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?