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    1 views8 pages

    Handbook Kimmel Cap.19

    Uploaded by

    Pablo Barrientos Lara
    Handbook

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    © All Rights Reserved
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    An Overview Don Sapo study the influences of gender on men’s health and illness (Courtenay & Keeling, 2000; Sabo & Gordon, 1995; Schofield, Connell, Walker, Wood. & Butland, 2000). The growth of women's health movements in the 1960s and 1970s fueled systematic and inter- isciplinary studies of gender and health, and by the mid-1980s, the focus on gender had become a recognizable aspect of epidemiology, medical sociology, and interdisciplinary studies of psychosocial aspects of illness (Lorber, 1997; Stillion, 1985; Verbrugge, 1985; Waldron 1983). However, most of this early work on gender and health revolved almost exclusively around women, For some men, the reconcept- alization of gencler that was initiated by feminist scholars and activists became the inspiration for the emergence of “men's studies” in the 1970s and 1980s. As the new men’s studies took shape jn men’s minds and polities, so too did some of those early male scholars begin to explore how conformity to traditional masculinity sometimes increased men’s physical health risks and impoverished their emotional lives. The theory S ccholars and researchers have begun to 226 Tue Stupy oF MASCULINITIES AND MEN’s HEALTH in men’s health studies generally followed the conceptual trajectory of interdisciplinary gender studies and, more particularly. the study of men and multiple masculinities (Connell, 2000; Courtenay, 2000:; Sabo, 1998) ‘Today. the study of men’s health has expanded! from a handful of isolated scholars and activists to an international array of researchers, health promoters, health educators, and special- ists working in world health organizations, gov- ernment programs, health eare delivery systems, academia, public health offices, and community- ‘based organizations. In academia, a nascent yet recognizable subfield within gender studies has taken shape. There is a growing awareness in social scientific and biomedical circles that males share specific health risks and needs; for example, a nurse working in a prostate cancer cline thinks in terms of “men’s health” as well as “women’s health,” and a reproductive health educator in Toronto, Canada, develops a program 0 teach adolescent males about safe sex. “Gender-specific health” is becoming a biomedical specialty (Legato, 2000b). Most recently, men’s health professionals and scholars have begun to think about their work within lobal frameworks, communicating and net- working across national and cultural boundaries (Courtenay, 2002). This global network is more a vision than a reality, but men’s health studies promise to expand in future decades, This chapter renders an overview of the history and development of the study of men’s health, along with providing a discussion of key theoretical models and some of men’s gender- specific health issues, Several groups of boys and men with unique health needs are identified, and finally, some global frameworks for under: standing men’s health are presented. This overview is incomplete because the subfield of men’s health studies has gotten too large, com- plex, and global for any one person to fully mon itor, so my primary focus on North American issues and developments is evident. Oniciys ann History North American research and writing on men’ health during the 1960s generally collapsed men fand masculinity into a demographic category. Biomedical researchers reported variations morbidity and mortality “by sex,” and disease rates between “the sexes” were compared and contrasted. A historical irony had unfolded. The bulk of academic scientific medical research after World War If had focused mainly on men because most physicians were men, men domi- nated medical research, and it was men and not ‘women who were selected as research subjects for most studies (Legato, 2000a, 20000). Not only did the patriarchal biases of male medical researchers progiuce myopic and sexist views of women, but they also reduced the personal and ccultural aspects of men’s lives to biological and statistical categories, The gendered aspects of both women’s and men’s health behaviors snd outcomes were not discerned. The growth of women’s health movements during the 1970s challenged the patriarchal sta- tus quo, Second Wave feminists made many researchers and health practitioners acutely aware of gender relations. They decried men's domination of health care delivery. systems, exposed sexism in the diagnosis and treatment of women, and explored how women’s adoption of certain feminine traits and behaviors negatively affected physical and mental health. Women’s Masculinity and Men's Health + 327 pioneering analysis of the links between gender and health, however, did not include critical scrutiny of men’s health, and only a few male ‘writers in the early “men’s liberation” movement alluded to men's health issues (Nichols, 1975: Snodgrass, 1977). Some prominent writers focused on men’s health issues such as the risks imposed by violence and overinvestment in work and career (Farrell. 1975; Feigen-Fasteau, 1974 Goldberg, 1976, 1979). Sabo (2000) described the thinking around men’s health in the 1970s as “exploratory.” that is, “tangentially informed by feminist theory and polities, and conceptually ‘organized around the general premise that men's conformity to traditional masculinity produce certain health deficits” (p. 134). During the 1980s, male scholars elaborated the deficit model of men’s health with greater zeal and detail, The emergence of profeminist men’s movements, the growth ofthe “new i studies” (Brod, 1987) and research on “men and masculinity,” and the rapid growth of sex role ‘theory in mainline social sciences formed a con- ‘ceptual framework for explaining how confor ‘ity to uaditional masculinity elevated. health risks, Bravado in boys was linked to fighting and physical injury, drinking, and automobile acci dents, while the “demands of the male role.” stress, and sympiom denial were tied to men’s risk for coronary heart disease (Harrison, Chin, & Ficcarrotto, 1992). Stillion (1985) explored differences in the ways females and males per: ceived sickness and death, Sabo, Brown, and Smith (1986) documented how men’s adherence to the traditional busband-provider role shaped their experiences with a female partner’s breast cer and mastectomy. Jackson’s (1990) critical autobiography explored how his masculine iden- tity suffused his experiences of being diagnosed and treated for heart disease. The growth of gay rights activism in the 1980s also fueled public health initiatives and educational efforts regard- 2 gay and bisexual men, There were protests against governmental and homophobic indiffer- fence to the health needs of gay and bisexual men, and community-based awareness. grew concerning the need for safe sex and the dangers of HIV transmission, In contrast, very little research or health initiatives focused on the health needs of poor men or men of color: uring the 1990s, the study of men’s health grew rapidly, imegrating clinical and epidemio- logical research findings into progressively TTT 328 + BODIES, SELVES, DISCOURSES interdiseiptinary conceptual frameworks that highlighted the workings of gender (Courtenay 2002). Analyses of men's health closely followed theoretical developments in wht in various schol- auly circles were called men’s studies, the new men’s studies or critical studies of men and mas- culinity. The use of eritial feminist perspectives, to analyze men, masculinity, and health emerzed as'men's health studies” (Sabo & Gordon, 1995), Building on critiques of sex role theory's narrow focus on gender identity, socialization, and con- formity 0 role expectations, critical feminist thinkers argued that men’s health is profoundly lected by power ciferences tht shape relation ships between men and women, women and ‘women, and men and men (Courtenay, 2000) Connell’ (1987, 1995) concept of “hegemonic: masculinity” forged a conceptualizaton of men’s, seender identity as actively worked out, revamped, and maintained by individuals who are situated in socially and historically constructed webs of power relations—and it is amid these myriad ‘webs that heal processes and outcomes were understood to take shape. Critical analyses of ‘men’s health increasingly recognized the “plural- ty of masculinities” and the intersections among sender, class race/ethnicity, and sexual orienta- tion. Men's health behaviors unfolded within mul- tiple hierarchies composed of rich and poor men, First World and Third World men, straight and gay men, and professional men and these who Iaored in factories or on farms “Mostrecenty. relational theories of gender and health have emerged that recognize that men's and women's health outcomes are intricately interconnected (Sabo, 1999; Schofield et al. 2000). Mast scholars have focused on health and illness within each sex rather than berween the sexes. As Schofield et al. (2000) stated it, “A gen- der relations approach is one which proposes that ‘men’s and women’s interactions with each ober, and the circumstances under which they interact, conteibate significantly to health opportunities and constraints” (p. 251). Sabo (1999) has devel ‘oped a model for assessing the health impacts of various. relationships between the sexes. He argues that a “positive gendered health synergy” exists where the pattem of gender relations pro motes favorable health processes or outcomes for both sexes: for example, a husband-ather’s com tributions to child care and domestic work fee up the wile-mother 1 purue a finess agenda In contrast a “negative gendered health synergy ‘occurs where the pattern of gender relations is associated with unfavorable health processes or ‘outcomes for one or both sexes: for example, a depressed male batters his wife, triggering physical injury and emotional trauma, Courtenay (2002) extends the vision of rela: tional models this way: These models would take into account the dynamic intersection of various health determi nants, such as those among biological functioning environmental pollution, psychological well being, social and cultural norms, genetic predis: Position, institutional poticies, pottcal climates, and economic disparities. (p. 9) Such “relationships,” he argues, cover a chal lenging span of human interactions and social structures, including relations between men and women, men and men, individuals and institu tional structures, cultures, and nations around the world, (More is said about globalization and ‘men’s health later in this chapter.) SieriNG THROUGH DeMocrapics oF DirFERENCE Ashley Montagu (1953) long ago observed the marked differences in the mortality rates between males and females. Because males died earlier than females throughout the entire human life span, from conception to old age he argued that men were biologically inferior to women, Epidemiological data show, for example, that males in the United States are about 12S more likely than females to experi- ‘ence prenatal death and about 130% more likely to die during the frst bree months of life. Table 19,1 illustrates the disparities between male and female infant mortality rates (i.e. death during the first year of life) across a 50-year span of the 20th century. Men's greater mortality rates persist through the “age 85” subgroup and, as Table 19.2 shows, male death rates are higher than female rates for 12 of the 15 leading causes of death in the United States (National Center for Health Statistics, 2002) Whereas biological differences between the sexes probably influence the variation in mortal- ity rates, social and cultural processes are also at play. For example, women’s relative advantage ‘over men in life expectaney was rather small in ee | Masculinity and Men's Health + 329 ‘Table 19.1 Gender and Infant Morality Rates forthe United States, 1940-1989 Year Both Sexes Mates Females 1940 470 528 413 1950 292 228 258 1960 260) 23 26 1970 200 24 7s 1980 126 Bo na 1989 98 108 88 SOURCE: Adaped fom Center for Disease Control and Prevention, Monthly Wad Static Report. 48. Suppl. 2. pA NOTE: Rats ar for infant (under 1 year) deus pe 1,000 five bis fr ll aes, ‘Table 19.2 Ratio of Male to Female Age-Adjusted Death Rates, forthe 15 Leading Causes of Death for the Total U.S. Population in 2002 [Nantber of Toa Male to Female Rank Cause of Death Deaths Percentage Ratio 1 Diseases of heart 710.760 296 14 2 Malignant neoplasms 553.091 20 1s 3 Cerebrovascular 167.661 70 10 diseases 4 Chronie lower 122.009 su 4 respiratory diseases ‘Accidents (unintentional 97,900 41 22 sures) 6 Diabetes mellitus 69,301 29 12 7 Influenza and pneumonia 65.313 27 3 . Alzheimer's disease 495558 2 08, 9 [Neptis, nephritc 37.251 18 14 ‘syndrome, nephrosis 10 Septicemia 3224 13 12 n Inventanal harm (suicide) 29.350 12 45 2 Chronie liver disease and 26552 ul 22 cirshosis B Essential hypertension and 18073 os Lo hypertensive renal disease 4 Assault ¢homicide) 16.765 07 33 Is PPheumonitis due to solids 16,636 07 18 ad liquids ‘SOURCE: Adapied fom National Center for Health Suisies,Naianaf Vita Staves Report, S018), September 16, 2002, Table the early 20th century (Verbrugge & Winegard, 1987; Waldron, 1995). As the century pro- gressed, female mortality declined faster than ‘male mortality, thus widening the gender gap in life expectancy. While women benefited [rom decreased maternal mortality, the rise in men’s life expectancy was slowed by higher rates of heart disease and lung cancer, which, in urn, ‘were owed mainly to increased smoking among males. In recent decades, the differences between men’s and women’s mortality rates hhave narrowed, partly because women have BEDE EEE EELS 330 + BODIES, SELVES, DISCOURSES increasingly taken up smoking and other tisk behaviors that elevated their rates of heart disease and certain cancers. The historical vari- ations in gender differences in lile expectancy in the United States, Canada, and other post industrial nations suggest that both biology and sociocultural processes shape men’s and women’s mortality. Waldron (1983) speculated that gender-related behaviors contribute more than biogenic factors to the variations in mortal- ity between the sexes, Although females generally outlive males, they report higher rates of acute illnesses such as respiratory conditions, infective and parasitic conditions, and digestive system disorders than males do. In contrast, males report higher rates of injuries than females, with injuries related to socialization and lifestyle differences. such as working in manufacturing jabs, involvement with contact sports, and risky occupations (Cypress, 1981; Dawson & Adams. 1987: Givens, 1979). Cockerham (1995) wondered if ‘women really do experience more sickness than ‘men, or whether men are less likely than women to report symptoms and seek medical care. He stated. “The best evidence indicates that the overall differences in morbidity are real” and, further, that they are due to a mixture of biolog~ jeal, psychological, and social influences (p. 42) Understanding the disparate morbidity and mortality rates between men and women is further complicated by the emphasis on gender Aifferences, which, ironically, has been part of traditional patriarchal beliefs and much Second Wave feminist thought, Whereas patriarchal cul ture exaggerated differences between men and women, and masculinity and femininity, Second Wave feminists. theorized a “presumed oppo sitionality” between men and women, and masculinity and femininity (Dighy, 1998). Epi demiologically, however, the emphasis on differ- ences can sometimes hide similarities. For example, Macintyre, Hunt, and Sweeting (1996) questioned the conventional wisdom that in industrialized countries men die earlier than ‘women, and that women get sick more often than men, They studied health data sets from both Scotland and the United Kingdom and found that, after controlling for age, statistically significant differences between many of men’s and women’s self-reported psychological and physical symptoms disappeared. They concluded that both differences and similarities in men's ‘and women’s health exist and, furthermore, that changes in gender roles during recent decades “may produce changes in men's and women’s experiences of health and illness” (p, 623), In summary, although some gender differ- cences in mortality and morbidity are associated ‘with biological or genetic processes, or with seproductive biology (e.g. testicular or prostate cancer}. itis increasingly evident that the largest variations in men’s and women’s health are related to shifting social, economic, cultural, and behavioral factors (Courtenay, MeCreary, & Merighi, 2002; Kandrack, Grant, & Segall, 1991), For this reason, Schofield etal. (2000) er fiqued the prevailing “men’s health discourse. which too often equates “men’s health” to the delivery of biomedical services to men, oF to pi vate sector marketing services of products designed to enhance “men’s health.” They reject Iumping “all men” into statistical comparisons between men’s and women’s health outcomes because, mainly, itis disadvantaged men (e.g. poor men, men of color, uninsured men, gay men) who disproportionately contribute to men’s collective higher mortality and morbidity rates in ‘comparison to women, As Keeling (2000) writes, ‘So it is that there is no single, unitary men’s health—instead, sexual orientation, race, socio economic status, and culture all intervene to affect the overall health status of each man and of men of various classes or groups” ¢p. 101). ‘Cursent Men's Heatra Issues. ‘A variety of health issues have received particu- Jar attention from researchers and men’s health advocates. Some issues that have received par- ficular attention in North America are discussed below. Alcohol Use Although social and medical problems stem- ming from alcohol abuse involve both sexes, males constitute the largest segment of alcohol abusers. Some researchers abserve connections between the traditional male role and aleohol abuse. Isenhart and Silversmith (1994) showed how, ina variety of occupational contexts, expectations surrounding masculinity encourage heavy drinking while working or socializing

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