Inside the Social Determinants of (Men’s) Health

June is Men’s Health Month. As such, we wanted to focus on the key health issues men face, how they relate to one another, and how providers are positioned to help.
Earlier this year, a revision by the American Psychological Association (APA) sparked controversy when they revised guidelines for interacting with male patients. The updated guidelines noted that “traditional masculinity — marked by stoicism, competitiveness, dominance, and aggression — is, on the whole, harmful.” Days later, Gillette released a polarizing advertisement, encouraging men to reject harmful behavior and be “the best men can be.” Others felt the advertisement unfairly criticized men.

While opinions were sharply divided, there is evidence to support the claims.

• Men, on average, die nearly five years earlier than women
• Men are more likely to die by suicide
• Men are more likely to be both the victims and perpetrators of violence

One common misconception is that the psychologists at the APA considered all types of masculinity, or the idea of masculinity in and of itself, harmful and negative. That is not the case. Rather, they noted a correlation between certain aspects of what is known as “toxic masculinity” and unhealthy, unhappy lives. These attitudes and behaviors are largely associated with traditional gender norms.
So, what are these norms and how do they hurt men?

How Gender Norms Harms Men’s Health

Aggression and competitiveness, often encouraged whether on the sports field or in video games, can lead to excessive risk-taking behavior. “Unintentional injuries” is the third leading cause of death for men. These same behaviors can be precursors to “substance use and suicide.” Men are more likely than women to abuse drugs and alcohol. One study found that alcohol abuse was a way for a man “elevates or maintains a man’s status in working-class social groups.”
Similarly, the individualism and stoicism have a dark side. The more men believe in “traditional masculinity,” the “less likely to visit a doctor when they are ill and, when they see a doctor, are less likely to report on the symptoms of disease or illness” or use preventive health services. This reluctance is one reason why men die from cardiovascular disease at an alarming rate.
Finally, traditional masculinity’s stoicism is often behind “a lack of emotional sensitivity,” both for themselves and others. This is one reason why men are less likely to share their experiences with depression, and in doing so, suffer intensely and in silence. Men are more likely to fail to have a purpose in life, a perspective that negatively impacts mortality.

What Can Providers Do?

Gender and its norms are subsets of the social determinants of health. A recent survey of men and women found that 97 percent of patients want providers to ask about their social needs. This can be difficult with men for three reasons: as mentioned earlier, men don’t visit their doctor often and, when they do, may withhold information. Thirdly, as stated by the World Health Organization: “Health programs often view men mainly as oppressors – self-centered, disinterested, or violent – instead of as complex subjects whose behaviors are influenced by gender.”
However, those behaviors are in many cases due to the very same social determinants of health. To illustrate this point, look at the APA’s risk factors that can exacerbate the effects of toxic masculinity:

• Exposure to violence at home, in relationships, media and in the community
• Poor family functioning
• Lack of services addressing exposure to trauma and stress
• Social rejection among peers
• Social norms condoning male dominance and violence

These risks actually overlap with many social determinants of health. For instance, “poor family functioning” could include food insecurity, unemployment, and unsafe housing. Similarly, “social rejection” could comprise racially or sexuality-based discrimination.
Therefore, providers may be in a position to reduce the harmful effects of toxic masculinity — on both men and women — by asking about male patients’ social needs. The same survey referenced earlier found that 80 percent of patients wished their physician would offer information on resources to assist with unmet social needs.
Traditional masculinity and the issues it entails is just that: tradition. Change can begin at any time and at any practice. Take a page out of Gillette’s book and help your male patients be the best (and healthiest) they can be!