How a Country's Gender Equality Affects Men's Health Outcomes
Gender equality is a provably good thing. It has benefits in business, in science, and in health. But in some sections of the popular culture, gender equality has been cast as purely a women’s issue. It’s not.
A new report from the World Health Organization (WHO) found that living in a country with gender equality also benefits men’s health, leading to lower mortality rates, higher well-being, and lower suicide rates.
To understand this correlation requires a modern understanding of what gender really is: a complex set of social relations and practices attached to biological sex. Masculinity, therefore, isn’t purely biological, but rather a set of attributes, values, and behaviors that are considered social norms essential to being a man in one’s culture. And in many cases, those social norms are unequal, unjust, and a detrimental determinant of health.
Historically, health policies with a gender-equal approach have focused primarily on improving women’s health. But men’s health has been largely ignored. As it stands, men are four times more likely to commit suicide, less likely to access health services, more prone to substance abuse, and, overall, more likely to die younger than women. Somehow, those inequalities have been normalized throughout society as a side effect of simply being a man. But the reasons for these disparities aren’t biological, and a more gender-equal approach could help resolve them.
Inequality in Men’s Health
The WHO report identified several points where gender inequality and social norms associated with traditional masculinity have negative impacts on men’s health, including increased risk-taking, adherence to the breadwinner model, and a general stigma against accessing health services.
Risk-taking is a broad category, but it manifests itself in sinister ways. For example, the WHO report cites a study of men in Russia that found heavy drinking of strong alcohol to elevate a man’s status in working-class social groups and facilitate access to power. In this instance, men aren’t drinking more because they’re men; they’re drinking more because of unequal social pressures to do so.
And similar forms of social pressure can extend to other areas of elevated risk that come with adverse health effects, leading to higher rates of smoking and increased chances of fatal traffic accidents. When taking risks is seen as a normal, even laudable, male trait, there will naturally be more risks taken—and therefore a larger number of men for whom the risk does not pay off.
The breadwinner model, which signifies the traditional norm of men being the primary earner and provider of the family, can also lead to serious negative health outcomes. Long hours at strenuous jobs come with their own inherent risk. But the additional pressure of being a sole provider can lead to an increased likelihood of smoking, depression, and hypertension. These negative outcomes can occur, or even become exaggerated, during periods of unemployment.
Other health risks are compounded by traditional views of masculinity that discourage men from seeking out health services. According to a study by IMAGES, men with less gender-equitable views were less likely to seek a prostate exam or get an HIV test. Furthermore, while the men in the IMAGES study were more likely to report high levels of self-esteem than women, they also reported higher levels of depression and negative feelings. Meanwhile, according to the CDC, men are nearly four times more likely to take their own life than women are, making suicide the seventh leading cause for death amongst men.
A study of nearly 2,500 young adults aged 18 and 19 found that men who strongly identified with the male-breadwinner social norm were more likely to have suicidal thoughts and exhibit signs of depression. Viewing the inverse, data suggests gender equality may reduce rates of male suicide by empowering women to reduce men’s financial responsibility and help weather economic uncertainty. Further research by the University of Oslo shows that areas with more gender inequality have higher rates of male suicide.
This isn’t a genetic defect, it’s representative of a glaring gap in health services able to effectively reach and treat men. Part of the problem has to do with the social norms, but part of it also has to do with inadequate service models, ones that fail to address men’s health in an equitable way.
Making Men’s Health Services More Gender Equal
Health systems need to change by incorporating more gender-equal social norms and people-centered services. Designing models of care that are accessible to men—and addressing the impact of masculinity across their lives—can reach out to at-risk men while simultaneously acknowledging their diversity.
Currently, health professionals aren’t adequately versed in gendered health care services. Research from the University of Leeds found that both primary care physicians and healthcare administrators need to be better trained in how to effectively communicate with men and encourage healthy choices and behaviors. Many of today’s health professionals have been found to lack competencies in counselling men on contraceptive methods. Also, family planning services are not adequately designed to welcome men. As such, they can reinforce sex differences and stereotypes.
Men avoid health services, in part, to avoid what’s perceived as weakness and vulnerability. But there are systemic problems at work in those health care services, too: many mental health systems use criteria generally focused around the behavior of women, such as the expression of sadness (rather than anger) when diagnosing depression. A truly transformative approach would aim to improve health outcomes by redefining harmful gender norms, challenging gender stereotypes, and developing more equal gender roles and relationships. Conversely, health initiatives that fail to take these gender perspectives into account not only risk a failure of service, they risk perpetuating the harmful stereotypes which are negative determinants of health for men.
The WHO report cites a survey of 82 men in less affluent areas of Northwest England. These men largely found marketing materials and stereotypes completely inaccessible. The media image of going to pubs and clubs and football matches wasn’t relatable for men who spent most of their time at work or doing grocery shopping. Advertising for health initiatives needs to take this into account and become more individualized, both to different subsets of men and also to different locations.
A 2010 report by the European Commission found that sex-differentiated prevention programs and health educaiton initiatives mainly target women. This is in spite of the fact that women are already more likely to seek help for health issues that they face. Furthermore, men require different programs than women and are incentivized by different approaches. The available literature suggests that men are more attracted to health services that do not require extensive time commitment, involve clear action and practical insertion into daily routine, and promote positive models of manhood (such as involved fatherhood).
Consider two ads designed for men who smoke: one that says you need to quit smoking because it’s bad for your health and another that says quitting smoking is a tough but worthy sacrifice. To some men, the first approach sounds like a nagging partner. The second approach sounds like someone who’s been there before.
Initiatives need to be developed to address the negative social norms around masculinity. The Men’s Shed, founded in Australia in 1998, does precisely this. It does away with the idea that men are not supposed to talk about emotions or care about their health. The motto: “Men don’t talk face to face, they talk shoulder to shoulder.”
The group’s activities include tools that promote skill-building and physical and mental health. The core values are leadership, equality, and openness. Since its founding, its grown into a global movement. There’s room for more movements like it.
A Team Effort Toward Healthier Socieities
Putting women’s health and men’s health in binary terms, instead of an interlinked issue, threatens the uptake of gender approaches to men’s health. Policy level fixes are available: flexible parental leave and better child-care can create a more even split of household tasks and foster a more equitable and healthier environment for all. Research shows that men who are more involved in their family life live longer, have fewer health problems, are more productive at work, and are generally more satisfied with their lives.
But gender equality isn’t about correcting problems related to a single gender and never has been: it’s a team effort, where the scoring isn’t zero-sum but universally beneficial.