PHM-Exch> Patriarchy, masculinities and health inequalities

[Claudio Schuftan]

*Patriarchy, masculinities and health inequalities*

Alex Scott-Samuel



*Introduction*

I want to draw attention to a central —and remediable— cause

of social and material inequalities in health which, despite this

status, is an )elephant in the room: an issue that almost all are

aware of but which is never addressed directly by those involved

with health inequality and public policy. While it is commonplace

to discuss the impact of gender inequality on women and girls1

and while it is also becoming commoner to discuss its impact on

men and boys, something which is never discussed is its general

impact on all public policy. However, there is a strong case to

be made that one particular, patriarchal, form of masculinity is

almost globally dominant, and that this dominance is reflected in

unhealthy and antisocial patterns of socialisation which affect

most if not all children and adults in Europe and in most societies

worldwide. Furthermore, this socialisation has major and unack-

nowledged impacts on public policy-impacts which contribute

importantly to much of the inequality and suffering experienced

by humankind.

*Concepts and definitions*

First some concepts and definitions. Patriarchy is the syste-

matic domination by men of women and of other men.

Masculinities are the range of alternative ways (national, social,

racial, sexual) in which male gender relations are expressed

(for example, working class, Latin American and gay masculinities).

Hegemonic masculinity is the form of masculinity which is

culturally and politically dominant at a particular time and place.

Health inequality refers to unfair or unjust differences in health

determinants or outcomes within or between defined popula-

tions. Structural violence is suffering caused by public policies and

institutions. Hegemony is a subtle and complex process whereby

particular beliefs, values and ideologies are reinforced by those

with political and cultural power such that they become perceived

as both natural and inevitable, in the words of former UK prime

minister Margaret Thatcher, speaking of market liberalism, )there

is no alternative*.

*Hegemonic masculinity now*

Given what we know of the massive scale of global sociocul-

tural variation it is extraordinary that, despite this diversity, a

relatively specific form of gender relations has for many years

remained globally dominant. I am referring to the variant

of masculinity which is characterised by generally agreed

)negative* attributes such as toughness, aggressiveness, excessive

risk-taking, suppression of emotions; positive attributes such as

strength, protectiveness, decisiveness, courage: and more contes-

ted attributes like individualism, competitiveness, rationality, and

practicality.

Perhaps the hegemonic dominance of this form of masculinity

is not all that surprising if one considers its obvious overlaps with

the equally dominant (neo)liberal economic relations of the free

market. More worrying is the fact that worldwide acceptance

of childhood socialisation into the above negative features

of this hegemonic masculinity is what subsequently results in

power inequalities between individuals, between social/racial/

gender groups and between institutions —and in turn— in the

individual and the structural violence through which power

inequalities are expressed. What I’m effectively saying is that patriarchal
sociali-sation and hegemonic masculinity are unacknowledged, preven-

table causes of most health inequalities.

*Structural violence*

Structural violence is a concept originally used in peace

studies. It differs from interpersonal violence in that it refers to

oppression and suffering caused by structural relations, such

as the civil, social and economic relations of public policy.

Its abstract nature should in no way detract from its importance.

In my view structural violence is a key concept for public health:

it provides a common conceptual framework for events as diverse

as what Engels called the social murder of the poor which

resulted from exploitative and oppressive 19th century living

and working conditions, the widespread suffering caused by the

aggressive economic and trade policies of the World Bank and the

World Trade Organisation, the avoidable damage caused by

unaffordable drugs or health care, and the terrible results of wars,

genocide, racism, and poverty.

An interesting example of the worldwide relationship between

hegemonic masculinity and structural violence is in a paper by

Caprioli and Boyer from the international relations literature.

They found that States that are characterized by higher levels

of gender equality (as shown by higher proportions of women

in national parliaments) use lower levels of violence during

international crises than those with lower levels of gender

equality. Such findings have important implications for how we

manage our societies, not least, for how we manage the health

inequalities resulting from the many varieties of structural

violence.

*What is to be done?*

While it is tempting to view the globally endemic problems of

patriarchy and hegemonic masculinity in a resigned and fatalistic

way, it is also important to acknowledge that they are —at least in

principle— preventable. The previous Swedish government’s

Education Ministry established a Delegation on Gender Equality

in Preschool which looked at the ways in which, from the very

beginning of education and socialisation, children in preschool

education face systematically gendered policies and practices,

and which made recommendations to change this situation

(unfortunately the report is not available in English). This provides

a small example of how such issues can legitimately begin to be

addressed through public policy. Given the nature of the global

institutions whose practices help to sustain patriarchy —such as

many of the world’s major religions— I would not pretend that the

task will be an easy one. Nonetheless, there is much to be said for

adopting a public health perspective on these issues. If we can

generate evidence and debate around the notion that patriarchy is

a preventable disease, this is a valid and a potentially useful

way forward. Another helpful approach would be to build public

pressure for a global commission on masculinities.

The fact that virtually no one is currently acknowledging, let

alone addressing this issue makes it no less important as a key

global cause of mortality, morbidity and inequality. Discussion

and action are long overdue.
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