Reacción a "Three studies suggest that, although men live shorter lives than women, their health receives little attention in health policies"

The fact that a journal as prestigious as The Lancet is devoting a series to men’s health strikes me, without a doubt, as good news, because it helps to raise the profile of an issue that deserves greater attention in the field of public health. However, we cannot say that this is a new topic, as for decades we have had research showing how gender norms and models of masculinity influence men’s health. But it is no less true that this series represents an opportunity to place the debate more prominently on the scientific agenda and within health policy. So, overall, I would say that one of its main contributions is that it brings together complementary evidence and perspectives that allow for a better understanding of health inequalities, focusing not only on the differences between men and women, but also on the social, economic and cultural conditions that help to explain them. In this respect, these are well-founded studies, combining the analysis of epidemiological data from established sources with a comprehensive review of the available scientific evidence.

Indeed, one of the aspects I find most noteworthy about this series is that it highlights the need to look beyond the health differences we observe between men and women. Some of the epidemiological measures used, such as life expectancy or disability-adjusted life years, provide us with valuable information on the magnitude of certain health differences and inequalities; however, on their own, these measures do not enable us to understand what lies behind them. That is why those of us who work in this field emphasise that disaggregating data by sex is, of course, a necessary first step, but it is not the same as incorporating a gender perspective. Nor should we forget – and I believe this is another of the series’ most noteworthy contributions – that there are also significant inequalities amongst men themselves, which can be obscured by population averages.

For example, we knew that the hegemonic traits of masculinity – defined by attitudes and ideals related to strength, control and a reluctance to show vulnerability, such as emotional repression – can encourage the adoption of risky behaviours that negatively affect men’s health. The series highlights issues such as cardiovascular health, suicide, injuries and the consequences of violence; not to mention a lower commitment to preventive and self-care practices, as well as the adoption of unhealthy lifestyles, such as a sedentary lifestyle and the excessive consumption of certain substances, such as alcohol. These patterns are associated with higher rates of premature mortality in men. In other words, we have solid evidence that a large proportion of premature deaths among men are due to non-communicable diseases and injuries. In this regard, the articles remind us that, whilst there are biological factors that we certainly cannot ignore, a significant part of the increased risk of premature death among men is due to social factors, over which there is scope for intervention.

Previous studies had already shown how certain ideals of masculinity are associated, for example, with men’s reluctance to express their health concerns; this is partly due to the internalisation of social expectations that link masculinity with self-sufficiency and strength. Consequently, acknowledging a health problem can be perceived as a sign of weakness, which conflicts with the norms of hegemonic masculinity. This need to project invulnerability not only affects their self-image and public perception, but may also limit their willingness to seek help and adhere to treatment. However, when discussing health from a gender perspective, it is also important to consider other structural and psychosocial factors. For example, the impact of unemployment on mental health tends to be greater among men, partly due to the frustration they may experience if they feel they are failing to fulfil the traditional role of being the main provider for the family unit.

In this regard, these articles help to ensure we do not fall into the trap of thinking that discussing a gender perspective means focusing solely on women. These publications in health-related journals reinforce the idea that, in societies such as ours, which have undergone significant socio-demographic changes in a short space of time, the analysis of gender identities is particularly relevant. And this is because it allows us to gain a more nuanced understanding of the differences and similarities in the behaviours and experiences that affect people’s health. In the case of the study of masculinities, this line of research highlights the health risks and problems that men often face as a result of how they interpret their identity and maintain their social position. In other words, certain social codes of masculinity may help to maintain positions of privilege, but at the same time pose health risks to men themselves. This phenomenon is precisely what our research group has conceptualised as ‘the dark side of privilege’.

This becomes evident when we observe that health disparities amongst men from different ethnic groups, social classes or geographical regions cannot be attributed solely to biological causes. Hence, throughout this series of articles, we have also highlighted the need to take gender analysis a step further by incorporating an intersectional approach.

The series also highlights that some countries have already developed specific health strategies or policies for men, which would also represent a significant step forward for Spain. The aim would be to develop a strategy that challenges harmful gender norms and promotes men’s active participation in looking after their own health and that of others. To this end, greater attention must be paid to policies and interventions that encourage men to share responsibility for informal care, child-rearing, the prevention of violence, and sexual and reproductive health. Furthermore, integrating a gender perspective into healthcare training and health services is key not only to eliminating gender bias in healthcare provision, but also to breaking down communication barriers and improving adherence to treatment.

On the other hand, although a significant proportion of research on men’s health has traditionally focused on analysing behavioural differences, I believe that designing policies, programmes and interventions exclusively around men’s risk behaviours reinforces a restrictive approach to gender. Furthermore – and the series is very illustrative in this regard – making progress in this area requires recognition of the health inequalities that exist amongst men themselves. Furthermore, acknowledging the consequences of hegemonic forms of masculinity for men’s health should not simply become a means of assigning blame, but rather an aspect that should guide the development of more comprehensive health policies that are sensitive to the incorporation of a gender perspective.