Main Article Content
men’s health, masculinities, psychosocial, socioeconomic factors, gender inequality, social inequalities
Empirical studies suggest gender inequity increases men’s health risks. Multiple pathways may explain this relationship. These pathways however have not been explored concurrently. This paper is based on an extensive review of the theoretical literature linking gender inequity to men’s health. It identifies a range of theoretical approaches and examines links between them. In particular, it discusses masculinities and health theory, which argues gender inequity is linked to gender norms that lead to poor health-related beliefs and behaviours; the impact of gender inequity on men’s psychosocial and emotional experiences through limiting social roles, setting unattainable and restrictive expectations, and reducing access to social and emotional support; reproductive pathways, wherein gender inequity compromises optimal reproductive and early life outcomes leading to lifelong health impacts for males; and political, economic and social processes influenced by women’s social position that shape the social and economic resources, such as welfare and support, available to men. There are important interdependencies between these pathways. For example, masculine gender norms appear to not only increase poor health-related beliefs and behaviours, but also limit men’s opportunities to satisfy psychosocial and emotional needs. The findings suggest the extent of gender inequity can accentuate or buffer the negative health effects of other social inequalities. Further, while gender inequity provides men with many benefits, it limits access to the rich array of re-sources required to meet a diversity of lifelong health-related challenges. The paper provides the basis for richer theoretical approaches to men’s health.
2. United Nations Development Programme. Human Development Report 2016 [Internet]. New York: United Nations Development Programme; 2016. Available from: http://hdr.undp.org/sites/default/files/2016_human_development_report.pdf
3. World Economic Forum. Global gender gap report 2016 [Internet]. World Economic Forum; 2016 [cited 2017 Apr 26]. Available from: http://www3.weforum.org/docs/GGGR16/WEF_Global_Gender_Gap_Report_2016.pdf
4. Connell RW. Gender - Short Introductions. Polity; 2002.
5. Walby S. Theorising patriarchy. Sociology. 1989;23(2):213–34.
6. Kavanagh SA, Shelley JM, Stevenson C. Does gender inequity increase men’s mortality risk in the United States? A multilevel analysis of data from the National Longitudinal Mortality Study. SSM - Population Health. 2017 Dec;3:358–65.
7. Kawachi I, Kennedy BP, Gupta V, Prothrow-Stith D. Women’s status and the health of women and men: a view from the States. Social Science & Medicine. 1999 Jan;48(1):21–32.
8. Stanistreet D, Bambra C, Scott-Samuel A. Is patriarchy the source of men’s higher mortality? Journal of Epidemiology and Community Health. 2005 Oct 1;59(10):873–6.
9. Holter ØG. “What’s in it for men?” Old question, new data. Men and Masculinities. 2014 Dec 1;17(5):515–48.
10. Kavanagh SA, Shelley JM, Stevenson C. Is gender inequity a risk factor for men reporting poorer self-rated health in the United States? PLOS ONE [Internet]. 2018 Jul 17 [cited 2018 Sep 12];13(7):e0200332. Available from: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0200332
11. Van de Velde S, Huijts T, Bracke P, Bambra C. Macro-level gender equality and depression in men and women in Europe. Sociology of Health & Illness. 2013;35(5):682–698.
12. Rovito MJ, Leonard B, Llamas R, Leone JE, Talton W, Fadich A, et al. A Call for Gender-Inclusive Global Health Strategies. Am J Mens Health [Internet]. 2017 Nov 1 [cited 2018 Sep 10];11(6):1804–8. Available from: https://doi.org/10.1177/1557988317723424
13. European Union. The state of men’s health in Europe [Internet]. Directorate-General for Health and Consumers, European Commission; 2011. Available from: http://ec.europa.eu/health/population_groups/docs/men_health_extended_en.pdf
14. Bots SH, Peters SAE, Woodward M. Sex differences in coronary heart disease and stroke mortality: a global assessment of the effect of ageing between 1980 and 2010. BMJ Global Health [Internet]. 2017 Mar 1 [cited 2018 Sep 20];2(2):e000298. Available from: https://gh.bmj.com/content/2/2/e000298
15. Wang H, Dwyer-Lindgren L, Lofgren KT, Rajaratnam JK, Marcus JR, Levin-Rector A, et al. Age-specific and sex-specific mortality in 187 countries, 1970–2010: a systematic analysis for the Global Burden of Disease Study 2010. The Lancet. 2012 Dec 15;380(9859):2071–94.
16. Seifarth JE, McGowan CL, Milne KJ. Sex and life expectancy. Gender Medicine. 2012 Dec;9(6):390–401.
17. World Health Organization. The health and well-being of men in the WHO European Region: better health through a gender approach [Internet]. 2018 Sep [cited 2018 Oct 31]. Available from: http://www.euro.who.int/en/publications/abstracts/the-health-and-well-being-of-men-in-the-who-european-region-better-health-through-a-gender-approach-2018
18. Stanistreet D, Swami V, Pope D, Bambra C, Scott-Samuel A. Women’s empowerment and violent death among women and men in Europe: an ecological study. The Journal of Men’s Health & Gender. 2007 Sep;4(3):257–65.
19. Connell RW. Masculinities. Australia: Allen & Unwin; 1995.
20. Stevenson A, editor. Oxford Dictionary of English [Internet]. 3rd Edition. Oxford University Press; 2010 [cited 2014 Feb 12]. Available from: http://www.oxfordreference.com
21. Connell RW, Messerschmidt JW. Hegemonic Masculinity Rethinking the concept. Gender & Society. 2005;19(6):829–59.
22. Courtenay W. Constructions of masculinity and their influence on men’s well-being: a theory of gender and health. In: Dying to be men: psychosocial, environmental, and biobehavioral directions in promoting the health of men and boys [Internet]. 1st ed. Hoboken: Taylor and Francis; 2011. Available from: http://ebookcentral.proquest.com
23. Pyke KD. Class-based masculinities: the interdependence of gender, class, and interpersonal power. Gender and Society. 1996 Oct 1;10(5):527–49.
24. Courtenay WH. Constructions of masculinity and their influence on men’s well-being: a theory of gender and health. Social Science & Medicine. 2000;50(10):1385–401.
25. Evans J, Frank B, Oliffe JL, Gregory D. Health, illness, men and masculinities (HIMM): a theoretical framework for understanding men and their health. Journal of Men’s Health. 2011 Mar;8(1):7–15.
26. Courtenay W. Engendering health: the social construction of gendered health beliefs and behaviors. In: Dying to be men: psychosocial, environmental, and biobehavioral directions in promoting the health of men and boys [Internet]. 1st ed. Hoboken: Taylor and Francis; 2011. Available from: http://ebookcentral.proquest.com
27. Courtenay W. Behavioral Factors Associated With Disease, Injury, and Death Among Men Evidence and Implications for Prevention. In: Dying to be men: psychosocial, environmental, and biobehavioral directions in promoting the health of men and boys. 1st ed. Hoboken: Taylor and Francis; 2011.
28. Dolan A. ‘Men give in to chips and beer too easily’: How working-class men make sense of gender differences in health. Health (London). 2014 Mar 1;18(2):146–62.
29. Lohan M. How might we understand men’s health better? Integrating explanations from critical studies on men and inequalities in health. Social Science & Medicine. 2007 Aug;65(3):493–504.
30. Wong YJ, Ho M-HR, Wang S-Y, Miller ISK. Meta-analyses of the relationship between conformity to masculine norms and mental health-related outcomes. Journal of Counseling Psychology. 2017;64(1):80–93.
31. Courtenay W, McCreary DR. Masculinity and Gender Role Conflict How They Influence the Likelihood That Men Will Engage in Multiple High-Risk Behaviors. In: Dying to be Men : Psychosocial, Environmental, and Biobehavioral Directions in Promoting the Health of Men and Boys. 1st ed. Hoboken: Taylor and Francis; 2011.
32. Pirkis J, Spittal MJ, Keogh L, Mousaferiadis T, Currier D. Masculinity and suicidal thinking. Soc Psychiatry Psychiatr Epidemiol. 2017 Mar 1;52(3):319–27.
33. Levant RF, Wimer DJ. Masculinity Constructs as Protective Buffers and Risk Factors for Men’s Health. Am J Mens Health. 2014;8(2):110–20.
34. Rogers AA, DeLay D, Martin CL. Traditional Masculinity During the Middle School Transition: Associations with Depressive Symptoms and Academic Engagement. J Youth Adolescence. 2016 Jul 19;1–16.
35. Leone JE, Rovito MJ, Mullin EM, Mohammed SD, Lee CS. Development and Testing of a Conceptual Model Regarding Men’s Access to Health Care. Am J Mens Health [Internet]. 2017 Mar 1 [cited 2018 Sep 10];11(2):262–74. Available from: https://doi.org/10.1177/1557988316671637
36. O’Neil JM. The Psychology of Men. The Oxford Handbook of Counseling Psychology [Internet]. 2011 Nov 25 [cited 2018 Sep 17]; Available from: http://www.oxfordhandbooks.com/view/10.1093/oxfordhb/9780195342314.001.0001/oxfordhb-9780195342314-e-014
37. Dworkin SL, Treves-Kagan S, Lippman SA. Gender-Transformative Interventions to Reduce HIV Risks and Violence with Heterosexually-Active Men: A Review of the Global Evidence. AIDS Behav [Internet]. 2013 Nov 1 [cited 2018 Jan 16];17(9):2845–63. Available from: https://link.springer.com/article/10.1007/s10461-013-0565-2
38. Sloan C, Gough B, Conner M. Healthy masculinities? How ostensibly healthy men talk about lifestyle, health and gender. Psychology & Health. 2010;25(7):783–803.
39. Sloan C, Conner M, Gough B. How Does Masculinity Impact on Health? A Quantitative Study of Masculinity and Health Behavior in a Sample of UK Men and Women. Psychology of Men & Masculinity. 2014 Jul 21;
40. de Visser RO, McDonnell EJ. “Man points”: masculine capital and young men’s health. Health Psychol. 2013 Jan;32(1):5–14.
41. Kubzansky LD, Seeman TE, Glymour MM. Biological Pathways Linking Social Conditions and Health. In: Berkman LF, Kawachi I, Glymour M, editors. Social Epidemiology. Oxford University Press; 2014.
42. Kubzansky LD, Winning A, Kawachi I. Affective States and Health. In: Berkman LF, Kawachi I, Glymour M, editors. Social Epidemiology. Oxford University Press; 2014.
43. Matthews KA, Gallo LC, Taylor SE. Are psychosocial factors mediators of socioeconomic status and health connections? Annals of the New York Academy of Sciences. 2010 Feb 1;1186(1):146–73.
44. McEwen BS. Protective and Damaging Effects of Stress Mediators. New England Journal of Medicine. 1998 Jan 15;338(3):171–9.
45. Siegrist J, Marmot M. Health inequalities and the psychosocial environment--two scientific challenges. Social Science & Medicine. 2004 Apr;58(8):1463–73.
46. Kristenson M, Eriksen HR, Sluiter JK, Starke D, Ursin H. Psychobiological mechanisms of socioeconomic differences in health. Social Science & Medicine. 2004 Apr;58(8):1511–22.
47. Barnett RC, Hyde JS. Women, men, work, and family. American Psychologist. 2001 Oct;56(10):781–96.
48. Payne S, Swami V, Stanistreet DL. The social construction of gender and its influence on suicide: a review of the literature. Journal of Men’s Health. 2008 Mar;5(1):23–35.
49. Månsdotter A, Lundin A. How do masculinity, paternity leave, and mortality associate? –A study of fathers in the Swedish parental & child cohort of 1988/89. Social Science & Medicine. 2010 Aug;71(3):576–83.
50. Barnett RC. Chapter 5 - On Multiple Roles: Past, Present, and Future. In: Karen Korabik, Donna S. Lero and Denise L. WhiteheadA2 - Karen Korabik DSL, Denise L. Whitehead, editors. Handbook of Work-Family Integration. San Diego: Academic Press; 2008. p. 75–93.
51. Månsdotter A, Backhans M, Hallqvist J. The relationship between a less gender-stereotypical parenthood and alcohol-related care and death: A registry study of Swedish mothers and fathers. BMC Public Health. 2008;8(1):312.
52. Månsdotter A, Lindholm L, Winkvist A. Paternity leave in Sweden—Costs, savings and health gains. Health Policy. 2007 Jun;82(1):102–15.
53. Nordenmark M. Multiple Social Roles and Well-Being A Longitudinal Test of the Role Stress Theory and the Role Expansion Theory. Acta Sociologica. 2004 Jun 1;47(2):115–26.
54. Chandola T, Martikainen P, Bartley M, Lahelma E, Marmot M, Michikazu S, et al. Does conflict between home and work explain the effect of multiple roles on mental health? A comparative study of Finland, Japan, and the UK. International Journal Of Epidemiology. 2004 Aug;33(4):884–93.
55. Harryson L, Novo M, Hammarström A. Is Gender Inequality in the Domestic Sphere Associated with Psychological Distress Among Women and Men? Results from the Northern Swedish Cohort. J Epidemiol Community Health. 2012 Mar 1;66(3):271–6.
56. Harryson L, Strandh M, Hammarström A. Domestic Work and Psychological Distress−What Is the Importance of Relative Socioeconomic Position and Gender Inequality in the Couple Relationship? PLoS ONE. 2012 Jun 13;7(6):e38484.
57. Kalmijn M, Monden CWS. The division of labor and depressive symptoms at the couple level Effects of equity or specialization? Journal of Social and Personal Relationships. 2012 May 1;29(3):358–74.
58. Bird CE. Gender, Household Labor, and Psychological Distress: The Impact of the Amount and Division of Housework. Journal of Health and Social Behavior. 1999 Mar 1;40(1):32–45.
59. Bird CE, Fremont AM. Gender, Time Use, and Health. Journal of Health & Social Behavior. 1991 Jun;32(2):114–29.
60. Shelton BA, John D. The division of household labor. Annual Review of Sociology. 1996;22:299–322.
61. European Foundation for the Improvement of Living and Working Conditions. Parental leave in European companies [Internet]. 2007. Available from: http://www.eurofound.europa.eu/sites/default/files/ef_files/pubdocs/2006/87/en/1/ef0687en.pdf
62. Looze ME de, Huijts T, Stevens GWJM, Torsheim T, Vollebergh WAM. The Happiest Kids on Earth. Gender Equality and Adolescent Life Satisfaction in Europe and North America. J Youth Adolescence [Internet]. 2018 May 1 [cited 2018 Oct 30];47(5):1073–85. Available from: https://doi.org/10.1007/s10964-017-0756-7
63. Backhans MC, Lundberg M, Månsdotter A. Does increased gender equality lead to a convergence of health outcomes for men and women? A study of Swedish municipalities. Social Science & Medicine. 2007 May;64(9):1892–903.
64. Osmani S, Sen A. The hidden penalties of gender inequality: fetal origins of ill-health. Economics & Human Biology. 2003 Jan;1(1):105–21.
65. Caldwell JC. Routes to Low Mortality in Poor Countries. Population & Development Review. 1986 Jun;12(2):171–220.
66. Marmot M, Atkinson T, Bell J, Black C, Broadfoot P, Cumberlege J, et al. Fair Society, Healthy Lives: The Marmot Review [Internet]. 2010. Available from: http://www.ucl.ac.uk/gheg/marmotreview/Documents/finalreport
67. Shonkoff JP, Garner AS, Siegel BS, Dobbins MI, Earls MF, Garner AS, et al. The Lifelong Effects of Early Childhood Adversity and Toxic Stress. Pediatrics. 2012 Jan 1;129(1):e232–46.
68. Barker DJP. The Developmental Origins of Adult Disease. Journal of the American College of Nutrition. 2004;23(sup6):588S-595S.
69. Malhotra A, Schuler SR, Boender C. Measuring Women’s Empowerment as a Variable in International Development [Internet]. World Bank; 2002. Available from: https://siteresources.worldbank.org/INTGENDER/Resources/MalhotraSchulerBoender.pdf
70. Carlson GJ, Kordas K, Murray-Kolb LE. Associations between women’s autonomy and child nutritional status: a review of the literature. Matern Child Nutr. 2014 Mar 1;n/a-n/a.
71. Koenen KC, Lincoln A, Appleton A. Women’s status and child well-being: A state-level analysis. Social Science & Medicine. 2006 Dec;63(12):2999–3012.
72. Homan P. Political gender inequality and infant mortality in the United States, 1990–2012. Social Science & Medicine [Internet]. 2017 Jun 1 [cited 2018 Feb 28];182:127–35. Available from: http://www.sciencedirect.com/science/article/pii/S0277953617302472
73. Aizer A. Poverty, Violence, and Health. Journal of Human Resources. 2011 Summer;46(3):518–38.
74. Aizer A, Currie J. The intergenerational transmission of inequality: Maternal disadvantage and health at birth. Science. 2014 May 23;344(6186):856–61.
75. Hunnicutt G. Female Status and Infant and Child Homicide Victimization in Rural and Urban Counties in the U.S. Gender Issues. 2007;24(3):35–50.
76. Wyndow P, Li J, Mattes E. Female Empowerment as a Core Driver of Democratic Development: A Dynamic Panel Model from 1980 to 2005. World Development. 2013 Dec;52:34–54.
77. Bolzendahl C, Brooks C. Women’s political representation and welfare state spending in 12 capitalist democracies. Social Forces. 2007 Jun;85(4):1509–34.
78. Young FW. Structural pluralism and life expectancy in less-developed countries: the role of women’s status. Social Indicators Research. 2001 Aug 1;55(2):223–40.
79. Clark R, Peck BM. Examining the gender gap in life expectancy: a cross-national analysis, 1980–2005. Social Science Quarterly. 2012;93(3):820–837.
80. Young FW. The structural ecology of health and community [Internet]. Ithaca, NY: The Internet-First University Press; 2009. Available from: http://dspace.library.cornell.edu/bitstream/1813/11809/1/Young%20Structural%20Ecology%20Health%20and%20Community.pdf
81. Young FW, Lyson TA. Structural pluralism and all-cause mortality. American Journal of Public Health. 2001 Jan;91(1):136–8.
82. Sampson RJ, Raudenbush SW, Earls F. Neighborhoods and violent crime: A multilevel study of collective efficacy. Science. 1997 Aug 15;277(5328):918–24.
83. Kawachi I, Berkman LF. Social Capital, Social Cohesion and Health. In: Berkman LF, Kawachi I, Glymour MM, editors. Social Epidemiology, 2nd Edn. 2nd ed. New York, NY, USA: Oxford University Press; 2014. p. 290–319.
84. Roelfs DJ, Shor E, Davidson KW, Schwartz JE. Losing life and livelihood: A systematic review and meta-analysis of unemployment and all-cause mortality. Social Science & Medicine. 2011 Mar;72(6):840–54.
85. Reeves A, Stuckler D. Suicidality, Economic Shocks, and Egalitarian Gender Norms. Eur Sociol Rev. 2016 Feb 1;32(1):39–53.