Improving the health of men and boys is a surprisingly complicated task involving problems, paradigms and gender politics, according to men's health specialist Paul Hopkins.

---This is article #21 in our series of #100Voices4Men and boys

Consideration of a combination of the sciences of human biology - neuroscience, psychology, endocrinology, and socio-biology, alongside social determinants of health, plus recognition of the influence on health of overlying cultural factors appears a reasonable premise for academic study and action on health concerns, with different disciplines working together to achieve a common good. However, add the words ‘gender’ and ‘male’ and academe enters a place of paradigms, politics and problems.

Welcome to men’s health: it’s complicated.

People who consider health to be a generic subject may ask why a focus on men? Why - because there is a sound rationale for action on men’s health. A cursory run through the evidence reveals that:

men die on average four years younger than women – and the gap has remained consistent throughout previous decades

cardiovascular disease is the largest cause of death of men in the UK, occurs at an earlier age in men and is a cause of premature male death

excluding breast cancer, men have a greater probability of cancer than women of most of the common cancers that befall both sexes

men are more likely to work in blue-collar jobs involving industrial processes that have an adverse affect on health

men are more likely to drink alcohol, smoke and use substances than women, more likely to be homeless or in prison

a disproportionate number of young males are killed in transport accidents and young men are consistently the group most at risk of suicide. The burden of suicide is three times greater in men

men tend to use health services less often than women and present themselves to health services at a later stage, often when their illness has advanced

services aren’t constructed so that they’re accessible to men; men may want to access preventative health services but they can’t

So what are we doing about it?

Given the weight of evidence it could be argued that a substantial national male health policy such as those introduced in the Republic of Ireland or Australia should have been put into place, and gendered, preventative health work embedded as part of health work infrastructure. Australia also has a ‘National Women’s Health Policy’ to act on the differential needs of females. However, whilst gendered health work may seem a sensible step to health strategists in Ireland and Australia, Western countries with similar evidence of the burden of male health, the UK has a Gender Equality Act via which inequalities in health are supposed to be addressed.

This may work in terms of ensuring single sex hospital wards, but it does not provide dedicated, gender-based preventative health policies and the actions required to implement them. In the meantime, preventative health work is driven by single-silo strategies that pay passing heed to male health concerns; the national male health policy that would provide a driver for real preventative health work does not appear to be part of the mindset of the architects and bureaucracies of UK health PLC.

The advent of commissioning of preventative health services, allied to the dispersal of health promotion departments and the loss of skilled staff in this area is also problematic. Public health and health promotion are allied but different disciplines. Whilst some public health commissioners may have a background in health promotion work, the current strategic concentration on the fiscal aspect of value for money services and a bean-counter mentality does not sit easily with gendered health work. An understanding of male health, what works, how to engage with men and attract men to services is vital to the provision of preventative services.

Given the single silo nature of public health work, with commissioners concentrating on one health topic - mental health, sexual health, obesity et al, it is likely that few commissioners have an understanding of men’s health, and even more unlikely to have undertaken serious study in the subject. Training, workshops or conferences would be a useful start, as might a discussion of the financial benefits of gendered work. But there’s another issue – and this one also has an antipodean twist to it.

Is feminism a barrier to improving men's health?

Any truly objective training on male health, or any national policy would come up against a paradigm issue, an academic debate at the heart of work on male health that has encumbered the disciplines involved and has resonance for practitioners involved in implementing preventative work. Male Studies is a recent academic discipline that has a largely Australian and American basis and seeks to explain men’s health outcomes based upon the biological sciences, social determinants and cultural factors mentioned at the beginning of this article.

Male Studies acknowledges that research into male health is not confined to any one discipline but covers a range of academic and professional disciplines and theories. The rationale appears straightforward, but for academics and practitioners wishing to establish Male Studies courses and undertake practical health work with men a politicised barrier is encountered; another humanities grounded academic discipline got there first.

There are two perspectives on male health. On one side is the Male Studies perspective already mentioned; on the other is a sociology-based camp that holds that masculinity is largely a social construct, that a traditional Western form of masculinity is damaging to health and thus work should be undertaken that challenges men on aspects of their masculinity, with an aim of decreasing risk-taking behaviours and improving health outcomes. A limited biological basis for men’s health outcomes is acknowledged.

The genitor of this work is an Australian sociologist, Raewyn Connell. This perspective has its roots in gender studies and feminist critiques of men; Connell’s 1995 work Masculinities is the formative text for this body of work. Men’s Studies or Critical Studies on Men are terms used to describe the sociology-based camp, which has a global presence, with established courses in academic institutions in many countries. Sociologists argue that Male Studies perspectives are overly deterministic and fail to take into account men’s hierarchical social practices as the key driver of men’s health outcomes; that Male Studies perspectives of working with some men ‘as they are’ may reinforce what is perceived as a harmful form of ‘masculinity’.

Are men behaving badly or are we helping men badly?

Male Studies advocates consider that health work should acknowledge male psychology and biology and the societal expectations, realities, and demands of men’s lives. That the narrative of ‘men behaving badly’ expressed by sociologists is a negative one, a deficiency approach of blaming males for health outcomes. Male Studies academics contend that male health work should concentrate on addressing the social determinants of health and consider the positive things that can be done to improve health, such as building social connections, promoting lifelong education, developing male friendly services and providing secure employment.

In a UK context, academic work and work that seeks to influence policy on male health is heavily weighted towards a sociology perspective. For example, the recent (2013) Men’s Health Forum, Haringey Man MOT Project. A review of the literature: men’s health-seeking behaviour and use of the internet, states that “there is a clear need for further studies to examine the influence of masculinities on how men behave.” It has been said elsewhere that the sociology-based work on ‘masculinities’ and men’s health holds a place of privilege in academia – primarily due to work being rooted in long-standing feminist and gender studies work.

The Male Studies biological, psychological, social determinants perspective is a more recent academic phenomenon. However, there is no university in the UK that has implemented work from this perspective - a Male Studies course. Indeed there is no university anywhere on the globe that is currently running such a course.

What became of the world's first Male Studies course?

A world first Male Studies course at an Australian university was the subject of a furore in the Australian press earlier in 2014. This emanated from an article by a journalist suggesting that the course was ‘antifeminist’ and that those involved were ‘male rights’ people. The intervention of the journalist occurred just prior to the launch of the course and whatever the official reasons were, it was cancelled. The first part of the course was a Male Health and Male Health Promotion component aimed at doctors, nurses and other health professionals; it was to be run by university staff and health professionals. Feminist academics rallied around the media article stating that there was no need for a Male Studies course and that feminism held the answers to men’s health. You pays your money you takes your choice – except there was no choice of course.

A concern is, is the debate about improving male health, or about the imposition of ideology? That adherence to an ideology based on equality is actually detrimental to one gender? That work that may enhance the health of men is stifled by an academic camp that purports that it has the answers based on an ideology, and that other perspectives are suppressed? Questions are asked but there has not been a meeting of academic minds; both camps are entrenched in their positions and there is a lack of dialogue between them other than to take pot shots and sling mud at each other. Don’t expect this to be resolved any time soon

So where now? There is consensus on both sides of the argument on the evidence base for work with men and the need to do something about it. In terms of strategic thinking, the Australian National Male Health Policy took a pragmatic view. It considered the different perspectives and research on male health; it acknowledged in part the social construction perspective, but also stated that men do value and are interested in their health – that services are not male friendly in terms of access, branding of services and timing of service opening hours. Provision of male friendly services to improve access for men is part of a policy that those of us working in the UK can only hope and lobby for.

That any future UK policy would consider both sides of the argument is a concern given the historical dominance of ‘masculinities’ in academia. In Australia and elsewhere, questions can be asked as to the motives for publication of an article sensationalising Male Studies work on the eve of the first Male Studies programme. In a global context the Male Health and Male Health Promotion course should have gone ahead. Not because of any tit-for-tat ideological argument, but because it allowed for consideration and application of other approaches to male health through the combination of different sciences and theories; approaches that may be beneficial to men’s health, not only in Australia but in other countries that share a similar burden of male health concerns.

---Picture credit: Flickr/speedoglyn1

Paul Hopkins is a Men's Health Promotion Specialist and practitioner; his work includes clinical practice, public health, not-for-profit work and more recently work as a Research Associate for the University of South Australia. He is currently involved in developing the Mengage (UK) initiative.