully report their health history and the exact details of their illness symptoms (Lantz, Fullerton & Harshburger, 2001, p. 194).
Men are less likely to engage in health behaviors such as reporting symptoms, practicing health-promotion, and utilizing health care services (p. 189). Medical encounters also differ between male and female patients, with men receiving less time, fewer services, less information and advice, and less encouragement to change health behaviors (p. 728). Further, when men do receive care, they are less likely to adhere to their medical regimen (p. 728).
The socially conditioned suppression of pain by men may lead to delayed help-seeking (Brownhill, Wilhelm, Barclay & Parker, 2002). Gender socialization may be responsible for the fact that men value more concrete rather than abstract information (Lantz et al., 2001, p. 194). Thus, men may be more likely to ignore vague somatic symptoms and to wait for more concrete signs of disease, thereby delaying treatment until the more advanced stages of disease (p. 194). Often, when men seek care, their disease process is more advanced'leading to higher morbidity and mortality (Lantz et al., 2001, p. 191). While women are more likely to seek care for symptoms, men generally seek medical care for employment or insurance reasons (p. 191). Delaying medical intervention leads to a state of urgency once assistance is finally sought (p. 191).
In men, emotional distress in men may be masked by outward symptoms such as chest pain, deliberate self-harm, drug or alcohol abuse (Brownhill et al., 2002).
Further, men expect health care professionals to be able to read their signs and symptoms without themselves having to disclose anything (Brownhill, et al., 2002). Other reasons for men's reluctance to seek health care may include a lack of understanding of making appointments, inconvenient opening hours, long waits for appointments, lack of trust, and fear of being judged. Men may feel social pressure to not reveal any weakness that may lessen their masculinity, and thus may not seek care. Solutions might include providing services that men can access anonymously (e.g., via the internet or telephone help-lines), and extending opening hours of services to include evenings and weekends.
Conclusion: Possible Solutions for improving Men's Health
Health educators and advocates for men's health should encourage men to consider the effects of gender on health behaviors and outcomes (Sabo, 2000, p. 139). Health education for men should address enhancing men's awareness that some of the culturally supported masculinity norms can lead to health-damaging behaviors (Williams, 2003, p. 730). Williams suggests that the meaning of manhood needs to be re-defined in a more positive way along with changes in cultural institutions and social structures, thus reinforcing positive health behaviors in men (Williams, 2003, p. 730). Modification of health behaviors may be one of the most effective ways of preventing disease (Courtenay, 2000, p. 1386).
One solution could be to provide earlier socialization of boys and young men that health promoting behavior is positive, that reporting health concerns is not a sign of weakness, and that better health encourages a more positive self-image (Lantz, Fullerton & Harshburger, 2001, p. 195). The development of the male gender role should focus less upon the roles of protector and provider, and should emphasize more greatly men's abilities as caregivers and nurturers (Brooks, 2001, p. 293). Such emphasis would enhance the presence of nurturance, attachment, and intimacy in the social construction of masculinity.
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