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

The three papers in The Lancet are of high scientific quality and adopt a socio-ecological approach that allows for the integration of the various factors explaining how men’s health is linked to masculinity – that is, to the way in which sociocultural constructs define what it means to be a man, with all the behaviours, habits and attitudes associated with it – and how this relationship results in poorer health.

What is surprising is that such an objective impact – reflected in indicators such as disability-adjusted life years (DALYs), which are 16 per cent higher for men than for women, a lower life expectancy, and an age-standardised mortality rate 38 per cent higher than that of women – has not been the focus of attention or policy by those men who have historically held positions of institutional power, from which the necessary measures to improve men’s health could have been developed.

The analysis of the situation takes the socio-ecological model as its conceptual framework, in which three main axes are interrelated: the first consists of social, structural and economic determinants; the second comprises the intersection of elements within the power system, such as class, gender, ethnicity, sociocultural factors, etc.; and the third, syndemic theory, which enables social and environmental factors to be directly linked to those associated with disease, and how this relationship produces a synergistic effect.

Reading the studies raises questions about the reasons for this ‘passivity’ in responding to such a serious problem with such far-reaching and profound consequences; for, as noted, the negative impact on men’s health leads to more severe social problems, which in turn further affect men’s health and, more broadly, that of society as a whole. And the reasons can be deduced from the very relationship described in the studies between sociocultural factors and the deterioration of men’s health – a relationship that has a dual impact, at both the social and individual levels.

At the social level, the idea of a virile, provider and stoic masculinity facilitates the emergence of psychosocial stress in various circumstances, and leads to habits that are harmful to health, such as the use of toxic substances, engaging in risky behaviour in different contexts, or resorting to violence. And at the individual level, once a health problem has arisen, behaviour is characterised by a tendency to seek clinical care later, as well as lower adherence to treatment or discontinuation of it.

The central role of sociocultural constructs in the factors leading to poorer men’s health is reinforced by the observation that those who have held institutional positions to develop a response to men’s health issues—who have themselves been men—have failed to do so. The response can also be deduced from the socio-ecological model and revolves around three key points. On the one hand, men’s health problems are associated with those who engage in a range of harmful habits under the concept of ‘toxic masculinities’; on the other hand, it is understood that men’s health problems represent a kind of ‘price’ to be paid for the social benefits and privileges that the model itself makes available to them through the very behaviours that cause these health problems; and thirdly, the intersectionality of factors that increase vulnerability in certain groups of men or in men in specific circumstances – such as when poverty, ethnicity, unemployment, etc., coincide – is interpreted in such a way that, rather than seeing the health problem as exacerbated by these intersecting factors, it is understood to be an individual problem of those men, not a social one. This idea justifies the invisibility of health problems associated with masculinity and reinforces the social model of inequality by leading people to believe that certain men are ‘inferior’ by nature.

Neither in Spain nor in most other countries are there specific strategies to address men’s health problems and their relationship with social determinants, which are not merely reduced to the individual level within a clinical framework. It is therefore essential to address these issues in health policies and plans, particularly at a historic moment when factors such as social uncertainty, job insecurity, psychosocial stress and isolation—exacerbated by the use of social media—are converging, all of which have a direct impact on men’s health.

The picture becomes even bleaker when we consider that two critical factors are currently converging: firstly, the promotion of an idea of masculinity based on traditional notions of virility, male stoicism, and the glorification of high testosterone levels – expressed both behaviourally and physically through a muscular physique. And, secondly, proposals that reject the use of gender as a framework for developing health policies – positions which are even calling into question all existing initiatives addressing women’s health, and which will make it more difficult to incorporate a gender perspective into health policies centred on masculinity.