Beyond Andrology: Trends in Men’s Health in Emerging Markets
Men’s health in emerging markets is more likely to be brought about by tackling attitudes than by improving access.
In my last column, I explored the concept of women’s health and considered the specific challenges that adversely impact female health outcomes in emerging markets as a result of their gendered roles in society. This month, I turn my attention to men’s health and look at how men in emerging markets face a different set of health challenges, again influenced in large part by the way gender is socially constructed, with the pressure to be a ‘macho’ man often having negative consequences on health.
As with women’s health, men’s health can have both broad and narrow definitions. The narrow definition begins with andrology; conditions specific to male biology – such as prostate problems, testicular cancer and erectile dysfunction. It is revealing to note that while androgyny’s female counterpart, gynecology, is a board-certified medical specialty in many countries, andrology is not. It has only been described as a distinct specialty since the late 1960s. This lack of recognition perhaps goes some way to explaining why conditions such as the andropause – the male menopause or ‘manopause’, in which testosterone levels diminish with age – remain controversial. While recent research indicates this may be far more common than originally estimated, it has yet to be well-studied and is not recognized by the World Health Organization.
The definition of men’s health can be extended to diseases that affect both sexes but are more common in men. Of the 15 top causes of death in the US, men lead women in all except Alzheimer’s disease, which as we saw in the previous column, many men don’t live long enough to develop due to their shorter life expectancies.
It has been argued that the reason for men’s shorter average life expectancy is not biological but behavioral – the result of unhealthy lifestyle choices. Globally, men adopt fewer health promoting behaviors than women. They are less likely to go to the doctor and more likely to present with a serious health condition when they do. Other unhealthy lifestyle behaviors and chronic disease risk factors such as smoking, alcohol and drug use are also more common in men than in women. Worldwide it is estimated that men smoke nearly five times as much as women. Men are also more likely to take part in ‘risky’ behavior, resulting in a higher rate of accidents and trauma, motor vehicle deaths and occupational injuries.
Being male has actually been argued by some as being ‘the single strongest predictor of whether a person will take health risks’. Taking this to the extreme, there is a glaring gender disparity in suicide rates, with men three times more likely than women to die by suicide. There are multiple factors that contribute to this, including gendered access to more lethal methods, a reluctance to seek professional help for mental health issues, and the disproportionate stigma men associate with talking about their problems. Research conducted by the Samaritans explored the role of conforming to a ‘perfect standard’ of masculinity and how this can be damaging to men’s health. This has been described by British male suicide prevention charity, Campaign Against Living Miserably, as 'propamanda' – the catalog of stereotypes aimed at making you a manly man, proper bloke, top lad”. Avoiding seeking medical help can be an assertion of masculinity; a way of conforming to these gender norms and stereotypes – in this case seeing asking for help as a sign of weakness, and therefore something to be avoided.
On the topic of asserting masculinity, I was surprised to discover men have a higher risk of skin cancer than women. While this is partly because they tend to spend more time outdoors, resulting in higher sun exposure, another contributing factor stems from gender stereotypes: men’s less diligent approach to applying sunscreen, which is often considered a ‘feminine’ behaviour.
Research suggests that there are worldwide similarities in men’s attitude to their health and seeking healthcare. Although the social constructions of masculinity which underlie male health-seeking behaviors are complex and exhibit considerable variations across cultures, generations, religions and ethnicities, man’s position in society tends to be very rigid in many emerging markets. The man is typically seen as the head of the household and main breadwinner. There is also a lack of specific men’s health programs and policies across emerging markets. A 2011 article in the Asian Journal of Andrology, for example, suggested that up to 15% of the male disease burden in Asia is associated with failures to address men’s health needs. Perhaps linked to this, men from higher-income countries have been found to live longer than men from lower-income countries. Russia has the largest gap between male and female life expectancy (63 years for men compared to 75 for women). This is largely as a result of the specific unhealthy lifestyle behaviors associated with the Russian male stereotype, such as heavy drinking and smoking.
My previous column touched upon ways in which gender roles and expectations are shifting and how this is impacting women’s health outcomes – the same is, of course, true for men. In much of Latin America for example, while there is still a ‘macho’ culture and men are four times more likely to commit suicide than women, there is a growing acceptance, particularly among more highly-educated men, that housework and childcare are part of their role, and many countries in the region have implemented laws promoting gender equality. In the Philippines, a National Digital Rectal Examination day has been declared since 1996 in an attempt to encourage men to visit participating health centres for checks, supported by surrounding media campaigns promoting prostate health. Even in Kazakhstan, a heavily patriarchal society, the country’s recent economic downturn has triggered an unprecedented number of men breaking the ‘seeking help is a weakness’ taboo and consulting with mental health professionals; one therapist recently reported that the number of male clients has tripled within a year. This follows the failure of a dedicated men’s crisis centre opened in Almaty seven years ago, which closed down after only a year when only 200 men contacted it for assistance.
Other emerging markets have further to go in closing the gap, and how gender is experienced can vary in interaction with other forms of inequality, such as poverty, race and ethnicity. In South Africa the role of black men is still impacted by the legacy of the apartheid era, where many men were sent off to work in the mines, leaving women to run the household and raise children. A study of male health seeking behavior in Uganda found that of 162 males studied, 69% experienced health problems but only 40% of those sought care (of which 58% sought care late), with men expressing high levels of conformity to masculinity (e.g. agreement with statements such as ‘real men do not fall sick’ and ‘men are supposed to be strong’) significantly less likely to seek care.
One might conclude from these examples that men’s health in emerging markets is more likely to be brought about by tackling attitudes than by improving access.
This issue has started to receive increasing attention and recognition in mature markets in recent years. A recent Prostate Cancer UK TV ad, which features an excruciatingly awkward father-and-son conversation aimed at getting older men to stop ignoring their prostate, is one example of how medical communications have attempted to tackle delayed presentation. Also trying to tap into the male psyche was a recent campaign informing men that erectile dysfunction can be linked to other conditions, such as diabetes, in an attempt to encourage them to get past any potential embarrassment and talk to their doctor about their symptoms. Research has shown that married or cohabiting men tend to live longer than single men. One reason suggested for this is that their partners encourage them to seek medical help when needed. Men’s health campaigns in mature markets are increasingly leveraging the power of the partner to motivate men to take action.
Adopting similarly gendered awareness campaigns in emerging markets, many of which have a major shortage of support programs targeted to a male audience will be critical to improve male health outcomes and maximize the men’s health opportunity. However given the diversity of the factors influencing constructions of masculinity both across and within countries, in-depth, specific market understanding is also required to ensure all communications are tailored to the appropriate cultural context.
Sources: Men’s Health Week 2016: 13-19 June