Be a Man and Get Some Help…!

Hammond, W., Matthews, D., Mohottige, D., Agyemang, A., & Corbie-Smith, G. (2010). Masculinity, Medical Mistrust, and Preventive Health Services Delays Among Community-Dwelling African-American Men Journal of General Internal Medicine DOI: 10.1007/s11606-010-1481-z

‘Compared to non-Hispanic White men, African-American men attend fewer preventive health visits, are less likely to know their cholesterol levels, have poorer BP [blood pressure] control, and face greater morbidity and premature mortality from conditions amenable to early interventions. African-American men also experience earlier onset and higher death rates from heart disease and cancers detectable through screening, and often present with conditions at more advanced stages’ (Hammond et al., 2010, n.pag.).

In this recent article by Hammond et al. (2010), they challenge the assumption that the more a man aligns himself with (traditional) masculine ideals, the less likely he will be to engage with preventative health services. That assumption, in part, is used routinely to justify why men tend to drop dead, on average, several years earlier than women do. Their delays in seeking help for such critical health conditions as hypertension, diabetes, and cancer often mean that necessary medical interventions are sought either too late or not at all (2010). Most, if not all of us, would have a male member of our own immediate family who has bragged incessantly about having ‘never seen a doctor,’ and who then fell off the twig 10, 20, 30 years or more ahead of his time.

It is further assumed that men from ‘socioeconomically challenged’ backgrounds, that is, in the case of Hammond et al.’s (2010) study, African American men (2010), are even more averse than your average Joe to engage with preventative health services. This cruel paradox allegedly comes about because men in these subordinate groups feel compelled to strive even harder to demonstrate that they are ‘real’ men. However, Hammond et al. (2010) argue that this assumption did not ring true with the 610 African-American men who they surveyed (I note here the quirkiness that 80.7% of those participants were recruited from barbershops). Rather, what deterred many of these men from engaging with preventative health services was ‘medical mistrust’ (2010) and, to a lesser extent, the unavailability of culturally appropriate health services.

Contrary to the much-touted view that real men avoid doctors like the plague, Hammond et al. (2010) conversely found that the more African-American men align themselves with masculine ideals, the more likely they will be to participate proactively in preventative health activities like blood pressure and cholesterol screening. The authors (2010) attribute this counter-norm behaviour to a combination of these men railing against ‘socio-structural barriers’ and re-defining their help-seeking as an expression of self-reliance. They go on to say that health service providers could use this counter-norm behaviour to encourage ‘African-American men to ‘seize control’ of their health’ (2010). Well, I caution, that might be one-element of a multi-pronged strategy…

By scanning the literature, Hammond et al. (2010) identified five key variables involved in the under-utilisation of preventative health services by African-American men:

1. Fatalism;
2. Socioeconomic barriers;
3. Limited health knowledge or awareness;
4. Medical mistrust; and
5. Masculinity.

Given that there is limited empirical research evidence (2010) into preventative health care utilisation by African-American men and that the aforementioned variables scream complexity, there is still a great deal that we do not know about how and why any man, or particular group of men, either avoids or embraces getting tested, screened, vaccinated, etc. For example, the variable ‘fatalism’ instantly conjures up a vision in my head of a putrid army of well-meaning white people here in Australia, who browbeat Indigenous men from the year dot into believing that they are doomed to a life of misery (child abuse, domestic violence, poverty, alcoholism, imprisonment, suicide or other premature death). Against such a rabid bulwark, what role might masculinity play in the decisions Indigenous men make about their health? Ditto for African-American men, who are similarly subjected to lifelong structural oppression…

See also…

Sanders Thompson, V., Talley, M., Caito, N., & Kreuter, M. (2007). African American Men’s Perceptions of Factors Influencing Health-Information Seeking American Journal of Men’s Health, 3 (1), 6-15 DOI: 10.1177/1557988307304630