Über die Autorin bzw. den Autor

Alex Broom is Professor of Sociology at the University of New South Wales, Australia. He is the co-editor of Health, Culture and Religion in South Asia; Men's Health: Body, Identity and Social Context; and Gender and Masculinities: Histories, Texts and Practices in India and Sri Lanka. He is the co-author of Therapeutic Pluralism: Exploring the Experiences of Cancer Patients and Professionals. Professor Jon Adams is at the Faculty of Nursing, Midwifery and Health, University of Technology Sydney (UTS) Australia.

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Men’s Health explores the social, political and theoretical underpinnings of the men’s health field. Drawing together academics at the forefront of research into men’s health, each chapter examines a different intersection of health and masculinity, providing an international and interdisciplinary perspective on the state of play in men’s health research.

The essential social science book on men’s health and masculinities
The first book to provide a critical overview of men’s health in international perspective
Written by experts in the field, drawn from a range of disciplines
International appeal, with authors from the UK, US, Canada, Finland and Australia

Aus dem Klappentext

Men’s Health explores the social, political and theoretical underpinnings of the men’s health field. Drawing together academics at the forefront of research into men’s health, each chapter examines a different intersection of health and masculinity, providing an international and interdisciplinary perspective on the state of play in men’s health research.

The essential social science book on men’s health and masculinities
The first book to provide a critical overview of men’s health in international perspective
Written by experts in the field, drawn from a range of disciplines
International appeal, with authors from the UK, US, Canada, Finland and Australia

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Men's Health

John Wiley & Sons

Chapter One

Will Courtenay

Introduction

Men in the United States, on average, die more than 5 years younger than women (Department of Health and Human Services [DHHS], 2007). For all 15 leading causes of death, except Alzheimer's disease, and in every age group, men and boys have higher death rates than women and girls (Courtenay, 2003). Men's age-adjusted death rate for heart disease and cancer are both 1.5 times higher than women's (DHHS, 2007). Men are also more likely than women to suffer severe chronic conditions and fatal diseases (Verbrugge & Wingard, 1987), and to suffer them at an earlier age. Nearly three out of four persons who die from heart attacks before age 65 are men (American Heart Association, 1995). Similar patterns in morbidity and mortality have been observed in the UK, Canada and Australia (see Courtenay, 2002; and Chapters 3, 6 and 9).

A variety of factors influence and are associated with health and longevity, including economic status, ethnicity, and access to care (Laveist, 1993; Pappas et al., 1993; Doyal, 1995). However, these factors cannot explain gender differences in health and longevity. For instance, while lack of adequate healthcare, poor nutrition and substandard housing all contribute to the health problems of African Americans (Gibbs, 1988), they cannot account for cancer death rates that are nearly twice as high among African American men than among African American women (American Cancer Society, 2005). Health behaviours, however, do help to explain gender differences in health and longevity. An independent scientific panel established by the US government has evaluated thousands of research studies and estimated that half of all deaths in the US could be prevented through changes in personal health practices (US Preventive Services Task Force [USPSTF], 1996). Similar conclusions have been reached by other health experts reviewing hundreds of studies (Woolf et al., 1996).

Gender is one of the most important sociocultural factors associated with and influencing health-related behaviour. Women engage in far more health-promoting behaviours than men and have more healthy lifestyle patterns (see Courtenay, 2000a). Being a woman may, in fact, be the strongest predictor of preventive and health-promoting behaviour (see Courtenay, 2000a). A recent, extensive review of large studies, national data and metanalyses summarises evidence of sex differences in behaviours that significantly influence health and longevity (Courtenay, 2000a). This review systematically demonstrates that males of all ages are more likely than females to engage in over 30 behaviours that increase the risk of disease, injury and death. This gender difference in health behaviours remains true across a variety of racial and ethnic groups (Courtenay et al., 2002).

Findings are generally similar for healthcare visits. Although gender differences in utilisation generally begin to disappear when the health problem is more serious (Verbrugge, 1985; Waldron, 1988; Mor et al., 1990), adult men make far fewer healthcare visits than women do, independent of reproductive healthcare visits (Verbrugge, 1985, 1988; Kandrack et al., 1991). According to the US Department of Health and Human Services (1998), among persons with health problems, men are significantly more likely than women to have had no recent physician contacts, regardless of income or ethnicity; poor men are twice as likely as poor women to have had no recent contact, and high-income men are two and a half times as likely as high-income women.

Despite their enormous health effects, few researchers or theorists have offered explanations for these gender differences in behaviour, or for their implications for men's health (Verbrugge, 1985; Sabo & Gordon, 1995; Courtenay, 1998a, 2000b, 2002; Courtenay & Keeling, 2000a, b). Although health science of this century has frequently used males as study subjects, research typically neglects to examine men and the health risks associated with men's gender. Little is known about why men engage in less healthy lifestyles and adopt fewer health-promoting beliefs and behaviours. The health risks associated with men's gender or masculinity have remained largely unproblematic and taken for granted. The consistent, underlying presumption in medical literature is that what it means to be a man in America has no bearing on how men work, drink, drive, fight or take risks. Left unquestioned, men's shorter lifespan is often presumed to be natural and inevitable.

This paper proposes a relational theory of men's health from a social constructionist and feminist perspective. It provides an introduction to social constructionist perspectives on gender and a brief critique of gender role theory before illustrating how health beliefs and behaviour are used in constructing gender in North America, and how masculinity and health are constructed within a relational context. It further examines how men construct various forms of masculinity - or masculinities - and how these different enactments of gender, as well as differing social structural influences, contribute to differential health risks among men in the US.

Health and the social construction of gender

Constructionism and theories of gender

Previous explanations of masculinity and men's health have focused primarily on the hazardous influences of 'the male sex role' (Goldberg, 1976; Nathanson, 1977; Harrison, 1978; Verbrugge, 1985; Harrison et al., 1992). These explanations relied on theories of gender socialisation that have since been widely criticised (Deaux, 1984; Gerson & Peiss, 1985; Kimmel, 1986; Pleck, 1987; West & Zimmerman, 1987; Epstein, 1988; Messerschmidt, 1993; Connell, 1995). The sex role theory of socialisation, for example, has been criticised for implying that gender represents 'two fixed, static, and mutually exclusive role containers' (Kimmel, 1986, p.521) and for assuming that women and men have innate psychological needs for gender-stereotypic traits (Pleck, 1987). Sex role theory also fosters the notion of a singular female or male personality, a notion that has been effectively disputed, and obscures the various forms of femininity and masculinity that women and men can and do demonstrate (Connell, 1995).

From a constructionist perspective, women and men think and act in the ways that they do, not because of their role identities or psychological traits, but because of concepts about femininity and masculinity that they adopt from their culture (Pleck et al., 1994a). Gender is not two static categories, but rather 'a set of socially constructed relationships which are produced and reproduced through people's actions' (Gerson & Peiss, 1985, p.327); it is constructed by dynamic, dialectic relationships (Connell, 1995). Gender is 'something that one does, and does recurrently, in interaction with others' (West & Zimmerman, 1987, p.140); it is achieved or demonstrated and is better understood as a verb than as a noun (Kaschak, 1992; Bohan, 1993; Crawford, 1995). Most importantly, gender does not reside in the person, but rather in social transactions defined as gendered (Bohan, 1993; Crawford, 1995). From this perspective, gender is viewed as a dynamic, social structure.

Gender stereotypes

Gender is constructed from cultural and subjective meanings that constantly shift and vary, depending on the time and place. Gender...