"Men's bodies, men's selves": men's health self-help books and the promotion of health care

International Journal of Men's Health, Jan, 2003 by Andrew Singleton

This paper is a critical analysis of men's health self-help books, focusing on the health care strategies encouraged by this advice literature. It is argued that the genre of men's health self-help overwhelmingly emphasizes the role of the individual in achieving good health and well-being. In presenting this message, men's health self-help reproduces a neo-conservative ideological perspective about public health: good health is primarily an individual concern, and that good health outcomes are largely the product of individual behavior. It is suggested that this emphasis on individuality works best for the genre's target audience of middle-class men, but is of limited use for health-care strategies aimed at achieving better health outcomes for a broader male population.

Key Words: men's physical health, self-help books, health-care strategies, individualism

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Throughout the 20th century, there have been many popular Western health movements (Starker, 1989), which have made a difference to people's health outcomes. For example, in the 1950s, the founding of the La Leche League signaled a turn away from bottle-feeding back to breast-feeding of infants, and subsequently, new forms of women's empowerment in the face of male medical dominance. Beginning in the 1960s, complementary and alternative medicine gained increased public support, and practices such as naturopathy, homoeopathy, and acupuncture have become an accepted part of many people's health regimen.

Fueled in part by concerns about men's higher rates of morbidity and mortality compared to women, the men's health movement has flourished in recent years in Europe, the United States, and Australia. This movement manifests itself in many ways: conferences have been organized by stakeholders to analyze and discuss men's health issues, scholarly explanations have been offered to account for men's poor health outcomes, and dedicated men's health services have been established by health-care providers. At this point in time, it is not yet clear what impact the men's health movement has had on men's health outcomes, especially those men with the poorest health.

In his book Oracle at the Supermarket, Starker (1989) observes that popular health movements of any kind are always supported by self-help literature. The burgeoning concern with men's health is no different. A visit to the local bookstore or on-line bookseller reveals an ever-increasing range of self-help books that present a total program for improving a man's health (as opposed to books covering just one area, like diet). In the first instance, these books offer practical advice for men in the prevention, diagnosis, and treatment of male health issues like testicular cancer and erectile dysfunction. Other areas of "body maintenance" (Saltonstall, 1993) also come under consideration, from general health problems, to lifestyle issues, fitness programs, and even personal grooming. These books share similarities with popular magazines like Men's Health and Men's Fitness, both of which dispense accessible health and lifestyle advice to the mass market. Unlike the magazines, however, men's health self-help books offer the consumer an all-in-one guidebook covering the major areas of men's health and thus ought to be viewed as a kind of do-it-yourself "comprehensive health promotion package" (Sabo, 2000, p. 134).

As a do-it-yourself form of health care, men's health self-help books are an intermediary between the individual and the wider health-care system. It is important, therefore, to understand the messages the reader receives about his health. In this paper, I analyze several men's health self-help books to determine the type of health care these advice books advocate and how this advice is positioned in relation to competing ideologies about health promotion and health care.

I argue that the reader is educated to see that he, the individual, is primarily responsible for his own health, and that good health outcomes are largely the product of individual behavior. In presenting this message about individualization, men's health self-help reproduces a neo-conservative ideological view about public health. (1) That is, good health is primarily an individual concern, rather than a problem for state or government agencies (the implication being that the cost of care should be borne by the consumer rather than the state). Rimke (2000), in her account of psychological self-help literature, suggests that self-help is a medium "which exalts the individual over the social ... [and] is elaborately consistent with the [neo-liberal] political rationalities promoted in advanced liberal democracies" (p. 62). In like manner, men's health self-help, it is argued, is both an instigator and a product of a neo-liberal or neo-conservative view of public health. I conclude the paper with a comment on the role these books might play in a broader movement aimed at improving men's health.

The aim of this paper is not to criticize the utility of men's health self-help books in enabling men to lead healthier lives; rather, it is to question the broader health-care ideology that these books can be interpreted as promoting and, arguably, how this is of limited value in improving men's health across the board. As Western governments continue to favor a free market health system funded by individual consumers, it is important to understand how associated and often inequitable healthcare ideologies are sustained. This paper is part of the evolving "sociology of health promotion" (Bunton et al., 1995), which involves a "critical analysis of the underlying assumptions inherent in health promotion" (Nettleton & Bunton, 1995, p. 42).