Why health campaigns are dangerous

Playing Balls - why are men obsessed with their health? was the surprising title of a debate held at last month's Battle of Ideas. Last month in this slot we featured the opening remarks of the one of the participants, the MHF's website editor Jim Pollard. This month we feature the views of two more of the panelists.

First up is Dr Dana Rosenfeld, a medical sociologist at Royal Holloway, University of London, argues that masculinity itself is now being seen as a health problem.

Then Dr Michael Fitzpatrick, a GP from Hackney, London explains in a specially writtten piece why, unusually for a doctor, he believes that health awareness campaigns are actually BAD for men's health.

• Read Jim's opening remarks here.

DANA ROSENFELD: Don't just accept claims about men's health — examine them

I'm not a practitioner; I'm a medical sociologist, which means that my job is to critically examine the claims and practices of medicine, and to consider how our health experiences are shaped by them, if at all. Medical sociologists — at least, critical ones — approach medicine and public health not as benign, objective, politically neutral and beneficent agencies, but as institutions of social control; we ask such questions as 'why is health the key prism through which we evaluate the success/condition of a society' and 'why is medicine the lens through which we evaluate social, societal, and individual states of health'?

So my concern with how men's health is being framed and treated is filtered through this larger project. And I think that something very interesting and new is going on in relation to the claims being made about men and their health. Men's bodies and emotions and behaviors used to be held up as the standard for health, against which women's bodies and behaviors and emotions were judged. Men were rational, intact, strong; women were irrational, leaky, and weak. Now, though, men and masculinity are being problematized, and are coming under increased medical surveillance and control.

We in the academy are just beginning to notice this. My edited volume, Medicalized Masculinities (Temple University Press, 2006) the first book on the medicalization of masculinity — the construction of masculinity itself as a medical problem, a threat to health. This is a recent invention — there have been hysterias over alleged crises of masculinity throughout the 20th century, but the claim that men are in trouble because they are men, because they are behaving in male ways, is very, very new — at least, the sheer number and intensity of these claims is very new.

Beginning in the early 1970s, scholars began to critique medicine's control of women. But, with a few exceptions (Ehrenreich), scholars failed to consider the possibility that men were also coming under the critical and pathologizing gaze of medical agents and agencies. Why has it taken so long for the academy to recognize that this is going on? Because we have painted ourselves into a conceptual corner.

Early work in this area focused on the increasing medical definition and control of politically subject populations, which, in regards to gender, meant women — men were the agents of medicalization, not its target (unless they were poor, members of sexual or ethnic minorities, and the like). Second, medicalization in relation to gender was hijacked by feminist scholarship, which produced a huge body of work on the medicalization of childbirth and reproduction — here, too, the assumption was that men were the medicalizers, not the medicalized. This was a very naÔve picture.

But the academy is beginning to recognize that masculinity is being medicalized as well — although whether it is just their behaviors or their very bodies that are being constructed as a threat to health is, as yet, an open question. I suspect that it's both — for example, men's suppressed emotions, risk-taking male culture, and the like on the behavior side, and testosterone (too much or too little?) on the biological side.

Now that we've recognized that men are being medicalized, it seems that we can see it everywhere we look. Consider these seemingly unconnected medical/scientific claims, some debunked, some still thriving:

• the XYY chromosome as a cause of male violence
• the 'discovery' of the 'homosexual gene'
• men's health-seeking behaviors as inferior to women's (so now women are held up as the standard for health, rather than men!)
• male drinking and recreation (too risky, grounded in a masculine culture, and a real threat to health!)
• men's coronary heart disease as the product of masculine aggression run amok. (Now that women are catching up to men, the argument is that women are behaving too much like men — so masculine behavior among women is being medicalized!)
• male sexual dysfunction (whatever that means): why is it a physical problem? Why is male sexuality viewed so mechanistically? Why is an interaction — sex is, after all, an interaction — coming under medical treatment when it doesn't play out in idealized ways? Why provide a pharmaceutical product for it?
• men's emotions. We are constantly hearing that men don't express their emotions in healthy ways — that men are emotionally repressed, and that this is bad for their health. This is a new claim; men's emotional expression used to be seen as laudable in relation to women's — men were appropriately in control, women were inappropriately out of control. Men were rational, women were hysterical. Now, men are being asked to become more emotional — why? In the name of mental and emotional and even physical health.

So, clearly, something is going on. Where do we go from here? Do what we've always done — conduct empirical studies, critically. Study the construction of prostate cancer, testicular cancer, male sexual dysfunction, men's emotions and risk-taking. Study instances of 'disorders' that are being diagnosed in men more than they are in women — as in ADHD. Don't just accept claims about men's health — examine them, as we've been doing here. We must ask the perennial sociological question 'why this now?' The answer is that we are probably witnessing a confluence of factors — for example, we live in a more reflexive, therapeutic culture; could this help explain the medicalization of men's emotions?

MIKE FITZPATRICK: Why are health awareness campaigns are bad for mens health?

1. It's normal to be healthy

Men are living longer and healthier lives than at any time in human history. Not only has life expectancy increased by around 30 years over the past century, and by about 7 years since 1950, but people also enjoy better health for longer than ever before. Men should regard health as their default state, one that allows them to get on with enjoying the important things in life.

2. Awareness of disease makes people ill

Promoting awareness of disease, and the measures men are supposed to take to avoid it, encourages the notion that it is normal to be ill. Health has become an ideal state that can only be achieved by eternal vigilance against external threats (pollution, infection), and by constant monitoring of personal behaviour (diet, exercise, cigarette/alcohol intake).

To achieve the goal of health, men are also supposed to present themselves to the doctor for regular check-ups. As the vast majority of men will certainly fall below the ideal, this process is guaranteed to make them feel ill. They are likely to become more anxious and more aware of minor passing symptoms that they might previously have shrugged off.

3. Prevention is not necessarily better than cure

Clean water, childhood immunisations and safety belts are all preventive measures of proven value. It is well known that stopping smoking dramatically reduces your risk of lung cancer.

However, the evidence that other lifestyle measures — such as a so-called healthy diet, taking more exercise, avoiding passive smoking — have a significant impact on health is weak and contradictory. There is no justification for coercive public health measures that seek to change individual behaviour (such as attempts to restrict passive smoking or so-called junk foods) in the absence of strong evidence that they produce substantial health benefits.

4. Early diagnosis may not improve your chances

Screening tests for cancer are based on the assumption that early detection leads to a better outcome. Unfortunately there is little evidence that this is true — even in the case of a fairly common condition like breast cancer, still less for a rare condition like testicular cancer.

The real problem is that, even though there have been advances in treatment, this is still not very effective against the more aggressive forms of cancer. Contrary to urban myth, men rarely present late with advanced cancers. The fact is that, if you've got cancer, you'll know soon enough.

5. Pocket billiards is a waste of time

Like breast self-examination, testicular self-examination is well known to create anxiety much more effectively than it detects tumours. Just as breasts are often naturally lumpy, the irregular area behind the testicle (the epididymis) often feels slightly lumpy and is a common site of benign cysts. Recognising the uselessness of self-examination, some health promoters have now shifted to encouraging a more general 'awareness'. But the consequences are the same: more pocket billiards, more anxiety, and further unnecessary medical examinations and investigations.

6. Prostate screening is unreliable

Greater awareness of prostate cancer encourages more men to seek screening tests (such as the prostate specific antigen, PSA, test) which are unreliable. Test results are sometimes positive when there is no cancer, leading to further investigations (such as biopsies, which may cause bleeding and infection) or even surgical treatment (which may result in incontinence or impotence). Studies have confirmed that having a PSA test does not improve life expectancy. Prostate cancer usually occurs in older men and often runs a benign course — most men with it die of some other cause. The real problems are that it is difficult to predict the course of the disease and existing treatments are not very effective.

7. Sometimes its hard to be a man

Promoters of men's health offer a caricature of masculinity, defined by mindless aggression, insensitivity and irresponsibility. As an alternative they promote a politically correct 'new man' characterised by self-indulgence, passivity and victimhood. Yet some traditional masculine virtues, including independence and self-reliance, perseverance and fortitude, are worth cherishing, for women as well as men.