Realities and challenges in men’s health promotion

Worldwide men’s health promotion initiatives tackle contextual, political, and philosophical issues as a matter of gender equity, involving differences in needs, power, resources and access to them, plus obstacles and opportunities.¹⁰ In this paper, men’s health is conceived within a framework of multiple aspects—psychological, physiological, social, cultural and environmental—that addresses the nature of boys’, youths’, and men’s health and wellness.

Canadian epidemiological statistics on the health of boys, male youth, and men reveal major health vulnerabilities also in the way men deal with risks and promote their wellness.¹¹ Men have higher rates of cancer, heart disease and diabetes than women. Men have higher rates of death due to suicide, and to “violence, accident and other injuries” as compared to women; in fact, the combined category of “violence, accidents and other injuries” is the third leading cause of death in men, and the leading cause of death for male children, aged 1 to 19 years.¹² For men living with multiple chronic diseases, statistics reveal the top health conditions are cancer, hypertension, obstructive pulmonary disease and asthma.^13-17 Drug use is considerably more common and problematic among male youth and adult men than females, including alcohol, cannabis, ecstasy, heroine, and crack-cocaine¹⁸ added to high incidences of sexually transmissible diseases, such as chlamydia, gonorrhea, and infectious syphilis.¹⁹Modifiable risks are among the top five leading causes of death for men in Canada. A potential explanation for these findings is that Canadian society has conditioned boys and men to not prioritize health in their lives.²⁰

While researchers have begun to outline gender differences and the effects of dominant masculinity in terms of the health consequences for boys, youth and men, it is needed to better understand the views and actions of men (and boys and male youth and parents) in order to shift them in more healthful directions. To reframe the understanding of what men’s health entails, it is critical to incorporate the perspective of the social determinants of health (SDH), which includes the dynamics of sex/gender. Such an approach should be understood by health care professionals, educators, and policymakers, communication professionals and the general public. This paper uncovers cues to re-posit the collective understanding of men’s health promotion issues.

This study had three objectives: (a) identify recurrent ideas in newspaper articles on the health of boys, youth and men in Canada as the prominent disclosure of social determinants of men’s health; (b) identify newspapers’ contribution to promoting general awareness of issues and challenges regarding this topic; and (c) discuss the potential impacts on the general public’s interest in participating in the movement for boys, youth, and men’s health. The main research question was: What types of messages about boys’, youth’s and men’s health are popular Canadian newspapers disseminating to the general public?

Conceptual framework

The Population Health Promotion Model (PHPM)²¹ includes among the dimensions of health promotion, the SDH (e.g. social support networks, personal health practices, coping skills, access to health services), which are related to places and conditions where individuals are born, live, work and develop.²² Strengthening community action, creating supportive environments, developing personal skills, building a healthy public and reorienting health systems are comprehensive health promotion actions to optimize the SDH. The model also indicates levels of interventions to promote health at the individual, family and society levels. Its appropriateness relies on its capability to support an understanding of how news dissemination helps to address an initial recognition of men’s health disparities as experienced in Canada (e.g., differences in social exclusion, suicide, crime involvement and imprisonment); in addition to unhealthy expressions of masculinity.

Source of documents

Articles were drawn from three national newspapers as the main source of documents to be analyzed; they are easily accessed by the general public, not limited geographically and typically written in plain language. The target newspapers were: National Post, The Globe and Mail, and, Metro News. The National Post and The Globe and Mail are leading Canadian English-language national newspapers; the latter 2.4 million readers weekly.²⁶ Metro News is Canada’s most read national daily newspaper and the first national newspaper to publish in both English and French; it is free, and has 1.6 million print readers daily, and 1.1 million web-visitors monthly.²⁷ Articles were from both printed and online sources, and both paid and free distribution newspapers, because of their broad availability and distribution to readers of all sex, gender, and socio-economic groups, as well as reading and literacy levels. The intention was to identify which type of health news reaches a broad cross-section of the male population of readers of all ages and social conditions.

Search strategy

Using Google search engine, DS and KJ retrieved relevant news articles from the newspapers’ websites archives, using the key terms: ‘boys’ health’, ‘youth’s health’, and ‘men’s health’, combined with “lifestyle”. “Lifestyle” is a target area of the CIHR program. This methodological decision is justified based on the non-existence of keyword classifications in the archives, as there is in the scholarly database. The PHPM²¹ did not determine the definition of search terms. The timeline was limited to the years 2010 through 2014 because this period was the most active time for reporting related to the CIHR-IGH launch of the Boys’ and Men’s Health Program. The Program was initiated circa June 2009, and the official Program was launched in November 2013.²⁵ Document retrieval ended in February 2014. A total of 56 articles were downloaded; after preliminary reading, 12 were excluded because their content was not relevant to the research objectives. Therefore, 44 articles composed the final corpus to be analyzed. Neither the length of articles nor their appearance throughout the newspapers nor the readers’ profile were features of interest in the analysis conducted.

Document analysis

The analysis started with a critical reading of the 44 articles. DS and KJ identified which content was related to men’s health promotion and completed a content retrieval chart displaying recurrent themes as proposed by the analytical method.^23,24 The chart comprised 7 columns: one for article identification (newspaper company, and date), and the remaining columns for the entry of the interpretative summaries that exemplified the 5 different message goals (elicit prevention, provide information, provoke awareness, introduce politics and unclear message), as well as a short sentence as a key, synthesis message contained in each article. Next, the content was assembled and classified by major topics (see Table 1) and message goal (see Table 2).

Message goal was established by readers who answered the following direct guide question: “What is the key idea in this sentence?” No other criteria of selection was applied, but an agreement among readers was sought. Major statements were identified and correlated with SDH (see Table 3). Finally, interpretation of key messages pointed to indicators for future major comprehensive action strategies to promote men’s health, grounded in the empirical evidence as reported by newspapers (see Table 4). The PHPM²¹ was instrumental to the analytical work in the phase of identifying SDH in each message and guided the classification of the messages’ core statements. Key media messages were then linked to the comprehensive actions for health promotion.

The results are presented in the upcoming sections according to the study’s objectives within the health promotion perspective. Results addressed issues of provision of health promotion to awaken individual’s awareness, education of preventative behaviours, as well as understanding political issues related to men’s health. The analysis was summarized within this perspective (see Table 2). Half of the retrieved messages involved the SDH. Core statements of those 24 messages and link them to 8 corresponding SDH are presented in Table 3. The analysis indicates that the core statements fit within the conceptual scope of the associated SDH. The PHPM assisted in classifying the top 10 messages as comprehensive strategies for health promotion. Some verbatim are presented as extracted from the newspapers.

Newspapers’ topics about boys’, youth’s and men’s health

The main health topics were arranged into Table 1 to illustrate their comparative frequencies and distribution by newspaper source. Metro News accounted for 60% of the total messages about men’s health. This is a significant result since this free newspaper likely due to its effective circulation reaches a broad readership, especially with its distribution in public transit stations, convenience stores, and other street level access points. The most common topic was prostate health and men’s sexual health; this reflects and perpetuates the stereotype that men’s health is centered on sexuality and the prostate, but also reminds the public of health risks, as the following quotes show.

“Men should be aware of their prostate cancer risk, especially those with a father who has had the disease. It almost doubles the risks…”

Mental health issues, social environment, and seeking medical attention were the lowest represented men’s health messages. This is unfortunate given the range of men’s health issues, including the rising rate of reported mood disorders from 2007 to 2011.²⁸

Messages’ goal about boys’, youth’s and men’s health

The messages were also analyzed with regards to their goal. Some articles involved multiple or mixed goals, which totaled 115 entries for 44 articles. Providing information was the most frequent goal (37.4%). Especially in relation to the SDH, this type of information pointed to associations with health outcomes, but did not suggest or promote advocacy or any political health movement and action. The following quote is an example:

“…most researchers would conclude that without comprehensive community development – housing, healthcare and education – there will never be a permanent decrease in violent crime.”

These messages might provoke certain interested readers, especially those who possess the resources to do so, to follow-up and pursue further information, and perhaps even call for action and advocacy in matters of men’s health. However, such messages offered nothing that would assist the reader in obtaining practical or instrumental information about the health topic presented, as the following quote shows:

“…one in six men will develop prostate cancer in their lifetimes…. It’s as big an issue as breast cancer… but there’s a significant gap in the level of funding and awareness.”

Despite no to do so, a culture of neutral message is expected to be changed due to the increasing seriousness of treated subjects. The least often recurring message goal introduced a political perspective or addressed government policy (7%). This type of content typically announced changes in government policy or the status of legislation and interventions intended to benefit boys’, youth’s and men’s health. This indicator of political messages suggests the need for more reflection in societal dialogue about the development of broad men’s health policies.

Importance of the newspapers’ messages

Only 24 messages included content related to the SDH and their role in the health of boys, youth, and men. Table 3 shows that personal health practices (33%) and social support networks (17%) were the most frequently mentioned SDH. The following quotes relate men’s health to the criminal justice system issues as well as domestic violence.

“The man who created Canada’s only shelter dedicated solely to male victims of domestic violence died on Friday.… His death has sparked outrage and sadness among those who are pushing for greater recognition of men’s issues in law and family court.”

Newspapers tend to focus on certain lifestyles, health practices and attitudes that boys, youth and men exhibit; these may also mislead health professionals (see Table 3).

These results suggest that relying only on men’s disclosure of traditional symptoms could lead to an under-diagnosis of depression in men and that clinicians should consider other clues when assessing depression in men.

Some men’s misconceptions about their relationship to women were revealed:

“There seems to be this general philosophy amongst men in that age group that they can do whatever they like to women”, she said. “We need to target men and boys and say to them you are responsible for the abuse and you need to stop this behavior”

The media illustrate how boys, youth, and men are deprived of knowledge about enhancement of their personal health practices and help-seeking behaviours.

“Men’s Health Network…points at men’s upbringing as one of the reasons guys might be hesitant to see their MD…. Shockingly, they also found that more than half of premature deaths among men are preventable.”

News articles show that lifestyle and health practices require behavioural change to improve well-being. The deleterious consequences of having ineffective coping skills were reported, particularly among socially vulnerable groups:

“We found that more First Nations children presented to emergency departments for disorders secondary to substance abuse and intentional self-harm than other children.”

Very little health news content referred to working conditions, education and income, significant SDH. This may reflect the current state of health research, which does not adequately incorporate the effects of these SDH.¹¹ It may also indicate a reproduction of dominant health knowledge and understanding of masculinity.

Key messages for future health promotion actions

The key informative messages present in the news reports are promising for future health promotion actions. Table 4 summarizes the top ten messages and relates them to two major comprehensive action strategies as proposed by PHPM. Seven of the 10 messages are related to developing personal skills, frequently linking men’s health to traditional views of masculinity by portraying health as a personal responsibility as opposed to a health promotion matter within a macro societal level perspective.

“From an early age, boys are taught not to cry or complain, and being ill is seen as a weakness.”

Conversely, the key messages can also bring awareness to their scope for autonomous choice:

“I can’t oppose legislation against this because I think it’s a travesty so many kids are being harmed on a regular basis with the complicity of the medical establishment.… [If] he wants to be circumcised, then that will be his choice.”

Some messages may inspire the mobilization of health and social care organizations, thus constituting a call for collective action.

“We particularly have more boys on the waiting lists [for Big Brothers] than we do girls. One of the reasons is because younger men often worry they become a surrogate father when they engage in these mentoring relationships…”

The remaining three messages relate to reorienting health services to better attend to men’s health vulnerabilities, and comments about the political implications in reports of men’s health research.

“But HPV can also threaten the lives and futures of young men… almost 100 per cent of head and neck cancer in men under the age of 40…also been linked to rectal cancer.”

None of the key messages related to building healthy public policy, strengthening community action, or creating supportive environments; this underscores the necessity of a broad political perspective regarding youth’s and men’s health. Summarizing, informative and awareness-raising messages are the newspapers’ predominant discourse on men’s health, mostly addressing prostate and sexual health. News reports were mostly silent about solutions to publicized problems related to political issues, access to health services, and collaborations or inter-sectorial actions. By limiting reporting to the results of research studies and describing initiatives, newspapers barely comment on government actions, or intentions to create a boys’, youth’s and men’s health policy, and did not address issues of citizen participation or engagement. Therefore, the potential for newspapers to influence the mobilization of a collective awareness of the political implications of men’s health issues is unrealized.

Potential impact of media discourse: General public’s buy-in and support for the development of a national boys’, youth’s and men’s health policy

The dominant messages on men’s health, as shown in Table 3, indicate that research results as publicized by the newspapers still reflect the view point of traditional masculinity in terms of the ideals that a man is expected to achieve and the related risky behaviour. The notion of risky behaviour also poses a social danger for others. Therefore, it is a matter of individual responsibility for men to autonomously change their risky behaviour and personal health. As it seems that little statistic information is available on such risky behaviour, media professionals may lack access to statistical information that reflects the reality. Consequently, the health status analysis, an important preliminary planning step before disseminating evidence-based news is compromised. Due to the easy availability of statistical information about delivery of sexual and reproductive health services, the Canadian journalist mainly focuses on those issues, thus unintentionally (or not?) reinforcing the limited scope of awareness of men’s health.

On the other hand, more recently, news reports on how community services are addressing youth’s and men’s mental health and acknowledging the impacts of cultural and economic struggles suggests a form of community mobilization and change in health practices. Both actions have been widely reported by newspapers, revealing the media’s reliance on the capacity of community members to address their own health and well-being issues, and responding to the influences of gender and collective conceptions of health/illness. In addition, community initiatives have emerged to create social support networks to overcome the effects of men’s abusive behaviour and fragile social bonds. News reports about social learning through community initiatives to help men develop their fathering skills, and to self-manage aggressive behaviours that may counteract the criminalization of youth’s and men’s acts, may help to reshape the general public’s perception regarding the potential for behavioural change.

News introduces a discourse suggesting that traditional, socially expected youth’s and men’s behaviours can be changed. However, changes in the general public’s attitudes toward more progressive views and forms of masculinity in terms of dealing with health issues may be paradoxically hard to take hold due to the multicultural nature of Canadian society. While for the general population, and particularly immigrant men, representations of male identity and social practices related to health matters still embody less attention to health. In this conversation, a combination of individual characteristics and specific SDH such as gender, class, sexuality, personal coping skills and views of masculinity should be incorporated.

Newspapers have the potential to educate the general public about how health can be jeopardized by the attributes of traditional masculinity; they can demonstrate that masculine behaviour is a cultural, rather than a natural, asset—a learned aspect of one’s intergenerational cultural capital, which is at the basis of one’s individual social life while determining one’s position in a given social order. Thus, new learning about health can unfold within a continuum from traditional to a modern masculinity, allowing men to learn about self-care, prevention, medical care seeking skills, disclosure of emotions, responsible fatherhood, and egalitarian relationships that could improve overall quality of life and overall health.

Popular newspapers could also disseminate information to promote political literacy about how community groups are multiplying social advocacy initiatives at several levels. Men’s health interest groups, although small in number in Canada, face a lack of consensus in the political agenda²⁰ even though this moment is extremely promising to fuel the discussion about men’s health. If these groups would agree to work together, they could establish research partnerships with scholars to explore the socio-economic dimensions and impacts of boys’, youth’s and men’s health.