Boys don’t cry. Stop acting like a little girl. Be a man. You’re a big sook. Suck it up.
Do these phrases seem familiar?
They are all examples of the harmful constructions of masculinity that contribute to why men are more likely to die earlier than women. This isn’t due to genetics, it is caused by preventable factors such as diseases and illness, unintentional injury, and suicide.
To mark Men’s Health Week, I would like to outline the sociological factors that influence men’s health and highlight the leading role nurses can play in improving it.
How gender stereotypes affect Men’s Health
In Australia, men will on average die aged 81 whereas women will die aged 851.
Sociology plays a part in this, as dominant constructions of masculinity in western society highlight an expectation for men to be tough, brave and strong. This construction is enforced from childhood, where the showing of emotion or pain by boys is seen as being less of a man and not worthy of status and respect.
This has a flow on effect to health care settings. Men who do present to services usually do so when critically unwell or injured, or have been ‘encouraged’ to do so by a spouse and are more likely to downplay their symptoms. These men are more likely to access emergency care rather than engage with their GP2.
In another quirky twist, some men who hold quite traditional gender roles are of the belief that health care is a feminine pursuit and that seeking care lowers their masculine, independent, and resilient value3. A study undertaken in Canada in 2016 found that amongst the 541 respondents with no history of depression or suicidal ideation, more than one third held stigmatising beliefs about mental health. The respondents stated that “I would not vote for a male politician if I knew he had been depressed,” “Men with depression are dangerous,” and “Men with depression could snap out of it if they wanted.”4
In my experience, these same men also adhere to an ideal that men are more competent doctors than women and so will actively seek out a male doctor. Researchers also found that these same men will also disclose less information to a male doctor than a female one5.
Whilst men have a personal responsibility to seek health care sooner, when they do, they should be presented with an individualised care mode. When they do, they are often unaware of the role of primary health care nurses and will downplay their symptoms so not to be seen as ‘whingers’. Women are more likely to engage in health prevention and promotion activities whereas men are more likely to ignore them and revert to the potentially harmful laid back Aussie bloke mentality of ‘she’ll be right mate.’
The cultural and societal pressure of stoic masculinity that has caused many to avoid treatment, especially those of the older generation, is highlighted by the fact that no country in the world has a male life expectancy equivalent to that of women.6
The role of nurses in improving men’s health
What can we, as nurses, do about this?
Obviously, we cannot change a long-held belief system and generationally imbedded behaviours overnight. However, what we can do is start small and make gradual changes.
A research study undertaken at Deakin University7 highlighted a possible gap in nursing education and the lack of knowledge in contemporary male health care. The study found that many nurses were not addressing the specific needs of their male patients. The nurses were uncomfortable and apprehensive when discussing the more intimate aspects of the male patient’s health due to embarrassment, lack of education or awareness on the topic.
This shows a need for nurses with enhanced knowledge and skills to engage male patients in health prevention and promotion especially with mental health, sexual health, health promotion and prevention. To meet the needs of their male patients, nurses need to do more and reassess their method of assessment. A ‘one size fits all’ approach does not seem to be working.
The primary care model that we currently have is not suitable when it comes to male mental health, sexual health, health promotion, and illness prevention. Male patients, like female patients have specific needs and care that is specific to their sex or gender. We have developed women’s health networks, testing services but very little exists for men that is specific to their needs.
Practical ways to promote Men’s Health
Men’s Health Week runs in June and is an ideal opportunity for nurses to be proactive in managing their male patient’s health. Steps that can be taken to create a healthy environment for men can include:
- Market your health services to men specifically,
- Reach out to men through community events, organisations, and locations such as Men’s Shed, the local football team, the RSL, or coffee shop,
- Work together with other health providers to services to coordinate your health initiatives.
Nurses also need to recognise the importance of primary health care when engaging with male patients. The Australian Men’s Health Forum along with Registered Nurse Helen Storer MACN placed emphasis on the need for nurses to build relationships with their male patients.
“It’s about building relationships. We (the nurses) are not as time poor as the GP’s and can take the time to identify what they might want to discuss with the doctor”.8
There are a variety of resources available for both the nurses engaged in men’s health and for the patients themselves. These include:
- Australian Men’s Health Forum (amhf.org.au)
- The Penis Project | Everything About Your Penis
- Healthy Male – What every man should know.
Male patients also need to be proactive in seeking health care and nurses can support them by being aware of the issues that men face when it comes to their health, both physical and mental. Nurses working with men can undertake professional educational whether via courses, podcasts, or reading journal articles in order maximise their knowledge and how to communicate effectively when engaging with men.
So, remember, the world’s largest recorded scrotum was 60kg9 and it ended up like that because he did not go to the doctor when he should.
Louise Lommerse MACN
Louise Lommerse MACN is a Stage Five Emerging Nurse Leader (ENL) and has an expansive background in emergency care, infection control and disaster response and recovery. Louise is passionate about support for rural and remote early-career nurses and disaster and multi-casualty health awareness in hospitals and is using the ENL program to improve her nursing practice and forge a pathway into nursing leadership and management.
1Australian Bureau of Statistics, Life Tables 2018-2020, Australian Government, Canberra, 2021
2Gast, J. Peak, T. “It used to be that if it weren’t broken or bleeding profusely, I would never go to the doctor”: Men, masculinity, and health. (American Journal of Men’s Health, 2011), 318-331.
3Novak, J. P. Associations between masculine norms and healthcare utilisation in highly religious, heterosexual men (American Journal of Mens Health, 2003) 13.
4Oliffe, J. Ogrodniczuk, J. Gordon,S. Creighton, G. Kelly, M. Black, N. Mackenzie, C. Stigma in Male Depression and Suicide: A Canadian Sex Comprison Study (Canada. Community Mental Health Journal, 2016) 302-310.
5Novak, J. P. Associations between masculine norms and healthcare utilisation in highly religious, heterosexual men (American Journal of Mens Health, 2003) 13.
6Harvard Health Publishing. Mars vs Venus: The Gender Gap in Health (Boston: Harvard Medical School, 2019)
7Lovett, D. Rasmussen, B. Holden, C. Livingston, P. Are nurses meeting the need of men in primary care? (Victoria: Australian Journal of Primary Health, 2017) 319-322.
8Trengrove, K. A patient’s response to nursing for men’s health (Australian Men’s Health Forum, 2022)
9Dent, Grace. Grace Dent on TV: Bodyshock: The man with the 10 stone testicles (The Independent, London, 2003)