Men, Masculinity, and Men’s health: A gender dimension

Nature and Culture both affect health. Both affect the body, heart and mind, which ultimately has an impact on one’s individual health.  The gendered expected-behaviour superimposes natural instincts, and thus both men and women strive to achieve the socially prescribed and culturally accepted behaviors. Masculinity can best be understood in this context.

Recently, there was a casual comment made by a male family member, ‘BP has become very normal these days, isn’t it?’ I responded in affirmation, “True. High blood pressure is more common among men. Their tendency to stress is an important reason behind it. If men too could talk their heart out, could gossip a bit here and there, and could manage to take life a little lightly, as many women do, they can beat the stress and avoid high blood pressure”.  My response was contradicted with lot of affirmation saying, ‘Alas that cannot be done. How can one change the nature? To this, I found an opportunity to ponder over the need for revisiting the various determinants of men’s health. 

Being a clinical matter, it is important to have a technical understanding of medicine to understand illness and treatment. However, being a subject of humanities, issues beyond medicine are relevant and important to understand and appreciate one’s health. The determinants of health are different from the determinants of illness. They could be individual as well as societal. They could also be environmental, political, occupational or economic. One’s health can depend on one’s behaviour, attitudes and practices, as well as those prevalent in one’s family and community too. Public health professionals study these factors.  The public health stream emerged in the western world; thus, the public health vocabulary is largely English, and therefore most public health discussions in India are limited to elites only.  At times, it is also difficult to find a parallel in the local vernacular language. This deters in-depth discussions of certain issues in Indian communities at large. For example, it is difficult to find the perfect translation for ‘depression’; most Indian languages do not offer a word that depicts depression with all its essence. One of the reasons why depression is not being discussed freely is due to the lack of a word in the local language.  ‘Gender’ is another such important word.

Gender.  We use this word so commonly and aptly in routine discourse in English. However, in most Indian languages, there is no parallel for Gender. In English, we use ‘gender’ and ‘Sex’ differently according to context.  Sex is used to indicate biological differences as in male or female in most living forms. While Gender denotes the social and cultural dimensions attached to boys/girls or men/women. However, such differences are not obvious, for example, in Gujarati.  Even in the best possible dictionaries, both SEX and GENDER have the same meaning i.e. ‘lingbhed’ or ‘Jatibhed”.  Cultural and social dimensions of gender cannot be described easily in Gujarati.  It is for this reason, most non-professional discussions about health and illness among men and women remain restricted to physical/physiological aspects only.  For example, most breast cancers occur in women and prostate cancers among men.  Most of the times this physiological difference is extended to justify other common illnesses as influenced by nature, as against culture. Non-communicable diseases like high blood pressure, is one such instance.  It is therefore important to understand gender as an important socio-cultural determinant of health of men and women. Gender – by virtue of different roles, norms and power dynamics for men and women affects one’s vulnerability towards certain illnesses and it determines the impact of certain illnesses. Let us understand this with examples before returning to men’s health and masculinity. 

Women bear two-third of the blindness burden globally.  Despite having almost similar eyes, why do women get impacted more due to blindness? A major reason for this is the women’s gendered role of being a homebound caregiver.  Most blindnessess occurs due to poor access to surgeries, preceded by an infectious eye disease - Trachoma, which spreads by contact of an infected person’s hands or clothing, especially infants and children.   In most cultures, women are responsible for cooking.  The very norm of being in charge of cooking put women at a higher risk to the illness.  Women exposed to indoor smoke are 2.3 times more likely to suffer from Chronic Obstructive Pulmonary Disease (COPD), than women who cook with cleaner fuels. Acrid smoke deposits are responsible for 39% of all COPD among women as compared to only 12% among men.  Are these health outcomes in women because of their anatomy or physiology? Or is it the result of their attitudes, behaviors and practices – something that reflects how society wants them to be, behave, and perform?

Now, let us turn to the men’s health issues.  According to an estimate in Canada, Men are 39% more likely to die from diabetes, 84% from arterial diseases and 78% from heart diseases. Men are more likely to experience illness, disabilities, injuries and death than women living in similar socio-economic conditions are. The proportion of men dying of road injuries, coronary heart diseases and suicide is higher than that of women. Similarly, the impact of non-communicable diseases like hypertension, diabetes, and cancer is very high among men.  It is also important to note that while vulnerability of men and women may be different to different illnesses, the impact of several illnesses is higher in men.  Now, the illnesses mentioned above are not sex-specific illnesses. They are common illnesses that can happen to anyone, irrespective of biological attributes. Then, why do men suffer more from such illnesses? Is it something to do with their anatomy or physiology? Or, is it result of their behaviour, which emanates from how the society wants them to be, behave, and perform?

Nature and Culture both affect health. Both affect the body, heart and mind and ultimately has an impact on one’s individual health.  Understanding of the cell and society is thus important to understand health and its determinants. Nature in this context includes the body, physique, anatomy and physiology. Cultural aspects include lifestyle, food and nutrition, beliefs, opportunities for prevention and control of illnesses, etc. These cultural aspects differ across families, societies, castes, religions, occupations, geography etc. The culture enforces a set of do’s and don’ts, and influences the norms around one’s behaviour and practices. Such behaviour and practices in the long run influence and affect one’s health. These gender-related social prescriptions are at times so deep-rooted and culturally ingrained that we tend to accept them as natural aspects of being men or women.  The gendered expected-behaviour superimposes natural instincts, and thus both men and women strive to achieve the socially prescribed and culturally accepted behaviors. Masculinity can best be understood in this context.  Masculinity is socially constructed and made up of socially defined and biologically created factors. 

Masculinity is not a natural or a biological phenomenon. It is the culmination of age-old social and cultural expectations from men.  Most men cannot resist the societal pressure to confirm to masculinity and are constantly engaged in measuring up to the ideal standard against which all men are judged. Men who fall short of achieving idealized masculinity feel stigmatized or marginalized, and thus respond through socio-culturally-defined compensating behaviors that place them at high risk of injury and illness.  The tendency amongst  many men to engage in high risk practices, avoid preventative care, deny illness, delay treatment, ignore health information and physician recommendations can be interpreted as an avoidance of femininity or practices of masculinity which  in turn, contribute to poor health outcomes for men.

The vicious cycle gets complete with men finding it difficult to accept their limitations, share the burden and seek help.  All these ultimately brings unnecessary burden on the heart and the mind of most men, making them vulnerable to stress, hypertension, and diabetes. The common coping mechanisms of men like - isolation, smoking, and drinking also aggravates their vulnerability.  While circumstances could be similar for women in similar socio-economic settings, they employ better coping strategies, are more likely to seek social support and are more effective in the provision of support than men are.  

There are two important points to consider here. First, there is a huge impact of hereditary factors in non-communicable diseases such as hypertension. There is certainly no denial of this predisposing vulnerability. However, equally important are the cultural and social factors, which can me identified and controlled at one’s own will.  Second, the discussion here is not about men or women but about the social and cultural aspects of being feminine and masculine. The discussion is about norms, roles, work distribution, and power dynamics around gender. It is also not about women empowerment or being feminist. It is certainly about identifying, understanding and mitigating the effects of such traditions, customs and norms around men and women that affect one’s health in the long run. 

Coming back to men’s health, it is high time for men to revisit one’s own understanding of masculinity. Without bringing nature or just being man as an excuse, it is important for men to introspect one’s own attitude, practices and behaviour.  Men must re-evaluate the age-old gender norms in light of changing societies, evolved life styles and improved socio-economic conditions of the family. They must identify traditions, customs and norms that do not fit well in the pursuit of their peace of mind. Such practices, which are a deterrent to health in the long-run, must be resisted at an individual level to begin with. Once convinced, they must also be resisted at large in family, community and society level. 

A Few things to ponder over would be -Why men tend to drive vehicles most of the times? Why men prefer not to cook/do other homebound chores most of the times? Why men need to be decision-makers most of the times? Why men cannot resist the need to be the center of attention in families most of the times? There can also be tougher questions to ponder over: Why men need to own property most of the times? Why men need to be the breadwinner of the family most of the times? Why men need to be at the forefront in most social and religious ceremonies/ gatherings? Or, we, the men, can also ponder over tough-to-do softer acts: Why men cannot talk their heart out instead end up talking about Bollywood/politics/cricket most of the times?