A Salutogenic Approach to Mens Health - Essay Example

Review of “A salutogenic approach to men’s health” Summary “A salutogenic approach to men’s health” by John Macdonald in his book “Environments for Health” discusses the requirement for revamping of men’s healthcare services. In the article Macdonald is concerned with the biased views and policies of healthcare and its providers. He suggests a completely new salutogenic approach to policymaking and giving healthcare to men. He argues that although men are considered the dominant sex, they are also a victim of genderization and stereotypes. For example ‘men are not in touch with their emotions’, ‘men are violent’ and especially ‘men don’t go to the doctor’. This type of stereotyping has had adverse affect on men’s healthcare and alienated men from healthcare. He stresses the need for new healthcare and policies for men that are without any biases and tailored to need their particular requirements be they children, young men or grandfathers. Critique Published by Earthscan in 2005, London J.J Macdonald’s book “Environments for Health” contains many arguments on the affect of social environments on health and in “A salutogenic approach to men’s health” (Ch. 6) he focuses on men’s healthcare. For Macdonald salutogenic health includes psychological and environmental factors, encompassing an interest in the lives of people: their physical, emotional, fiscal and cultural environment. Macdonald believes that any public health approach should address the needs for prevention of disease and access to health care of all categories including children, women, elderly people or men. He feels men’s health is a neglected field. He concentrates on the issue of men’s healthcare and the biases surrounding it. It is rather that in any population health approach one should adopt an overall systems look at the needs for prevention and access to care of different groups in their own right, whether children, women, older people or men. An objective view of the health needs and status of any population will lead to the inclusion of men’s health issues as a matter of course. He concentrates on the social position of men vis-à-vis their health, how factors like stress, status, poverty, violence and gender bias negatively affect provision of necessary healthcare. (Macdonald, 2005) The first thing Macdonald notes is that men’s healthcare is focused on disease rather than men in general and that men are perceived to “behave badly” i.e. the general stereotyping of men is that they are violent, abusive and neglectful of their bodies and health.. So heart disease, cancer etc are attributed to male tendency to neglect and abuse their own health. Even special men’s healthcare programs endorse this view. He talks of ‘deficit model’ of men as at the root of the problems in men’s healthcare policies. In particular he criticizes the Australian DRS (Doctors’ Reform Society) policies that state: The Doctors’ Reform Society recognizes that there are particular issues for men which affect their health. These issues can arise from the process of socialization to compete and dominate in social and political spheres which can foster violence. As a result of this, many men experience a number of psychological difficulties, a reluctance to acknowledge and address their own health issues and diffidence in approaching health services (Doctors’ Reform Society, undated) Macdonald is adamant that such approaches instead of encouraging men to participate in healthcare drives them away, and that the DRS stresses wrongly on male “violence” and “reluctance” to get medical aid reinforcing stereotyping of men. He stresses on dispelling stereotypes and insists: “there is no female monopoly of gentleness and thoughtfulness, just as there is no male monopoly of energetic drive”. (Macdonald, 2005) He argues that to make men participate in good healthcare practices we must first provide positive reinforcement and assure of their value to society especially in the case of young men and retired males. He notes that nowadays young men commit suicide regularly and that Australia leads the world in this field, and that this emphasizes the need for a “cultural shift towards the fostering of the positive inner life force of all men” this point is well made as according to AIHW (Australian Institute of Health and Welfare) the reappraised figures of Australian Bureau of Statistics shows that: “Since the mid 1970s…Australian men aged 20-39 have increased their rate of suicide by 93%, and 18.5% in the past two years alone.” (Costello 2000) Class is also seen as a social determinant to men’s health by Macdonald, his views are collaborated by those of many others including Cockerham who states: “As elsewhere in the world class is the greatest, predictor of health and longevity….. ………….Traditionally the poor have had the worst health and shortest lives” (Cockerham, 2007)In the recent publication of Australia’s Health the AIHW has noted that:“Compared with those who have social and economic advantages, disadvantaged Australians are more likely to have shorter lives, higher levels of disease risk factors and lower use of preventive health services.” (AIHW, Australia’s Health, pg62) This also proves Macdonald’s argument that “men are not a homogenous bundle and social stratification is still a major factor influencing health, including men’s health” (Macdonald, 2005) Macdonald maintains that many boys are diagnosed as ADHD (Attention Deficiency Hyperactive Disorder) and ADD (Attention Deficiency Disorder). He however questions the validity of medicalisation of these symptoms and treating them as disease instead of behavioural phenomena common to excessive energy and vitality in children. Just because society cannot cope with their exuberance does not indicate ADHD children (mostly boys) are ill and need medication. He warns against the unnecessary pathologising of boys and their natural behaviours. This is an interesting question raised by Macdonald and should be considered seriously. . Macdonald advocates a non-deficit approach that would treat “maleness” as natural and acceptable. He highlights the irony of having to exhort “male friendly” approaches in a field where most and many high ranking positions are held by men. He insists that healthcare providers should create environments supportive of men’s health and their access to health services, in ways suitable and attractive to them. Instead of changing the nature of man, the way he is treated should be changed. A sound advice and argument made in favour of improved healthcare. In the text Macdonald states that stress can easily affect both men an d women an then immediately contradicts himself by stating: “many men both see themselves and are seen by their families as the main providers, responsible for the delivery of the basic necessities of life. Permanent insecurity of job tenure in such a context is a recipe for constant stress.” (Macdonald, 2005)This seems a bit of an exaggeration as the western society is now much advanced in gender equality and men are no longer regarded as the sole wage earners. The stress of earning and job insecurity in these times of global recession cannot be attributed to any single sex. A WHO (World Health Organization) report that MacDonald quotes says: Social and psychological circumstances can cause long-term stress. Continuing anxiety, insecurity, low self-esteem, social isolation and lack of control over work and home life have powerful effects on health. Such psychosocial risks accumulate during life and increase the chances of poor mental health and premature death. Long periods of anxiety and insecurity and the lack of supportive friendships are damaging in whatever area of life they arise. (WHO, The Solid facts, p 8).Now nowhere in this statement is their any mention of any sex being more stressed than the other and the claim of men being more stressed because the have to earn a living is inaccurate. Furthermore although Macdonald is all praise for the aboriginal culture on “talk the talk and walk the walk” he does not clarify what “Australian Indigenous understanding of health” (Macdonald, 2005) he is referring to. So the reader (particularly non-Australian) is left mystified as to his meaning. He also does not include any statistical data on men’s health. For example the number of men suffering from ill health according to age, status, race etc. His argument about suicide rates in Australia and elsewhere would have benefited by being backed by statistical data. His focus is on Australian men’s health and the article would also have benefited from the inclusion of data and references from sources outside the country giving it an international appeal. This lack of scientific and statistical data is a big deficiency in an otherwise well written and comprehensive article on the social determinants of men’s health. “A salutogenic approach to men’s health”is a well written text in clear and concise language. Macdonald brings to light several deficiencies in perception and public health care of men. He stresses the need for a mindset which counters the medical pre-occupation with the pathologies of men with a salutogenic approach to men’s healthcare. This article is good resource and must read for students and practitioners of public health interested in the social determinants of healthcare. Bibliography 1. Australian Institute of Health and Welfare. (2008). Australias health 2008.Pg. 62 Retrieved from http://www.aihw.gov.au/publications/aus/ah08/ah08.zip Australias health 2008 is the 11th biennial health report of the AIHW. Its the country’s leading source of statistics and informed commentary on: - patterns and determinants of health and illness across the life stages and the supply and use of public health services and related information. It is useful reference material for students, teachers and practitioners and policy makers of public health and related concerns. 2. Cockerham, W. C. (2007). Social causes of health and disease. Cambridge: Polity. In this book, William Cockerham, assesses the evidence that social factors have direct relating effects on health and various diseases. He notes that stress, poverty, unhealthy lifestyles, and objectionable living and work conditions are all directly linked with illness. He notes a new highlighting upon social structure in both theory and research techniques, he argues that a pattern is now emerging in medical sociology, which looks beyond singular explanations for health and illness. It is an interesting reading for all scholars of medical sociology. 3. Costello T 2000 “Youth suicide myth”, The Age Oct http://www. theage.com.au An interesting article on youth suicide rates and issues in Australia in the news publication ‘The Age’. It is disheartening to find such low levels of self esteem among our youth especially boys. 4. Doctors’ Reform Society of Australia (undated), Policy Statements: Men’s Health Retrieved from http:// www.drs.org.au/policy08.htm The DRS is an organisation of doctors and medical students supporting health care reforms in Austalia.their policy on men’s health demonstrates their poor understanding of males and is something that must be reworked to a more unbiased view of men’s nature. 5. Macdonald, J. J. (2005). Environments for health: A salutogenic approach. London: Earthscan. Salutogenic healthcare makes a holistic examination of the individual as part of a social and environmental group rather than as a private collection of symptoms; it also seeks to re-examine the very meaning of health. This book sets out to map the main steps of the new salutogenic movement and to point toward some of the ways of thinking and action that can help form new methods of approaching healthcare. Indispensable and inspirational reading for students and health practitioners alike 6. World Health Organization. (2008). Closing the gap in a generation: Health equity through action on the social determinants of health: Final of the commission on social determinants of health. Retrieved from http://www.who.int/social_determinants/final_report/csdh_finalreport_2008.pdf A report on the sociology of health by the WHO, this provides valuable statistics and information on health and healthcare. The principles elucidated for salutogenic healthcare for all population groups are sound and applicable in all nations across all genders. Read More