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Men around the world generally live shorter lives than women. The reasons for this may be multiple, including simple biological differences. But disparities in behavior—like not seeking medical help or taking more risks—could also be important factors.

Now, a new study suggests another important factor in these disparities in longevity: the cultural pressures men face to “prove their manhood.”

How precarious is manhood?

A prior study by Jennifer Bosson, Joseph Vandello, and their colleagues surveyed men and women in 62 countries around the world on their attitudes toward manhood by asking how much they agreed with statements like these: “Some boys do not become men no matter how old they get”; “It is fairly easy for a man to lose his status as a man”; or “Manhood is not assured—it can be lost.” The higher the score, the more the country as a whole endorsed what researchers call “precarious manhood”—a belief that becoming a man is hard, must be earned, and is easy to forfeit. That belief, they found, did vary quite a bit by country. For example, Kosovo, Albania, and Iran had the strongest adherence, while Finland, Spain, and Germany had the weakest.

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In the new study, the research team (which included Vandello and Bosson) wanted to see how beliefs about manhood might result in men engaging in more risky behavior in order to prove themselves.

To start, they compared countrywide scores on precarious manhood beliefs with men’s countrywide rates of risk-taking behaviors (like smoking, binge drinking, or contact with venomous animals) and health outcomes associated with high-risk behaviors (such as liver failure, cancer, or premature death). They also compared how manhood beliefs related to death rates and health outcomes not associated with risky behavior (such as having appendicitis or Alzheimer’s disease, and even mortality rates from air pollution) as a way of distinguishing general risk from that associated with proving one’s manhood.

Before looking at the relationship between attitudes and health, though, the researchers considered other factors that could account for different health outcomes within a country, such as the number of doctors per 1,000 people, women’s rates of risk taking and health outcomes, the level of gender equality (according to the Global Gender Gap Index), and the country’s human development score, based on its overall economy, health, and education levels.

When the researchers analyzed the results, the men in countries with stronger beliefs about precarious manhood had much higher rates of risk taking and worse health than countries with weaker beliefs. Men in those countries also suffered significantly shorter lives when their manhood status was questioned, living almost seven years less on average than men in countries with weaker precarious manhood beliefs.

Lead author Vandello, of the University of South Florida, says this difference in longevity was particularly striking, suggesting men pay a high cost for these cultural pressures.

“When you start to aggregate together a lot of little health behaviors related to precarious manhood beliefs, you see these strong patterns—and really strong patterns when you look at longevity, specifically,” he says. “A belief in precarious manhood is bad for health.”

How risky is masculinity?

Why would that be? Vandello says that the risky behaviors men take to avoid having their manhood questioned often begin early in life, leading to death at young ages. In fact, men in their early 20s are three times more likely to die than women of the same age, and those deaths are mostly due to higher risk taking.

Not only that, risk-taking men many also feel less motivated to care for their health, overall, because it makes them less “manly.” For example, they may worry about being teased for choosing to eat a healthy salad instead of red meat or for going to a doctor instead of just toughing it out—and that’s bound to have a cumulative effect on health. In fact, among the leading causes of death in the United States, men outpace women on every one of them, says Vandello, except Alzheimer’s—and that’s only because it’s more strongly associated with old age (and so women tend to live long enough to get it).

“If you look at that list, most of those have a behavioral component to them. It’s not simply inevitable or biological,” he says. “The more of a behavioral cause there is for a disease, the bigger that gender gap gets.”

Though women also took more risks in societies that adhered to precarious manhood beliefs, it didn’t eliminate the effect on men. These cultural beliefs still hurt men more than women—above and beyond factors like health care opportunities, economics, and even general gender disparities.

“These [other] things probably matter, but once you take them out, precarious manhood beliefs still have predictive power,” says Vandello. “There’s something specific about the relationship between cultural beliefs about manhood and men’s health. By and large, living in a culture with strong precarious manhood beliefs seems to be negatively associated with health.”

What’s positive about masculinity?

This doesn’t mean that all masculine behaviors are bad for health, though, adds Vandello. In fact, men tend to exercise more and play more sports than women, he says, and that is certainly a healthy behavior—as long as they are not pushing themselves beyond their limits. Also, men may feel more agency when faced with illness, which can be useful for healing as long as it’s not taken to an extreme (like eschewing all help from others). 

But masculine traits are different than beliefs about manhood’s fragility, he says. And, unfortunately, those beliefs are hard to change or challenge.

Still, he argues, we could use research like his to reconsider how we frame health issues among men. For example, we may want to hammer less on the dangers of risky behaviors, like smoking (which could make them inadvertently more attractive to men), and focus more on the importance of men being healthy so they can do what they want—like be a good provider or father to their children.

Vandello also thinks that health education courses should challenge masculine beliefs about what it means to be healthy and introduce the importance of mental health early in life. “Boys, especially, need to understand that it’s OK to talk to someone when you’re having problems and to open up emotionally,” he says.

Overall, Vandello hopes his research will inspire people (including Americans) to think more seriously about how we socialize men in ways that hurt them. Perhaps, we, as a society, can find ways to challenge this idea about manhood and take the pressure off of men to feel like they have to prove themselves, he says.

“Our culture endorses the idea that manhood is something that has to be earned, and our men’s physical health is not so great compared to other comparably rich countries,” he says. “The implications for this is that we’ve got a lot of work to do.”

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