BRAZIL – Masculinities and health: experiments in (attempted) systems change + links to two other papers on sexuality, health and gender

In the 12th seminar of the Lancet Commission on Gender and Global Health series, Commissioner Gary Barker (above) drew on his experiences within the intersection of masculinities and gender to offer insights and interventions gleaned from his work with Promundo.

Barker started his presentation with a brief snapshot of men’s health in both the global and local contexts, highlighting contestations within the arena of gender and global health where men’s health struggles to carve out a space for itself without being framed as a competitor to women’s health. A common misconception of men’s health – and indeed, gender equality as a whole – holds that our patriarchal structures privilege all men over all women, but an intersectional understanding facilitates a more nuanced consideration of socioeconomic stratification among men and women alike, and the complex power differentials that result. Men’s health services cater to some men and some health issues, such as sports medicine and cardiovascular health, while other fields more closely linked to non-hegemonic masculinities remain underfunded and understudied….

Delving into the quantitative evidence on men’s health, Barker shared that 50% of premature male mortality and 70% of male morbidity is attributable to five health risk factors: diet, smoking, alcohol, drug use, and occupational risk. Returning briefly to the question of social norms, Barker shared that representative data validates a connection between masculinist views and health outcomes, an association that holds up “in robust ways” across multivariate and bivariate analyses, but these social norms “are never, never the only issues”. Susceptibility to these factors is shaped by norms, behaviors, and structural factors that operate far beyond surface-level understandings of gender and masculinities, with income level, educational attainment, geographic context, marketing pressure, family dynamics, and more coming together to form the complex terrain of men’s health. Using norms as a point of entry, gender-transformative approaches which actively engage with men ultimately yield better results in terms of changing men’s individual outcomes and behaviors, with evidence of a positive ripple effect on households and family members as well.

National men’s health programs are not easily found; there are only approximately six countries in the world with such programs. This absence is especially noticeable in the global south, making Brazil’s implementation of a National Men’s Health Program in 2009 particularly noteworthy. The program was born out of activism and created in dialogue with women’s rights and women’s health, taking special care not to divert attention and resources from “the fragile gains made in terms of women’s health”. After a rough start, which included a sparse budget and narrow focus on urology, the program developed a more holistic approach that sought to locate men within the public health system and meet them where they are. Accompanying a partner to a prenatal visit was identified as the primary point of contact, and a prenatal health protocol flow was developed to transform the point of contact into a point of entry.

SOURCE: Lancet Commission on Gender and Global Health seminar series, in United Nations University, International Institute for Global Health, by Gary Barker, 8 September 2021 + PHOTO, Gary Barker, from Time magazine

SEE ALSO FROM THE SAME SERIES: Men: the elephant in the (gender and global health) room by Morna Cornell, 11 August 2021

SEE ALSO, JUST PUBLISHED: BMJ Global Health, January 2023;8:1. Global health, sexual and reproductive health and rights, and gender: square pegs, round holes, by Anna Coates, Pascale Allotey. Open access.