A stitch in time saves nine

Roselyne Sachiti Features, Health & Society Editor
MEN are an interesting demographic. They exhibit a rather bizarre behaviour, especially in matters that concern their health. For fear of being deemed weak, not wanting to worry family, most men will suffer in silence when they have an ailment only to seek medical help when it is sometimes too late.

In Zimbabwe, men in many communities exhibit this disturbing lack of health-seeking behaviour. When they eventually do so, their families know the situation is really bad.

A report by Esther Mufunda titled “Differences in Health and Illness Beliefs in Zimbabwean Men and Women with Diabetes” published in The Open Nursing Journal, 2012, Volume 6 confirms this.

The study explored beliefs about health and illness that might affect self-care and health-seeking behaviours in Zimbabwean men and women with diabetes.

The study showed that Zimbabwean males and females with diabetes have different beliefs about health and illness which affect health-seeking behaviours.

Females were more active in self-care and searched for more information in order to adapt to the condition, while males tended to adopt a rather passive attitude.

The Zimbabwe Demographic and Health Survey (ZDHS) 2015 also reported that among respondents who reported having an STI or symptoms of an STI, 55 percent of men sought no advice or treatment compared to 48 percent females.

Also only 16 percent men, compared to 30 percent women, received an injection from a health worker in the 12 months preceding the survey.

This week, the world commemorated the Men’s Health Week which falls between June 10 and 16. This year’s theme is “Make the Time. Take the Time”.

Men’s Health Week is important as it is a time to bring awareness to health issues that affect men disproportionately. Among many other issues, it focuses on getting men to become aware of difficulties they may have or could develop, and gain the mettle to do something about it.

In its 25th year, having begun in the US in 1994 following a Senate Joint Resolution to establish the week by Senator Bob Dole, President Clinton signed the Bill on May 31. The week was linked to Father’s Day in the US (the week always ends on that day, the third Sunday in June) and it became an international event in 2002 when it was first marked in the UK. It has since been adopted in Australia, Canada, Denmark, Ireland, New Zealand and beyond.

Men’s Health Week puts men’s health on the map both nationally and globally and also provides an opportunity to advocate for changes to health policy and practice.

A new report “Masculine Norms and Men’s Health: Making the Connections” published recently by Promundo also provides an overview of the current state of men’s health globally and illustrates the direct connections between health-risk behaviours and salient masculine norms.

Founded in Brazil in 1997, Promundo is a global consortium working to promote gender equality and create a world free from violence by engaging men and boys in partnership with women and girls.

Presenting a new analysis of men’s health using data from the 2016 Global Burden of Disease (GBD), the report outlines the leading causes of morbidity and mortality among men globally.

In the report, evidence on the links between hegemonic masculine norms and influential health-risk behaviours, including poor diet, substance use, occupational hazards, unsafe sex, and limited health-seeking behaviour is quite clear.

The report emphasises that salient norms related to masculinities and the gendered nature of men’s lives are a driving force in men’s ill-health.

It further states that while biological factors are involved in male-specific ill-health, the vast majority of men’s morbidities and excess mortality is related to health practices, and the social and cultural influences that shape them.

“In short, while some gender norms can be protective in terms of health outcomes, men’s poor health is most often driven by their efforts to live up to or adhere to restrictive societal norms related to manhood.

“Leading health-risk behaviours that account for a major share of men’s ill health are directly related to masculine norms and masculinities interacting with other factors,” the report posits.

These six health behaviours — poor diet, tobacco use, alcohol use, occupational hazards, unsafe sex, and drug use — according to 2016 GBD data, account for more than half of all male deaths and about 70 percent of male morbidity globally.

The authors also added men’s limited health-seeking behaviour to this list of six health behaviours. Worth noting is that there are some positive masculine norms that may support health-seeking behaviour.

The Zimbabwe Demographic and Health Survey 2015 also brings out similar patterns of male behaviour as in the survey, nine percent young men reported having multiple sexual partners in the 12 months before the survey compared to only one percent women doing the same. Among those who had sexual intercourse in the past 12 months before the survey, 80 percent young men had sex with a non-marital, non-cohabiting partner compared to 20 percent women.

However, 84 percent of young men used a condom at last sex with this type of partner compared with 57 percent young women.

Evidence from the Promundo report shows that, in some settings, men who are more involved as fathers and caregivers are more likely to have better health, suggesting that the care of others may also support an ethic of self-care.

In a 2017 multi-country study of masculine norms, Promundo referred to these norms collectively as the “Man Box”, which is set of beliefs that place pressure on boys and men to think and behave in specific ways.

The idea of the “Man Box” is based on a construct originally created by social justice educator Paul Kivel.

In the study, Promundo, in partnership with Axe, operationalised the prevalent social constructions of masculinity seen in many parts of the world into seven “pillars”.

Pillar 1 — Self-Sufficiency and Emotional Control

There is a widespread social expectation that men should not rely on other people, talk about their feelings, or seek help for their physical and emotional health.

Pillar 1 encompasses how men cope with stresses and disease in their lives.

Acting Tough and Risk-Taking
A man’s toughness is seen as closely tied tovphysical strength and invincibility. The beliefs included in Pillar 2 hold that a man must be willing to defend his reputation by fighting or using physical force, if necessary, as well as take risks and engage in activities that are not perceived as weak.

Attractiveness
Pillar 3 includes ideas related to men’s physical appearance, body image, and physical attractiveness. Men who prioritise physical attractiveness will engage in behaviours that they believe make them appear desirable to women and seem “cool” to their peer group. This pillar is associated with the potentially dangerous use of anabolic steroids and other mind — and body— altering substances.

Rigid Masculine Gender Roles
Pillar 4 reflects the perception that certain activities and duties are either masculine or feminine. Men who subscribe to these rigid beliefs relate to the still-common expectation that men contribute to family well-being primarily as financial providers, while seeking healthcare or taking care of the health of those in the home is a female task.

Superiority Among Males
Pillar 5 reflects the socially constructed hierarchy of male identity and a belief that men must experience feelings of superiority. This includes the marginalisation or idolisation of men based on specific behaviours seen as more or less masculine. Men who do not engage in certain behaviours (e.g. excessive drinking, eating meat) are deemed to be feminine or non-masculine, and are marginalised by other men.

Hypersexuality
Pillar 6 emphasises not only that a man should be unambiguously straight or heterosexual, but also that he should always be ready for sex and always eager to acquire another “sexual conquest”.

The hypersexuality implied in Pillar 6 serves to undermine men’s sexual agency and sexual health, along with women’s, in that it can contribute to sexual coercion and limited attention to sexual health.

Power, Aggression, and Control
Pillar 7 emphasises the need for men to use physical, emotional, sexual, financial and psychological violence when necessary and to hold control and power over women and male peers around them.

In light of this, the report states several solutions that could work.

The report suggests that national governments should ensure that health policies and services actively address potential barriers to men’s use of services — such as available hours and staff composition — and increase the provision of health services that actively seek out men as well as women in the workplace, in the community, and in other settings.

It also recommends governments to develop and implement multi-sectoral health and well-being policies, and monitor the differential effects by sex.

Governments have also been urged to develop and implement multi-sectoral health and well-being policies that take into consideration the effects of social, economic and cultural factors, including masculine norms, on the health outcomes of men.

Furthermore, it is important for governments to integrate awareness of harmful masculine norms into occupational safety and employment policies in an attempt to neutralise their effects.

Governments can also promote policies and create gender-transformative programmes that, by implicitly or explicitly questioning the underlying masculine norms that often drive harmful behaviour (e.g., tobacco use, drunk driving and unprotected sex), aim to reduce men’s risk-taking and harmful behaviour, the report further mentions.

According to the report, it is important to publish and appropriately fund national and local men’s health strategies, as part of broader work on gender and health, that ensure specific consideration for men who are members of minority groups.

In the public health provision system, the report suggests building the capacity of medical and health personnel within countries to understand masculinities and men’s health needs and to incorporate them into their diagnostic, referral, and treatment practices.

Global and regional health institutions and bodies should adopt specific global commitments, and accompanying frameworks and strategies, to better address the links between masculinities and men’s ill health.

The report also challenges researchers, scholars and academic institutions to widen the breadth of research on alternative dimensions of masculinities that are less researched and that could promote healthy behaviour, such as responsibility, self-control, and how men’s positive involvement as fathers and caregivers may also provide a way to promote self-care and help-seeking.

As men commemorate the Men’s Health Week, it is important for them to remember that a stitch in time saves nine.

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