It is common knowledge that women live longer than men and that health care use is greater among women than men. Death rates for men are higher than for women in the major causes of death. Although the overall interest in health promotion and illness prevention has increased, men’s health issues remain largely unaddressed (Baerlocher and Verma, 2008). Women’s health has become a specialty practice with courses and programs available in many colleges of nursing. A specialty in men’s health has not been established.

This chapter focuses on exploring the health needs of men and the implications for community health nursing. Specific areas that are discussed include the current health status of men, physiological and psychological theories that attempt to explain men’s health, factors that impede men’s health, factors that promote men’s health, men’s health needs, and planning gender-appropriate care for men at the individual, family, and community levels.

Despite the differences in mortality rates, men tend to perceive themselves to be in better health than women do (Brown and Bond, 2008). In the National Health Interview Survey of 2003 (NCHS, 2004b), which asked people to rate their health status, men were more likely to rate their health as excellent or very good as opposed to fair or poor. Morbidity rates, or rates of illness, are difficult to obtain and have been available usually only in Western industrialized countries. For example, in the United States, reports of analyses of morbidity rates by gender lag several years behind analyses of mortality rates by gender. Gender differences in morbidity rates reflect the latest available reports. The following are common indicators of morbidity rate:

Men seek ambulatory care less often than women. According to the 2003 National Health Interview Survey (NCHS, 2004b), the physician’s office is the primary setting for ambulatory care for both men and women. In this report, males visited physician offices, outpatient departments, or emergency departments less often than women in all age groups, with the exception of males over age 75 years. Men were likely to visit a physician only if a specific health-related symptom was experienced (Brown and Bond, 2008). Injury-related visits to hospital emergency departments are higher for males than females. Males aged 18 to 24 years are twice as likely to visit hospital emergency departments for unintentional injuries as females in the same age range. Even though gender differences in ambulatory care utilization are lessening, males continue to delay medical treatment, resulting in men being sicker when they do seek health care. Because they are sicker, they require more intensive medical care. Physicians see men more frequently than women for the chronic diseases that are more prevalent among them. Males are twice as likely to visit specialists (Singh-Manoux, et al., 2008).

The literature indicates that hospitalization rates also vary by sex. In 2003, rates of discharges from short-stay hospitals were lower for males (102 per 1000) than for females (133 per 1000), even when discharges for deliveries were excluded. However, males had a longer length of stay in the hospital than females (4.3 vs. 3.8 days). Discharge rates increase for both men and women after 45 years of age; however, rates for men increase more rapidly. After 65 years of age, men’s discharge rates continue to be higher than women’s rates (NCHS, 2004b).

Preventive examinations and appropriate health protective behavior are necessary for health promotion and early diagnosis of health problems. Men do not engage in these health protective behaviors at the same frequency as females (Brown and Bond, 2008). Most men do not have routine checkups. National health surveys indicate that women are more likely than men to receive physical examinations (NCHS, 2004b). Men are twice as likely to report no usual source of care although eligibility for primary care in males exceeds that for females (Lynch, 2008).

Admission for serious mental disease accounts for the largest number of hospital admissions for men aged 45 to 74 years. Women of the same age are more likely to be admitted for disease of the heart. Women are also more likely to reside in nursing homes because they have a longer life expectancy. Men are more likely than women to be admitted for psychiatric services in state and county mental hospitals (NCHS, 2004b).

Several biological factors influence sex differences in mortality and morbidity rates, including genetics, effects of sex hormones, and physiological differences, which may be influenced by genetics, hormones, and environmental factors (Waldron, 1995a, 1995b, 1995c, 1995d, 1995e). The embryo is unisexual until the seventh week of gestation. Androgen, a hormone from the Y-chromosome coupled with the maternal androgen source, results in the development of the male sex. More male births occur than female births. In 2003, 1049 male births occurred for every 1000 female births. However, infant mortality rate for males was 9% higher than for females, thus reducing this ratio. Sex ratios at birth appear to be lower for births to older fathers, black fathers, higher-order births (i.e., second, third, or fourth births), and births after induced ovulation.

Whether sex ratios at birth are influenced by sex ratios at conception or sex differentials in mortality rates before birth is unknown. Current evidence suggests that more than two out of three prenatal deaths occur before clinical recognition of the pregnancy. Embryonic research shows excess male fetuses in early pregnancy and less male delivery at term. Males’ experience of higher mortality rates for perinatal conditions is attributed to biological disadvantages such as males’ greater risk of premature birth, higher rates of respiratory distress syndrome, and infectious disease in infancy resulting from the influence of male hormones on the developing lungs, brain, and possibly the immune system of the male fetus (National Vital Statistics Reports, 2009). Sex chromosome–linked diseases, such as hemophilia and certain types of muscular dystrophy, are more common among males than females (Waldron, 1995d).

Biological advantages for females may also exist later in life because the mechanism produced by estrogen protects against heart disease. Some evidence supports the hypothesis that men’s higher testosterone levels contribute to men’s lower high-density lipoprotein levels. Body fat distribution, specifically the tendency for men in Western countries to accumulate abdominal body fat versus the tendency for women to accumulate fat on the buttocks and thighs, may also contribute to sex differences in development of metabolic syndrome (Kirby et al., 2006). Men’s higher levels of stored iron also may contribute to risk for ischemic heart disease. Some additional physiological gender differences are the following (Tanne, 1997):

A second theory for explaining sex differences in health is socialization, especially within the area of masculinity. Society emphasizes assertiveness, restricted emotional display, concern for power, and reckless behavior in males. Pursuit of these attributes results in increased risks in work, leisure, and lifestyle. Internalization of these norms of masculinity reduces the likelihood of engaging in health promotion behaviors for fear these behaviors might be interpreted as a sign of weakness. Gender-role socialization may influence these differences. Peer pressure plays an important role in adhering to masculine norms. Men enculturate their sons to believe that risking personal injury demonstrates masculinity (Brown and Bond, 2008).

According to the National Institute for Occupational Safety and Health Workers Health Chartbook (2004), 54.2% of U.S. workers are males. Male workers account for 66.1% of the reported occupational injuries and 92% of work-related fatalities. Men’s higher exposure to carcinogens at the work site is associated with high rates of mesothelioma and coal worker’s pneumoconiosis. In the United States, men score higher than women on measures of hostility and lack of trust of others, which may place them at higher risk of ischemic heart disease. Although occupational hazards to women’s health are being identified, evidence indicates that, unlike for men, employment of U.S. women outside the home has a positive effect.

Popular male leisure, sports, and play activities place men at high risk for injury. Males between the ages of 18 and 24 years are twice as likely as women to visit a hospital emergency department because of motor vehicular accidents, stabs, or intentional injury (NCHS, 2004b). Statistics show that men drive faster than women, receive more traffic violations, and are less likely to wear seat belts, all of which contribute to a greater number of motor vehicle fatalities. Although prevalence of smoking is decreasing, 25.5% of males smoke (NCHS, 2004b); 68% of men consume alcohol, and men are five times more likely than women to drink heavily. Males have a greater use of illegal psychoactive substances and are three times more likely to be involved in criminal activity (NCHS, 2004b).

Men are more likely to be involved in violent crimes, and violence is a typical precursor to homicide. Men are victims in four out of five homicides. Black males are involved in a homicide seven times more often than European-American males (NCHS, 2004a).

Many barriers exist that prohibit positive male health behavior changes, but female family members were seen as facilitators. Cheatham and colleagues (2008) reported that several studies showed males to be more likely to change health behaviors when these changes were suggested and supported by female family members who they thought were concerned about the well-being of the man.

Illness orientation, or the ability to note symptoms and take appropriate action, also may differ between the sexes. Most diseases, injuries, and deaths prevalent among men are preventable. However, the stereotypical view of men as strong and invulnerable is incongruent health promotion. Boys are socialized to ignore symptoms and “toughen up.” Surveys done by Men’s Health reveal that 9 million men have not seen a health care provider in 5 years. Men may be aware of being ill, but they make a conscious decision not to seek health care to avoid being labeled as “sick.” Brown and Bond (2008) suggest that men lack the somatic awareness and are less likely to interpret symptoms as indicators of illness. There may be a desire to rationalize symptoms and denial of susceptibility to disease that contributes to the delay in treatment (Brown and Bond, 2008).

Health protective behavior, or the ability to take action to prevent disease or injury, also may vary between the sexes. Perhaps as a result of the contraceptive developments of the 1970s, women have a higher likelihood to seek preventive examinations. Routine reproductive health screening (i.e., the Pap test and breast examination) has been expanded to include some general screening, such as testing blood pressure, urine, and blood for chronic problems. Men do not have routine reproductive health checkups that include screening, which would detect other health problems at an early stage. Among respondents to the National Health Interview Survey (NHIS) of Health Promotion and Disease Prevention, more women than men reported wearing seat belts, receiving blood pressure checks, having their blood cholesterol checked, and seeking help for an emotional or personal problem in the past year (NHIS, 2002a). Men reported spending more time in leisure activities than women, including playing sports regularly. The rapid growth of gymnasiums and health spas indicates a growing interest in maintaining physical fitness. Only 4.9% of male respondents and 5.5% of female respondents reported knowing that exercise periods of 20 minutes per session three times per week are necessary to strengthen the heart and lungs.

The survey results also revealed that in other areas of preventive health behaviors, men are less likely than women to visit a dentist, and 26.1% of men over age 65 years have no natural teeth. Males tend to participate in exercise, but 68% of men over 20 years of age are overweight. Men consume more fatty foods and are less likely than women to change their eating habits.

Gender differences in preventive health behavior are a fertile ground for continued research. Meryn (2009) reported that 21% of research was devoted to men’s health compared with 53% for female health. He suggests that large-scale research in this area would add to the small evidence bases of health promotion behaviors among men. Specific national health objectives have only recently addressed the health care needs of this aggregate. Uniformly recognized preventive screening programs for males have only recently been developed. With the advent of managed care, men who are eligible for coverage will have access to these routine health screenings. However, it is undetermined whether men will take advantage of these programs. Box 18-1 discusses matters related to men’s reproductive health needs.