The Battle of the Sexes in Health Care?

In the past few decades, women’s health issues have risen to the forefront of public awareness campaigns. Most people recognize the pink ribbon as a symbol of the fight against breast cancer, for example. Due to increased public health campaigns, more women now visit their doctors for routine Pap smears to detect cervical dysplasia and cervical cancer, reducing the number of women who die from cervical cancer by fifty percent over the past forty years. Various programs seek to provide women with everything from emotional support for survivors of gender-based violence to prenatal care. But what about men’s health?

In a recent post, NPR blogger Michaeleen Doucleff wrote that men are now the “unsafe sex.” Why? Because “programs and policies for men have been ‘notably absent.’” Doucleff pointed to the UN’s 2000 Millennial Declaration (now known as the 8 Millennial Development Goals) to improve global health as evidence that overall there has been far too much attention on women’s health issues and not enough on men’s.  Goal  5, for example, addresses maternal health, a female condition, while none of the UN’s Millennial Goals specifically address men’s health issues. This indeed would be a recent phenomena considering science has historically defined the male body as the norm and woman’s body as the “other.”[i]  Ancient Greeks, such as Plato, Aristotle, and Galen, “proved” women’s inferiority using a multitude of “scientific” theories, including the argument that stated women’s genitals were the inverse of men’s because they did not have enough heat to perfect their genitalia and push them out like men. You’d think the general idea would’ve died, but no. Medical and gender historians, like those here at Nursing Clio, have discussed many instances of a gender bias in science, medicine, and health care. Some of it is still intact.[ii]

NPR’s blog post loosely (and I mean very loosely) based its material off of a study published in The Lancet. In “Gender and Global Health: Evidence, Policy, and Inconvenient Truths,” Sarah Hawkes and Ken Buse examine the influence (or absence of influence) of gender in global health care. The study by itself has some problematic aspects, such as its limited sources as the basis for its argument. Its key problem, however, is similar to the NPR post in its oversimplification of the role of gender in health care. The study also incites a battle of the sexes when it concludes with the following: “Now is the time to take the call from Alma Ata in its literal sense- “Health for All” not only for some.”

Heath care is unquestionably a concern for all, not just one sex alone. In the United States, men face roughly a 1 in 6 chance of developing prostate cancer in their lifetime. This rate is higher than the 1 in 8 chance women have of developing breast cancer, although the number of deaths for breast cancer (40,030) exceed those for prostate cancer (29,720). Even with screening measures in place for prostate cancer, they are not routinely used, since a federal panel claimed these blood tests were “unnecessary.” Of course more should be done to address this problem, including more effective screening measures and better treatments to decrease deaths from prostate cancer. But this disease wasn’t even addressed in the NPR post. Instead, the writer, like some other men’s health advocates, focused on alcohol and tobacco usage as well as aggressive driving practices.

Now, let’s look at this in the United States. Is alcohol abuse only a male problem? Nope.  In fact, while men are twice as likely to be diagnosed as alcoholics, women are more likely to develop health related problems from heavy alcohol use. Women don’t have to consume as much as men to have a higher blood alcohol concentration level, and so they start experiencing alcohol-related health problems at lower drinking levels than men. Historically, recognizing alcoholism in women has been a problem. Early members of Alcoholics Anonymous (AA), for instance, were reluctant to include female alcoholics. Health problems from alcohol are less gendered than generally assumed. How about tobacco use; is that a men’s problem? Well, more men do smoke when compared to women, but the rates are 23.1% of men and 18.3% of women. I wouldn’t exactly call that 5% difference worthy of labeling smoking as a men’s issue.  And, what of the last problem noted- aggressive driving? Men are reportedly 25% more likely to be at fault in an accident and almost three times as likely to die in a car accident (which is a notable difference), but a recent study in DC found the gender gap in aggressive driving is not as large as people think. They discovered 54% of women admitted to aggressive driving behavior, including tailgating and speeding, compared to 64% of men. Nationally, aggressive female drivers appear to be on the rise, particularly among young women. In short, the main problems cited by NPR and some other men’s health care advocates- drinking, smoking, and aggressive driving- are not specific to men.

Moreover, what benefit would PSAs against alcohol abuse, tobacco use, and aggressive driving have by claiming these problems as men’s issues? Yes, media campaigns target a specific audience hoping to have a larger impact, but medical campaigns are to raise awareness. The point is to improve global health, not increase inequalities or perpetuate gender stereotypes, like in this billboard.

“This year thousands of men will die from stubbornness.” The ad draws attention to the problem of male resistance to seeking medical help, and it shows the negative consequences that can result. However, it also reaffirms stubbornness as a part of masculinity.

Sarah Hawkes from the University of London’s Institute of Global Health pointed to gender norms as key in contributing to men’s health issues, and I heartily agree. When young boys are taught that being a “real man” is to be aggressive and stubborn, to avoid the doctor because needing medical help shows supposed weakness, this sets some men up for preventable, avoidable health problems. Maybe I’m channeling the Women’s Liberation Movement by saying we need a gender revolution, but I find it logical to change how we define manhood to something healthy– something that creates fewer medical and social problems. Masculinity (and femininity for that matter) shouldn’t be so narrowly defined, nor should it be detrimental to one’s health. Unlike the NPR article and Lancet study, I don’t think some health issues should be used to address gender norms, particularly those in which the disparity between men and women suffering from the same health problem isn’t terribly large. For instance, presenting smoking as a men’s health issue to counter aggressive masculinity leaves out a sizeable group of women who face the same health risks from tobacco use. The point is to decrease overall mortality, not increase inequitable treatment of health care issues based on sex. Instead, structural issues that drive problems in men and women’s health should be researched and considered in health care, and specific campaigns, such as the Healthy Masculinity Action Project, would be more effective in addressing gender norms by modeling a healthy alternative.

To address men’s health issues, we don’t need inflammatory stories like NPR’s article. Reading the comments (which I would never advise anyone to do), I saw a whole battle of the sexes with every conceivable stereotype used. Doucleff’s article does not create a thought-provoking conversation, but instead merely stirs up a hornet’s nest. Health care isn’t a men versus women problem. We shouldn’t be pitting women and men against each other, arguing whose health is more important.

What we need is a productive conversation about gender and health. How do we do that? Well, here’s my two cents:

1) Correctly identify problems of a certain sex. Prematurely labeling something as one sex’s health issue can take years to correct, such as what happened with heart disease. For men’s health, we should recognize what exactly is a men’s health issue and what is a choice everyone faces. Research and campaigns to promote men’s health on things like prostate cancer are definitely needed, for example, but PSAs on alcohol abuse, smoking, and arguably even aggressive driving, while important, are unhealthy behaviors of the general public.

2) Acknowledge the importance of women’s health care issues. Just because decreasing ovarian cancer or maternal mortality doesn’t impact men’s mortality rate, as the NPR article alluded to, that doesn’t mean it is without value or somehow increasing inequality between the sexes. Women need medical resources that are sometimes different from men, and that’s (brace yourself) ok.

3) Realize that health care comes with its own history as well as its own biases. As medical historian and Nursing Clio blogger Elizabeth Reis writes, “Doctors have been and continue to be influenced by values and anxieties of the larger society, which render any medical management a cultural rather than a simply scientific endeavor.”[iii]

4)  Be careful not to shift medical views back to the androcentric model. We’ve already been there. Viewing the male body as normative and the female body as “the other” does more harm than any conceivable good. There are centuries of evidence to prove just how problematic reorienting the medical focus to the male ideal can be.

5) Address gender norms. Or better yet, bring on the gender revolution! I say this not just because current gender norms contribute to neglecting health care but also because aggressive masculinity promotes a rape culture, gun violence, and intimate partner violence- all of which cause physical and emotional problems.

Health care is an issue for all of humanity. While certain groups are at risk for particular health problems, we aren’t helping anyone by creating another battle of the sexes and perpetuating stereotypes. We owe it to ourselves and our loved ones to have a productive conversation about improving everyone’s health.