It has long been observed that women live longer than men, worldwide. On average, the life expectancy for women is six years greater than for men. It’s a conundrum – after all, men tend to have more privilege, opportunities, and power than women and girls in many societies. Why then, are health outcomes for males so often worse than for females? The answer lies not in biology but from examining the social determinants of health.
Social determinants of health—as defined by the World Health Organization—refer to the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems that shape daily life. Gender plays a crucial role in all our life experiences; it is one of the main social determinants of health and wellness. However, it’s not the sexual and reproductive organs themselves that have such power, but the meaning and conditions that people and society attach to those organs; in other words—gender roles and notions of masculinity and femininity.
In many societies, women are conditioned to think of themselves as ‘the weaker/dependent sex,’ and men the dominant ones. Entire cultural and religious traditions have been created to reinforce this notion, along with others about power, control, and the ‘ordering’ of society. These ‘norms’—artificial though they are—have taken on a great deal of significance, impacting multiple facets of daily life. Men’s health, in particular, suffers as a result of societal conditioning and harmful notions of masculinity.
Worldwide, studies have shown that women are more likely than men to use health services. While this disparity may reflect women’s increased use of services during their reproductive years, the fact is that men’s health gets far less attention compared to women. For instance—women have become accustomed over the years to messages telling them to check their breasts for cancer. There are annual walks, awareness programmes, screening campaigns etc. This is necessary since breast cancer is the most common cancer affecting women worldwide (Note: men can get breast cancer too, but that is much rarer). There are cancers—such as testicular and prostate cancer—that affect men specifically. However, not as much attention is given to these diseases or to educating men about how to detect them. How many men reading this column, for example, have ever given themselves a testicular exam? How many have ever gotten their prostate checked?
Testicular cancer is a highly treatable and very curable form of cancer. It typically affects younger rather than older men, and can occur in one or both testicles. Prostate cancer develops in older men—almost 99% of cases are in men over age 50—and is one of the most common cancers worldwide, being the second most common cancer diagnosed in men. No matter the kind of cancer however, the earlier it is detected, the better one’s chances of survival generally are. As such, men need to be informed about how to conduct testicular self-examination and encouraged to get regular prostate cancer screening as they age. (Note – there is some controversy about prostate cancer screening with some organizations recommending against it as it may lead to over-diagnosis.)
Men however, are notorious for neglecting their health, ignoring and downplaying concerns, delaying seeking care, and not following treatment regimes as directed. Sociocultural practices that have conditioned boys and men to not show pain, hide their emotions, and ‘be tough’ are hugely to blame. Some men avoid seeking sexual and reproductive healthcare because they are unwilling and uncomfortable with having other men touch them, even if it’s done in a professional setting.
Men’s ego can also sometimes be a barrier to the achievement of good health. Because some men may not feel comfortable admitting when they do not fully understand something—such as the advice and recommendations from a doctor or other healthcare professional—they may misuse medication or not follow up with additional treatment options as needed. And while men may often brag about their sexual conquests, they can be less open to discussing their risk-taking behaviours and the psychological and social factors that may be behind such behaviours.
Economic pressure for men to be the ‘provider’ and breadwinner for their families and loved ones can also significantly negatively impact men’s health and wellness. Men desperate for employment may accept dangerous working conditions and not report hazardous situations or injuries they receive on the job site. They may overwork themselves and not allocate enough time for rest and recuperation.
Social conditioning can also affect men’s ability to acknowledge—both personally and publicly—when they are suffering from emotional distress. Men and boys in particular, are not educated or encouraged to be ‘emotionally intelligent’ ie to share their feelings, be vulnerable, and express themselves openly to others. This can affect men’s ability to provide a comprehensive medical history to their healthcare provider, as well as to acknowledge illnesses such as depression. As a result, men who experience depression, anxiety, and other mental health concerns often do not get the care and counseling that could make their lives better. Instead, too many turn to drugs and alcohol to numb their suffering.
Gender’s impact on health and wellness cannot be ignored; it must be acknowledged, and education and interventions tailored to take gender issues/roles into consideration at all times. However, to really achieve improved health and wellness over the long term, we must fundamentally change the established gender ‘norms’ and harmful notions of masculinity and femininity that have taken root in our societies.
We must teach boys and men to be sensitive, open and expressive, and to value themselves and others. We must create environments that support, prioritize, and promote empathy, critical thinking and inquiry, and social connectedness. We must redefine what it means to be a man/manly. It is not manly to hurt and oppress others, to deny and suppress one’s emotions, or to engage in harmful, risky, or aggressive acts. These traditional ideas of masculinity have become toxic, to men as well as women.
Sherlina can be contacted at firstname.lastname@example.org.