An argument for male gender as a root cause or fundamental social determinant of health

Abstract

Undeniably health disparities and social determinants of health are connected. While there are many definitions of health disparities, in the United States the legal definition comes from US Public Law 106-525 and is as follows: Health disparities are differences in the incidence, prevalence, mortality, and burden of diseases and other adverse health conditions that exist among specific population groups in the United States. Whitehead in the United Kingdom defined health inequities as the differences in prevalence, incidence, mortality, and morbidity that are unnecessary, avoidable, and unfair. For our purposes, a health disparity occurs whenever a negative, unjust, and preventable health-related prevalence, incidence, or disease burden difference (e.g., cancer incidence rates and mortality rates) is measured between population groups (i.e., men and women, African American and Caucasian men, or low and high socioeconomic status groups). Health disparities grow out of social determinants of health. A social determinant of health is an independent factor that influences and/or shapes health. Such factors may be geographic, socioeconomic, psychosocial, behavioral, or social in nature. Disparities or inequities in health arise because of the circumstances or social determinants that influence how people live, work, and age and the social structures or systems constructed to deal with disease and illness. In the late 1990s, Link and Phelan opened up a provocative debate about which social determinants of health are key contributors to health disparities or inequities. We believe that examining how male gender affects health status, health care, and health behaviors can affirm male gender as a fundamental or root social cause of health inequity. As defined by Link and Phelan, the following four features characterize a fundamental social cause: (1) it influences multiple disease or health outcomes; (2) it affects these outcomes through multiple risk factors; (3) it impacts access to resources that may be used to either avoid risks or minimize the consequence of disease; and (4) the association between the fundamental cause and health is reproduced over time through the replacement of intervening mechanisms. In this article, male gender is explored as a fundamental or root social cause of health inequities by taking these characteristics and posing four questions about male gender.