Men's Health Issue as a Public Concern - Research Paper Example

RUNNING Head: MEN'S HEALTH AND ILLNESS Men's Health and Illness Overview Prevailing understandings of men's health have been greatly influenced by a way of talking about the issues that we will call men's health discourse. A range of government-funded initiatives has included a draft national policy; a second national conference; a parliamentary investigation; and the development of task forces, advisory groups, policy and strategy on men's health in the states of Western Australia, South Australia, Victoria, New South Wales, and the Northern Territory. Modest health department funding in several states has established a limited range of men's health education and promotion services. In a relatively short period, then, men's health has appeared on a variety of policy and service delivery agendas; this activity in the realm of government has been vital to the emergence of men's health as a theme of public concern. The provision of information and discussion of "men's health" in local, community-based settings have also been important. Much of the drive has come from local men's groups and community service organizations, such as Rotary and Apex. Private-sector men's health services have been another force active in the development and marketing of programs to improve and promote men's health. A key feature of these programs is the promotion of group support for personal change. Two of these programs have been especially popular--MENDS (Men Exploring New Directions after Separation) focuses on men's experience of separation and relationship breakdown; "GutBusters," which describes itself as a "waist-loss program," seeks to reduce men's risk of cardiovascular disease through abdominal weight loss. Also important in creating a men's health discourse has been the heightened media interest in the issue. A wave of mass media stories accompanied the first national conference, and more media attention has followed the major government initiatives. The Epidemiology Despite the rapid proliferation of men's health discussions, explicit definitions are difficult to find. As we have already noted, the meaning of the term is often taken as self-evident. In practice, the concept of men's health in many documents is constructed by a contrast with "women's health." Women's health is generally understood in public discussions as a sex-based aggregate of reproductive pathologies (mainly breast and cervical cancer) and statistical indicators related to women's mortality, morbidity, disability, and lifestyle practices. Men's health is, correspondingly, constituted by men's diseases of the reproductive organs (primarily prostate and testicular cancer) and by the margins of difference between men's and women's rates of death, disease, and so on. Nevertheless, there is some tension in this formulation. Although all men might appear to be the subject of men's health discourse, the discourse also emphasizes some ways in which men's health disadvantage is not generalized among men. Particular groups of men are often identified as beating a particular burden: indigenous men, men from non-English speaking backgrounds, African American men (in the United States), men with disabilities, gay men, men of low socioeconomic status, and rural men. It is they who account for most of the differences in men's and women's health status and services. The implication here is that social disadvantage produces the margins of difference between men's and women's health patterns. So in the men's health discourse, men's health is the outcome of some combination of social disadvantage and an ill-defined state evoked by such phrases as "being a man." How such a combination works--that is, what social or historical mechanisms have produced it--is neither examined nor explained. This is not to say that we lack scholarly discussions of the social complexities involved in men's health. On the contrary, some very sophisticated research deals with certain issues in the field, such as the sexual practice of men in the context of the HIV/AIDS epidemic. (Dowsett, pp. 794-800, 2006) In the United States, in particular, an emergent scholarly "men's health" discussion indicates a vigorous sociological and psychological engagement with the subject (see, for example, Courtenay(Courtenay 2007); Sabo and Gordon(Stevens 347-366, 2005). However, public and media debates and official policy-making have yet to incorporate (and in some cases even to acknowledge) the understandings yielded by this work. Although common sense presumes a simple parallel between men's health and women's health, there is an important contrast between the prevailing men's health approach and the ways in which women's health has come to be understood. From the outset of the women's health movement in the early 1970s, social and economic disadvantages were recognized as creating more pressing health difficulties for some women than for others.(Stevens 347-366, 2005) This did not negate, however, the existence of certain health concerns common to all women. These were related mainly to the gendered organization and culture of health services, particularly with respect to women’s reproductive and emotional health, (Schofield 2008) at the heart of these services, according to women’s health proponents, were a hierarchy and power dynamic that served medical interests first and foremost. Professional imperatives exerted a powerful influence in shaping these services but so, too, did patriarchy, or men's subordination of women. From such a perspective, medical services were seen to be male dominated. They were said to infantilize women routinely, transforming them into objects of an invasive and instrumental clinical practice. Doctor-patient interactions were not characterized by mutuality and respect but by domination and subordination. Medical encounters, according to women's health activists, did not simply reinforce the generalized social phenomenon of men's power over women; they were an active force in its creation. (Boston Women’s Health Collective 2003) It was from within this context that women's health discourse argued that governments should develop specific women's health policies and sex-specific services. Men's health discourse, however, provides a much more blurred rationale for developing a sex-specific public health policy and services response for men. Its insistent concern with the health differences between men and women seems to require an approach in which men's health is understood in terms of the relations between the sexes. But men's health discourse has disclosed no such direction to date. Indeed, at the policy level, "men's health" is in a separate box from "women's health," addressed in different policy documents, and promoted by different bodies (e.g., policy committees). The fact that policy making is gender-segregated must shape the ways that men's health and women's health are presented in the public realm. Just as significant is the type of research that policy makers have drawn on, to which we now turn. Australian men who smoke also endanger their lives and the lives of those who become passive smokers around them. The likelihood of smoking is decreased by (a) belief in the severity of the diseases caused by smoking, (b) belief in one's vulnerability to those diseases, (c) belief that smoking cessation is an effective way to avoid the diseases, and (d) belief that one can successfully stop smoking. On the other hand, the likelihood of cigarette smoking is increased by intrinsic rewards (e.g., physical satisfaction), extrinsic rewards (e.g., peer approval), and the costs of an adaptive response (e.g., enduring withdrawal symptoms) in Australian men. The increased likelihood of an adaptive response (not smoking) depends primarily on four cognitive perceptions. Severity, personal vulnerability, self-efficacy, and response efficacy enhance the persuasive effects of health warnings by eliciting protection motivation, an intervening variable that arouses, sustains, and directs activity for self-protection. Strong beliefs about these four variables arouse protection motivation; consequently, individuals are more likely to change their attitudes and subsequently to adopt the health behaviour (smoking cessation). (Lear, 2007) Patterns of Masculinity A gender-relations approach has the further advantage that it systematically raises the issue of differences among men, a key issue in practical health work. One of the major conclusions of the recent international research on masculinity is that different groups of men are differently placed in gender relations.(Connell pp.3-23, 2008) In any complex society or institution, therefore, different masculinities are likely to be produced--and with them, different health practices and health effects. In most settings, there is a culturally dominant form that researchers often call the hegemonic masculinity of that particular setting. (Connell pp.3-23, 2008) Anthropology shows that the hegemonic patterns of masculinity differ from one culture to another. They may also differ between subcultures or between ethnic groups, as research in the contemporary United States indicates.(Hondagneu-Sotelo, pp.200-218, 2004) In contemporary mass society, nevertheless, a great deal of common ground is created by mass media, large-scale institutions, and economic structures. Therefore, a familiar pattern of masculinity exists that is hegemonic in the society as a whole. Highly visible examples are found in commercial sport, the sporting hero being for many people today the model of true manliness. It is ironic, then, that many of the practices of elite sport are actually hostile to the body's health and well-being--the heavy stress that falls on young bodies, "playing hurt," on-field violence, and overtraining. More widely, the culture of elite sport emphasizing competition, aggression, and personal dominance over others is connected to health problems, such as violence (including sexual violence), steroid abuse, and denial of vulnerability. (Messner & Sabo, pp. 46-54, 2004) In other ways, too, hegemonic masculinity may be implicated in health problems. A certain kind of masculine camaraderie is a part of familiar patterns of alcohol abuse. Displays of masculine toughness in response to challenges are factors in certain patterns of violence, such as public violence in bars. (Tomsen pp.90-102, 2007) There is even a certain masculine symbolism in diet, specifically a diet high in red meat ("feed the man meat") and low in fresh vegetables ("rabbit food"). The attempt to show toughness or conceal vulnerability may make men unwilling to seek help or reveal their problems. For instance, research on sexual interactions among US college students (Lear, 2007) have found the men relatively unwilling to discuss their sexual encounters with the women, disclose their sexual histories, or discuss their practice within an encounter. In this case, it is likely that the effects of hegemonic masculinity, as a cultural ideal, spread far beyond the (possibly small) group of men who consistently enact the full pattern. In this sense, hegemonic masculinity is probably implicated in the familiar problem of men's pattern of contact with health services. As we have already mentioned, it is a widespread finding that men use general practitioners' services less frequently than women. When they do seek primary healthcare, they are more likely than women to focus on physical problems and less likely to disclose mental and emotional problems. Hegemonic masculinity, we have emphasized, is not the only pattern of masculinity. It is not necessarily the most common in everyday practice. What is the health issues connected with other patterns of masculinity? In contemporary western culture, the most important example of subordinated masculinity is homosexual masculinity. The heterosexual/homosexual distinction is symbolically very important in our gender system; it has health consequences in several ways. Both heterosexual and homosexual groups may develop specific patterns of sexual conduct that constitute distinct pathways of transmission for sexually transmitted diseases. This is very familiar now in HIV/AIDS research, where the classification of types of epidemics has centred on these differences. The relationship between heterosexual and homosexual masculinities, thus, becomes a health issue. Homosexual men are subject to homophobic violence from certain groups of heterosexual men--sometimes deadly violence. Some of these crimes are explained---or explained away-by heterosexual men's "panic" responses to homosexual overtures. (Tomsen, pp.44-57, 2008) Others are clearly an expression of group hatred. Health professionals, in their turn, are not immune from society's dominant ideas about gender and sexuality. So gay men, when they need healthcare, may further suffer the effects of discrimination. Large numbers of heterosexual men also accept the gender division of labour and the conventional symbolism of masculinity without, themselves, enacting a strenuous hegemonic masculinity. The routine involvement of men with motor vehicle use, manual labour, and heavy industry underlies the marked gender differences in accident statistics and certain occupational diseases. The effects of this routine exposure to risks may, of course, be exacerbated by attempts to prove one a "real man" by dangerous driving, as seen in the case studies by Walker, (Walker, pp.23-43, 2008) and by not wearing safety equipment. Some men actively try to change the pattern of masculinity. They are not all moving in the same direction; Messner (Messner; 2007) notes that there are now at least eight distinguishable men's movements in the United States, each with a different agenda for men. Focusing on those who are trying to reshape their lives in the direction of more peaceable and equal relations with women, a rather different set of health issues arises from those we have already noted. Such men must face a certain amount of stress in personal relations because the changes they seek often meet with incomprehension or opposition. Although they are likely to avoid the risks of injury in competitive sport, these men need to find other forms of exercise and body culture. If heterosexual, then they must negotiate forms of sexual relationship that have excitement without dominance. They must find new forms of relationship that provide long-term commitment and support without the inequalities of the "traditional" family form. These are not easy challenges; but they are being taken up, for instance, in the "fair families" studied by Risman. (Risman; 2008) We have noted that health issues differ between groups of men in different social class or ethnic groups. In the conventional understanding of sex-as-biological-difference, these differences appear irrelevant or arbitrary. But from a gender-relations point of view, they are relevant. There is a regular interaction between the structures of gender, class, and ethnicity, as Poynting and associates (Poynting et al., pp.76-94, 2008) emphasize in a recent study of Lebanese immigrant youth and their experiences of racism in Sydney, Australia. Certain gender patterns or symbols may be important in racism or in the shaping of an ethnic identity. Thus, "protecting the White woman" became a main theme of racism in the United States after the Civil War, with serious long-term effects on the situation of African American men. In a very different context, men from Shanghai have the reputation of being more egalitarian in household work and marital relations than men from other regions of China, and that is part of the sense of distinctiveness of Shanghai men. At the other extreme, a polarization of gender, a construction of men as warriors and women as mothers of the nation, is seen in resurgent ethnic-national identities in the Balkans.(Najcevska, pp.24-28, 2007) Health consequences of these gender/ethnicity interactions may range from organized violence to diet to problems in AIDS prevention. Conclusion Clearly, men's health is neither a simple concept nor a single problem. We must acknowledge that some groups of men in affluent societies, such as Australia and the United States, are doing very well in terms of high standards of healthcare and rising expectations of life. Journalistic claims of a "men's health crisis" are much exaggerated. Yet, in some areas we might well speak of crisis situations. These include the very high suicide rates among young men; the very high rates of illness and premature death among indigenous men in Australia (half of whom do not live past the age of 50 years); the very high rates of injury, imprisonment, and death among African American men (Staples, pp.121-138, 2005); and the appalling rates of motor vehicle injury and death among youth. Furthermore, in areas such as diet, alcohol abuse, violence, and use of health services, the deep-seated problems among broad groups of men must be regarded as major health issues. As the public health approach emphasizes, in talking about men as a target group in health policy, we are necessarily talking about gender. This is not a matter of choice or preference. The group "men" is a group defined in gender terms by its difference from and relation to another gender group--"women." As we have seen, the discourse of men's health developed around the idea of margins of difference between men and women. Yet, the greater part of research related to men's health consists of sex-difference studies that treat gender as an abstract category rather than a lived reality. Most biomedical research on men's health, whatever its topic, is entirely unconnected with research on gender relations, men, and masculinities. As a result, much of it is non-cumulative and provides little understanding of the causes of the health problems studied--with similar vague speculations repeated over and over again in different contexts. In short, the field of gender and health is mostly segregated; and this segregation is a fundamental weakness. It is intellectually indefensible, given that gender is an interactive system. It invites conflict and rivalry, which is already a threat in this field, given the misogyny found in some corners of the men's health movement and the defensive anxiety of some women's health activists about loss of funding. It stands in the way of important forms of research and action that must extensively involve both women and men. The way to respond to these problems is clear. We need to develop an integrated approach in which men's health and women's health issues are seen in relation to each other. Such a framework will have important benefits for both research and its application in action. It will allow a coherent approach in which poverty, ethnicity, and region--factors frequently identified as important in the health of specific populations of men--may be incorporated systematically in examining the causes of men's health and illness. These forces also act on women's health; understanding how they act on either group requires research on family structure, family/workplace links, and cultural definitions of masculinity and femininity; in short, a gender framework. Similarly, men's violence toward men, a growing concern in research and practice, cannot be understood in isolation from men's violence toward women (domestic violence and sexual assault being important concerns in women's health). Recent European research (Hearn; 2008) is showing how to connect these issues. Finally, the gender-relations framework makes possible gender-informed healthcare and health promotion action across gender boundaries. Programs that address gender issues by involving both men and women in interaction may be called gender-relevant programs, in contrast to gender-specific programs that address only men or only women. Because many health issues ranging from diet and child safety to sexual health and industrial health involve gender dynamics and must involve both women and men in the solution, the gender-relevant strategy appears not only useful but is also essential in some areas. The work of developing an integrated gender framework and effective gender strategies in health policy and healthcare provision has only just begun. We are, however, encouraged by recent attempts to develop conceptual frameworks for this work (e.g., Sabo 2001, (Sabo pp. 99-114, 2001) Courtenay 2000(Courtenay 2007)) and, in another publication; we have shown how this approach can help integrate a very diverse body of health research. (Connell et al., pp. 347-366, 2001) References Australian Institute of Health and Welfare. Australia's Health 2002. Canberra: AGPS; 2002. Boston Women's Health Collective. Our Bodies, Ourselves: A Book by and for Women. New York: Simon and Schuster; 2003. Broom D. Damned If We Do: Contradictions in Women's Health Care. Sydney: Allen & Unwin; pp. 801-823; 2001. Connell RW, Schofield T, Walker L, Wood J, Butland D. Men's Health: A Research Agenda and Background Report. Canberra: Commonwealth Department of Health and Aged Care; Pages 347-366; 2001. 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