Despite overwhelming evidence that gender-based stereotypes and expectations can adversely impact health, gender-related health issues are largely ignored or misunderstood, with international health organizations often limiting gender-specific efforts to women or, even more narrowly, to mothers. And yet, according to the World Health Organization, in all but three countries worldwide, women can expect to outlive men, by up to seven years in Japan or by as little as a year in the poorer countries of Sub-Saharan Africa.
Women’s longer life expectancy has long been linked to differences in “biological pre-disposition,” with theories ranging from the protection afforded by women’s lower iron levels to the absence of “extra” genes on men’s Y chromosome. But some of the most obvious factors shortening men’s lives are to be found in a more pedestrian, yet politically sensitive, area: the differences in the “appropriate” behaviors for men and women, as dictated by society and reinforced by the market.
Data published in The Lancet last year show that the top ten most burdensome global diseases are more common in men than women, and often by a large margin. For example, men die from lung cancer at more than twice the rate of women. Likewise, road injuries and alcohol-related death and disability are responsible for the loss of three times as many potential years of healthy life in men than in women.
These disparities can be explained largely by the fact that men are exposed to more risks than women. While there may be a biological component to men’s propensity for risk taking (especially among young men), gender norms reinforce risky or unhealthy behaviors by associating them with masculinity.
Understanding and exploiting gender norms offers commercial benefits. Given that social norms in much of the world discourage women from smoking, drinking alcohol, and, in extreme cases, driving cars and motorcycles, advertisers in these industries tend to target men. For example, alcoholic-beverage producers are leading sponsors of men’s professional sports, but rarely sponsor women’s sporting events.
Moreover, advertisers often promote a “live fast, die young” philosophy in order to encourage men to ignore their product’s health risks. While three of the original “Marlboro men” died from lung cancer, their macho spirit endures in tobacco-product advertising in many low- and middle-income countries.
Differences in health outcomes are exacerbated further by women’s tendency to use health-care services more than men. Some of this additional use is due to women’s needs for family-planning or prenatal services, seeking either to prevent or promote reproduction. But even when health-care use would be expected to be equal, such as care for HIV/AIDS in Africa, gender-based expectations impede HIV-positive men from obtaining antiretroviral drugs proportionate to their needs.
Although gender norms are clearly undermining men’s health worldwide, key international organizations continue to disregard the problem or address only those issues that are specific to girls and women when devising strategies to improve global health. The Global Health Initiative, for example, uses American-taxpayer money to offset the “gender-related inequalities and disparities [that] disproportionately compromise the health of women and girls.”
To be sure, girls and women are less powerful, less privileged, and have fewer opportunities than men worldwide. But that does not justify disregarding the evidence. After all, an approach that focuses on the half of the population that takes fewer risks and uses health-care services more frequently cannot be expected to eliminate gender inequalities.
Coping with the emerging social and economic burdens associated with poor health – not least those stemming from aging populations in many countries – requires a new approach to replace the unbalanced, unproductive model that currently prevails. It is time to exchange the gender norms that are undermining men’s health for a social, cultural, and commercial emphasis on healthier lifestyles for everyone.
Gender norms are not static. Societies, cultures, and potential markets change. For example, patterns of alcohol consumption in Europe are beginning to shift. While men continue to drink more – and more often – than women, the frequency with which girls and boys report being drunk is now about the same. As Asian and African markets open up, similar social changes may follow as alcohol and tobacco advertisers seek new customers. We need to act now to bring gender justice to global health.
According to the Roman philosopher Cicero, “In nothing do men approach so nearly to the gods, as in giving health to men.” The multi-billion-dollar global health industry appears to have turned Cicero’s maxim on its head, focusing instead on “giving health to women.” But emphasizing the health of one gender undermines gender equality and misses the point of global health initiatives, which is – or should be – to improve health outcomes for all.
Sarah Hawkes is Reader in Global Health and Wellcome Trust Senior Fellow in International Public Engagement at the Institute for Global Health, University College London.