1.
MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.
Gender and Health
2nd Feb 2016
Dr Matt Maycock
MRC|CSO Social and Public Health Sciences Unit, University of Glasgow
matthew.maycock@glasgow.ac.uk

2.
MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.
Session overview
• Theories of gender and health
• Theories of masculinity
• Theories of masculinity applied to a health
promotion intervention - Fit for Life
• Practical application of theories of masculinity
to a health promotion resource

3.
MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.
DEFINITIONS
• Sex – biological or genetic differences between
men and women. Largely universal.
• Gender – socially/culturally constructed
differences between men and women. Variable.
• Sexism – the personal and institutional
differentiation of power and status between the
sexes which limit opportunities for girls and
women.
• Gender/sex role – pattern of behaviour a
particular society expects from individuals of
either sex. Learned through socialisation.

4.
MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.
Recognising the Social
Construction of Gender
‘Gender refers to women’s and men’s roles
and responsibilities that are socially
determined. Gender is related to how we
are perceived and expected to think
and act as women and men because of
the way society is organised, not
because of our biological differences’.
Gender and Health, WHO (1998:5)

5.
MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.
THE SECOND SEX
‘In truth, to go for a walk with one’s eye open is
enough to demonstrate that humanity is divided
into two classes of individuals whose clothes,
faces, bodies, smiles, gaits, interests and
occupations are manifestly different.
Perhaps these differences are superficial, perhaps
they are destined to disappear.
What is most certain is that they do most obviously
exist.’
Simone De Beauvoir – 1953

6.
MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.
Social explanations of gender
differences
• Feminine traits are de-valued and under-
valued by society.
• Women as relative beings – ‘woman as
other’.
• Men are the ‘unmarked’ or norm

7.
MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.
Explanations Cont.
• The process of socialisation places men in a
different position to women: a masculine
(hegemonic) archetype
• Traditional notions of masculinity position men as
‘breadwinners’, risk takers (in terms of hazardous
work – industrial accidents, contact with harmful
substances, and other pursuits such as sport, sex,
violence and health damaging behaviours –
smoking and excessive alcohol intake)
See Doyal, L. (2002) in Bendelow, G. et al (eds)
Gender, Health and Healing. London:Routledge.

8.
MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.
Social or Biological?
‘Men’s health is not a medical issue, it is
societal’ argues White (2001:3)
Equally, argues Doyal (2002), this is the
case for women also – both nationally and
globally.

9.
MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.
Difference/sameness debate
• Why should any difference – if it exists, or
we believe it to – be constructed as
disadvantage, particularly for women?
• If we are the same – the problem of
women's relative disadvantage and lack of
power remains unresolved.
• What needs to be addressed is not are we
the same or different, but what structures
exist which convert this into
disadvantage?

10.
MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.
Gender & health inequalities
‘Women get sicker but men die quicker’
(Miers, 2000)
Morbidity rates are higher for women
Mortality rates are higher for men

11.
MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.
Statistically Speaking…
• Life expectancy is higher for women than
men: in 2001 life expectancy at birth for
women was 80.4 years compared with
75.7 for men.
• Life expectancy for men has been
increasing faster than for women: an
increase of 4.8 years for men, and 3.6
years for women between 1981 and 2001.

12.
MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.
More stats…
• In 2001 obesity levels were similar for both sexes: nearly
half of men were considered overweight, compared with
a third of women
• Underweight: men 4%, women 6%
• Men twice as likely to exceed recommended daily
benchmarks for alcohol consumption (3-4 units daily for
men, 2-3 for women)
• Young men more likely to binge drink
• Student drinking levels/behaviours revealed no significant
differences between the sexes!

13.
MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.
CRITIQUE
THE PICTURE IS MORE COMPLEX
• Age ranges are significant.
• Men have higher rates of serious illness than
women
• Women have higher consultancy rates than men –
particularly GP contact

14.
MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.
Impact on Health
Women may still (just) have some
advantage over men in life expectancy,
may seem to get ‘sicker’ (higher rates of
morbidity), may be protected to some
extent from CHD due to oestrogen levels –
but their changing patterns of behaviour
are giving cause for interest and concern:
women are becoming more like men, and
thus experiencing similar health problems.

15.
MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.
• To examine gender differences in consulting in
primary care in the UK population using routinely
collected general practice data. ▪
• To explore whether gender differences remain when
consultation for reproductive reasons or treatment for
common underlying morbidities are accounted for.

16.
MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.

17.
MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.
• The crude consultation rate was 32% lower in men than
women.
• The magnitude of gender difference varied across the life
course, and there was no ‘excess’ female consulting in early
and later life.
• The greatest gender gap in primary care consultations was
seen among those aged between 16 and 60 years.
• Gender differences in consulting were higher in people from
more deprived areas than among those from more affluent
areas.
• Accounting for reproductive-related consultations
diminished but did not eradicate the gender gap.
• However, consultation rates in men and women who had
comparable underlying morbidities (as assessed by receipt
of medication) were similar

18.
MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.
• Conclusion: Overall gender differences in consulting are
most marked between the ages of 16 and 60 years; these
differences are only partially accounted for by consultations
for reproductive reasons.
• On average, men consulted less than women between the
ages of 16 and 60 years, but not at younger and older
ages.
• After controlling for medication for common underlying
morbidities (depression and cardiovascular disease), gender
differences in the use of primary healthcare services reduce
substantially and are modest.

19.
MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.
Why are women the main consumers
of health care?
• Women assume main responsibility for contraception
• Women encounter medical profession during pregnancy and
childbirth
• Women assume prime responsibility for well and sick
children
• Women’s anatomy is seen to be more complex than men’s
and appears to be more likely to succumb to health
problems and illness
• Traditionally women have been seen to be frail – medicine
has capitalised on women’s perceived weaknesses ( from
the vapours to pms)
• Women see themselves as ill more often than men

20.
MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.
Hegemonic Masculinity, Raewyn Connell (2005)

21.
MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.
Hegemonic Masculinity
• “hegemonic masculinity” - a form of masculinity that is
dominant in society, establishes the cultural ideal for what
it is to be a man, silences other masculinities, and
combats alternative visions of masculinity.
• Hegemonic masculinity’ is a concept that draws upon the
ideas of Gramsci. It refers to the dynamic cultural process
which guarantees (or is taken to guarantee) the dominant
position of men and the subordination of women.
• hegemonic masculinity - rejection of the idea that all men
are the same

22.
MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.
Hegemonic Masculinity Cont…
• a change from the concept of masculinity to the concept
of masculinities
• allows meaningful distinction between different
collective constructions of masculinity and identification
of power inequalities among these constructions.
Masculinities:
• Are actively constructed (not biologically determined)
• Are dynamic- change over time
• Have negative impacts- be tough don’t cry, can lead
to disengagement, health problems, aggression,
overwork and lack of emotional responsiveness.

23.
MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.
Criticisms (V. Seidler)
• Leaves gender roles, and in particular patriarchy
unchallenged
• Leaves out personal and emotional perspectives-
emotional lives of men ignored.
• “There is a danger of creating a fixed category of
‘abusing men,’ rather than learning how pregnancy
invokes unresolved emotional feelings in men”
• Is often applied to research quite uncritically

24.
MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.
Inclusive Masculinity, Eric Anderson (2009)

25.
MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.
• Eric Anderson’s theory of Inclusive Masculinity describes
changes in the ways some men conceive of and enact their
masculinity. Employing ethnographic methods and “social-
feminist thinking” (14)
• Inclusive masculinity, like hegemonic masculinity, frames
gender (partially) in terms of power relations. However, it
suggests a shift toward a more egalitarian conception of
masculinity and a less rigidly vertical notion of hierarchy
• Anderson claims that “university-attending men are rapidly
running from the hegemonic type of masculinity that scholars
have been describing for the past 25 years” (4).
Inclusive Masculinity (2009)

26.
MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.
• Connell’s definition of “hegemonic masculinity”—emerges
as insufficient for describing “the complexity of what
occurs as cultural homohysteria diminishes.” To rectify
this shortfall, Anderson proposes “inclusive masculinity
theory,” his own “new social theory” (7).
• homohysteria “describes the fear of being
homosexualized,”
• diminishing “homohysteria,” which Anderson defines as
combining “a culture of homophobia, femphobia, and
compulsory heterosexuality” (7).
Inclusive Masculinity

27.
MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.
Criticisms (de Boise, 2014)
• Misread hegemonic masculinity to be a type of person as opposed
to a web or matrix of configuration
• Assumes that hegemonic masculinity is inflexible and doesn’t adapt
to periods of low homohysteria
• Assumes a singular dominant ideal, but Connell uses a
multidimensional understanding of gender
• Claims of a ‘decline’ homophobia and homohysteria are questioned;
can levels of prejudice be objectively established; are acts like
same-sex kissing indicative of attitudes, is homophobia is really as
insignificant as inclusive masculinity claims.

28.
MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.
Prison masculinities and health in
Scotland (post-doc)

29.
MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.
Can FFIT be adapted to attract men to positive lifestyle change in a
prison?
Football Fans in Training (FFIT) has helped overweight and obese men
lose weight, improve diet, and increase physical activity (Hunt et al,
The Lancet, 2014)

30.
MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.
Context
Prisons are largely
all-male
environments
p-FFIT delivered to
men-only groups
Content
Info about science of
weight-loss presented
simply
Role of alcohol in
weight management
FFIT logo branding
Delivery notes
adapted to take
account of prison
context
Style of delivery
PEIs have detailed
knowledge of
prison context
Participative and
peer-supported
learning
Encouraged male
banter to facilitate
discussion of
sensitive topics
Testing feasibility of delivering an adapted version of FFIT, Fit for Life
was delivered in two prison gyms over course of 10 weeks

31.
MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.
Methods
Prison A
Delivered to 18 prisoners by prison
Physical Education Instructors (PEIs)
Data collection
Observations of all 15 sessions
Interviews with participants who
completed programme (n=9)
Interviews with participants who did
not complete (n=3)
Focus group with PEIs (n = 1)
Delivered to 21 prisoners by
community coaches from a
professional football club
Data collection
Observations of all 12 sessions
Interviews with participants who
completed programme (n=9)
Interviews with PEIs and staff
(n=3)
Prison B

32.
MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.
Health in prison contexts
Context-specific challenges to
prisoners’ mental and
physical well-being
The prevalence of overweight and
obesity among male prisoners in
the UK is ‘unacceptably high’
(Herbert et al, 2012)
Many prisoners do not take given opportunities to eat healthily and
exercise regularly and are less likely to achieve recommended
minimum PA guidelines (Herbert et al, 2012)

33.
MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.
Prison masculinities
In (largely male) prisons environments, there are performances of masculinity that
are structured in hierarchical ways in reference to both orthodox/hegemonic' and
'inclusive' masculinities
Orthodox/ hegemonic
masculinity
" inclusive form of
masculinity based on social
equality for gay men,
respect for women, and
racial parity and one in
which... men bond over
emotional intimacy"
(Anderson, 2008, 604)
"masculine performance
labeled as orthodox attempts
to approximate the hegemonic
form of masculinity, largely by
devaluing women and gay
men." (Anderson, 2005, 338)
(Bourdieu, 1998) (Connell,
1995)
Inclusive
masculinity

34.
MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.
Prison is an ultramasculine world where
nobody talks about masculinity. (Sabo et
al 2001, 3)
…a hegemonically defined hypermasculine
and heteronormative environment with an
abundance of alpha males, sexism, and
violence. (Jenness and Fenstermaker,
2013, 13)
…prison facilities are a
particular kind of institutional
setting, one that actively resists
the diversity of masculine
practices and identities.
(Curtis, 2014, 121)
…places of great humour and
playfulness, of friendship and
camaraderie, of educational
enlightenment, of successful
therapeutic intervention. (Jewkes,
2013, 14).
in their mutual support and
encouragement, it was also possible
to discern sublimated forms of
intimacy. Certainly, the vivid and
joyful ways in which prisoners
engaged in collective exercise, and
the sheer amount of physical
horseplay among younger prisoners,
pointed to submerged emotional
sentiments. (Crewe et al, 2013, 11)
Orthodox/ hegemonic
prison masculinities
Inclusive
Prison masculinities

35.
MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.
Orthodox masculinities in the context of the
Fit for Life programme
I can understand aboot guys being
apprehensive an’ that, ken I think
when, especially wi’ everybody else
in the hall, ken, an’ you’re goin’ and
they’re goin’ “aye, goin’ tae fat
club,” an’ a’ this carry on, ken whit I
mean? So I could imagine people
being apprehensive aboot it, eh.
(Prison A - P2)
I was hammering everybody fae
the word go. I'm the sort o' person,
see once I get up there I don't like
anybody beating me, you know?
Determined an' that, you know?
(Prison B - P11)
Ken what I mean? I’ll par—ken, I’ll... I’ll
take—I’ll partake in anythin’ eh? And as I
say when, ken when I got there I was
like that, ‘right, fair enough.’ I mean
you’re only putting your view forward. I
mean we’re in a hostile situation
here, eh? And people dinnae want
tae speak forward in case the boy,
“he’s a fucking idiot,” excuse my
French. (Prison A - P11)

36.
MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.
Inclusive masculinity within the context
of the Fit for Life programme
I think it was a part of—it was
being a part of a group. On the
outside I’m a lone person. I’m no’
part of any group. So see learning in
a group, and interacting wi’
people, and speaking to people
in the group that kept me
motivated as well. (Prison A - P11)
it was important for me tae, for me tae
do my thing and for me tae tell people
that they was doing good at their
thing, and encouraging them and
pushing them and stuff like that.
(Prison A - P3)
Well you’re having a laugh wi’
people and it’s like yous are losing a
wee bit o’ weight an’ you’re kinda
like, it’s just you’re no’ coming an’
you’re no’ like if you’re coming tae
the gym, it’s like you’re no’ the
fattest person in the gym. So
you’re here and yous are all
kinda fat, yous are all here for
the same reason. (Prison B - P3)

37.
MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.
Embodied masculinity - The gym,
muscularity and weight
You’ve gottae get big, aye, you’ve
got a group, your group o’ guys,
that’s what they’re intae, their
bodybuilding an’ they’re strength
things like that. (Prison A - P8)
You want everybody tae go intae a
prison an' they all want tae dae the
weights, they a’ want tae get big
an' strong. That's what they all want
tae dae. (Prison B P11)
I actually get people that go like
that, “oh how long did it take you to
get that [large] size?” And this is the
first time I’ve ever trained in my life!
Know what I mean? And I’ve just
worked hard at it, and worked hard,
and I explain that to guys. I just,
know what I mean? Guys were all
wanting to get like me, and like
as big as me kinda thing. (Prison
B-P1)

38.
MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.
Changes to bodies and appearance
I think people in general do take a
lot more care of themselves
nowadays and it happens more in
prison. So you're not
automatically in inverted
commas 'a poof' if you use face
cream and keep yourself clean
and... yeah. (Prison A - P4)
When I lost weight I kind o'... I
like tae keep my strength up an’ I
felt as if when I was losing my
weight that I was losing my
strength as well, that my strength
was falling away. (Prison B - P11)
Some people don't care aboot
themselves 'cause they're in the jail,
they've hit rock bottom. (Prison A
- P7)

39.
MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.
Orthodox to Inclusive masculinity -
Group dynamics
I think it was a part of—it was being
a part of a group. On the outside I’m
a lone person. I’m no’ part of any
group. So see learning in a group,
and interacting wi’ people, and
speaking to people in the group that
kept me motivated as well. I mean I
enjoyed the group. It’s one of
the biggest things I’ll take away
fae it has been involved in the
group. (Prison A - P11)
...you dinnae want tae be yourself,
‘cause you just single yoursel’ oot, ken
whit I mean? As I say you can put
yourself the gither as a team an’ you
take it on as a team, ken whit I
mean? An’ you support each other
through it. (Prison A - P2)
Yeah, there was two lads in
particular that were like really
taking the piss an’ I didn’t enjoy
that bit. No-one had control over
them. D’you know what I mean?
But other than that everything went
really, really well. (Prison B - P5)

40.
MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.
Results - ActiGraph data – Total Moderate to
Vigorous Physical Activity (MVPA) (HMP Perth and
Kilmarnock, Phase three)
Mean
54.70956504
Mean
81.0760771
0
20
40
60
80
100
120
140
Basline 12 week
M
i
n
u
t
e
s

41.
MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.
Results - ActiGraph data: Sedentary time (HMP
Perth and Kilmarnock, Phase three)
Mean
473.475067
Mean
427.5057823
0
100
200
300
400
500
600
700
Basline 12 week
M
i
n
u
t
e
s

42.
MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.
Results - ActiGraph data: Step counts (HMP Perth
and Kilmarnock, Phase three)
Mean
8817.266193
Mean
12522.58197
0
2000
4000
6000
8000
10000
12000
14000
16000
18000
20000
Basline 12 week
S
t
e
p
s

43.
MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.
Results - Self reported - Portion sizes (HMP Perth
and Kilmarnock, Phase three (14 participants))
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
Cheese Pasta Meat Chips
Baseline
12 weeks

44.
MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.
Results - Self reported – Self-Esteem (HMP Perth
and Kilmarnock, Phase three (14 participants))
Mean
14.54545455
Mean
15.22727273
8
10
12
14
16
18
20
baseline 12 weeks

45.
MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.
Fit for Life - Conclusions
• Masculinity has shaped the planning and the experience of engagement in the
Fit for Life programme.
• An approach to men's health similar to that taken by FFIT has the potential to
be successfully adapted for secure settings.
• A gender and context sensitised health promotion intervention has the potential
to facilitate engagement with a cohort of hard to reach and disadvantaged men
in a secure setting.
• Performances of both hegemonic/orthodox and inclusive forms of masculinity
were evident amongst men who took part in the Fit for Life programme.
• Programmes such as Fit for Life have the potential to enhance more inclusive
forms of masculinity.
• There are many, often contradictory implications for masculinities in taking part
in programmes to enhance health and wellbeing.

46.
MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.
Practical exercise
In groups think about a health promotion resource in the
form of a leaflet that will communicate men or boys about
health.
• Consider how the theory/s of gender/ masculinity
will shape the resource
• Consider how you will design the leaflet in a
gendered way
• Consider about what subjects/issues you will cover

47.
MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.
Masculinity and health – the Haynes Man Manuals
Men&Work
Warning:
Reading this may
seriously improve
your health

48.
MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.
Masculinity and health – the Haynes Man Manuals

49.
MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.
Questions/ Comments