Men's health has emerged as a distinct public issue in the 1990s and in the past several years we have seen somewhat of a flurry of activity in this area. There have been two national conferences and the development of a Draft National Men's Health Policy by the Commonwealth Government, a range of other forums, consultation documents, media attention, and the inclusion of men's health in the curricula of several universities. While the health status of men is an important concern I ask myself why is men's health emerging as an issue now? Is the emerging men's health lobby, and its related concerns in the "men's movement" (eg family law and boys' education), just about addressing the single issue of health or are there other issues at hand?
My concern is that in some instances men's health is becoming obscured by the debate about men's rights, subsequently neglecting the consideration of the diversity within men's health and the implications of the dominant constructions of masculinity for men's health and health of others.
In addressing this concern I will discuss the underlying logic being used to substantiate men's health in the media as one site of an emerging discourse of men's health. Secondly, I will provide substantive examples of media representations of men's health. Finally, I will discuss a simple framework, developed by Dorothy Broome in 1996, for considering men's health in a contextual and historical manner.
Men's Health - A Political Issue
Apart from being a health issue men's health is a social and political issue. It is a social issue because it involves different groups of people describing, defining and addressing men's health as a matter of concern. It is a political issue because it involves a contest for meaning between these different groups of people and a contest for legitimacy between other groups of people lobbying for other health issues, for example women's health. In this sense men's health is a construction - a dynamic, multifaceted discourse representing a whole range of meanings, interests and ideas.
When I look at the emergence of men's health I look to see who is lobbying for this issue to be addressed, what are they saying, where do they come from, who are they saying it to and why are they saying it? By looking at men's health so far we can see that government's are involved, the media is reporting it, commercial organisations are targeting it, community health and hospitals are addressing it and men's groups are lobbying for men's health issues to be heard.
Men's health is emerging in various ways and is promoted by various groups of people, from feminist researchers to people who feel that men's health rights have been neglected. Here I will focus on mainstream media representations of men's health which develop an oppositional stance to women's health.
Media, Men and Health
There is a large proportion of media articles and health documents which adopt this oppositional logic, some explicitly and some implicitly. From my collection of media articles on men's' health over the last two years it is clear that the mainstream media particularly, demonstrate an explicit adversarial stance between men and women's health.
For example, Ferrari in the Australian in 1994 states "although both men and women live longer, men still die earlier and in greater numbers. An article in the Advertiser in 1996 by Williams entitled The Weaker Sex also constructs men's health in relationship to women's health status and the Sydney Morning Herald in 1995 asks "What's Killing Men more then Women?". Furthermore, an article by Maslen in The Bulletin in 1995 is most indicative of the logic underlying the men's health and men's issues discourse. Emblazoned in sensational terms across the front cover of the magazine are the words
"Superior Sex - Women are smarter, healthier, more honest and live longer. These days it's the men who need help.
Other titles include: Men hit as hard [as women] by mental illness written in The Age in 1995; Losers in the war of the sexes [women are the winners] seen in the Sydney Morning Herald in 1994; Health funding: are we getting enough [as much as women] in Men's Health Jan/Feb 1996; and The real weaker sex [not women] in The Advertiser, 1996.
These articles, amongst many more (in the hundreds), all base their argument upon who is more ill or more disadvantaged. Remarkably, there is little (although some) consideration of race, class or ability/disability issues within the men's health subject area. There is also little attention paid to ideas of gender, power or history.
One of the major problems with constructing a picture of men's health in relation to women's health is the construction of men's health as a somehow unified and whole entity. For example, men are seen as a homogenous and undifferentiated group. The word man, or men, comes to represent a certain perception of man, or men, most likely a white, straight and middle class view - a hegemonic view. This perception is based upon a simplistic notion of one or the other, wrong or right, man or woman etc. Men's health is just worse than women's health and therefore more important.
A result of this view is that issues of Aboriginal men's health, the health of disabled men or men from lower socio-economic areas are disregarded. Men's health comes to represent a certain group of men and the health needs of marginalised men are neglected.
So is there any use for a comparative approach in men's health? I think that comparisons have some value although their use has to be carefully considered. A men's/women's health comparison allows us to see that men's health is gendered by illustrating the differences in health status. By observing these differences we are given a basis for asking why men's health status is poorer than women's health status and an avenue to arrive at a consideration of masculinity and health practices. However, when using such an approach I think that it should be stated clearly why this approach is being used and what it means for women's health. The tendency has been that comparisons have been made without any consideration of how they shape dominant perceptions of men's health and women's health.
To use a fully comparative approach to men's health is to ignore the implications of power and oppression for the dominant constructions of masculinity. Women or Aboriginal people, for example, experience levels of poor health or disadvantage in relation to a common axis of oppression; patriarchy or white supremacy respectively, therefore justifying their use of comparisons to bring attention to their health needs. Men do not experience a common axis of oppression in this form, although different men may experience forms of oppression along other axes, for example race, class or sexuality. It is therefore disingenuous to compare men's health status to women's health with the intention of illustrating how disadvantaged men are in relation to women.
`Men OR Women' or `Men AND Women'
It is clear that a simple `us or them' equation isn't useful when it comes to considering men's and women's health issues. The implications of prostate cancer and breast cancer, as one example, cannot be seriously considered in simple comparison. At the 1996 Women's Health Conference Dorothy Broome outlined a framework of gendering health and sexing illness for considering both men's and women's health. She developed this framework in anticipation of the oppositional element of men's health which is emerging.
For Dorothy Broome gendering health refers to the problematisation of gender in relation to health practices. The women's health movement problematised the notion of woman and femininity in relation to both health and the dominant constructions of masculinity thus finding ways of addressing and improving their health and manipulating the constraints of traditional femininity. It can be argued that the invisibility of the male medical subject, generic throughout medical and health related concepts, is an example of the failure to problematise masculinity in relation to health. Gendering men's health would both problematise masculinity in relation to both men's health practices and to the dominant constructions of masculinity. This would involve not only considering how adopting dominant masculine practices are a health hazard, but also exploring how the broader manifestations of these practices in medicine, policing, politics, defence, education or citizenship harm men, women and children and also oppress various groups of people.
Sexing illness, is a concept which aims to contextualise notions of sex and illness. The male generic basis of medicine has excluded the consideration of sex differentials in illness. For example, AIDS, various cancers, heart disease and even longevity all show possible biological bases to men and women's illness. However these issues, amongst many others, become universally attributed to one sex rather than considering the disease in relation to the subject, for example heart disease is seen as a preponderantly male disease although it is also the leading cause of death in women. Consequently, the sexed nature of these diseases are neglected and the different experiences and effects of various illnesses on men and women is concealed. Or on the other hand it is argued that somehow conceptually similar illnesses, like prostate and breast cancer, share some medical equivalence when, as discussed, a sexed consideration of the illnesses clearly provides a different picture.
Conclusion
Just as women's health emerged in a particular social climate - in a time of left politics and emerging social movements - men's health is emerging in a time of conservative politics - a time of anti-"political correctness" and economic rationalism. While the ways in which men's health is fashioned by this ideological change are contestable my interest lies in finding positive ways of discussing men's health and women's health. Briefly, for me this would mean being positive toward, and supportive of, the needs of men and women. It would also mean working from a social justice platform and addressing the health needs of different groups of men, and the needs of women, in relation to the dominant constructions of masculinity. Finally, it would also mean adopting a process of accountability in addressing men's issues which would acknowledge the power imbalances of various groups and put in place mechanisms to deal with these power differences.
Unfortunately, the emerging men's health discourse I have discussed sets a scene for antagonism and perpetuates a hierarchical way of understanding and justifying health needs. As long as one group defines their health status in relation to another group's health status, one group will be subordinated and their needs potentially neglected. To adopt an `us and them' approach to health, implicitly or explicitly, is unhelpful and creates a focus less concerned with men's health and more with some notion of men's rights. This ultimately distracts us from the real issue - the project of developing healthy and respectful ways of being.
First published in the magazine XY: men, sex, politics, 7(1), Winter 1997. XY, PO Box 4026, AINSLIE, ACT, 2602, AUSTRALIA. ©Reprinted with permission.