News media are constantly reporting ways that everyday activities can damage our health, but perhaps the most far-reaching, yet neglected global health risk stems from gender norms.
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. According to the WHO, 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. However, 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 10 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 to encourage men to ignore the 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 healthcare 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. However, even when healthcare 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 US taxpayer money to offset the “gender-related inequalities and disparities [that] disproportionately compromise the health of women and girls.”