"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

THE INDIVIDUAL'S RESPONSIBILITY IN ACHIEVING GOOD HEALTH

In this section, I demonstrate the techniques and strategies through which "individual responsibility" (Watson, 2000) is promoted in the pages of men's health self-help, with particular reference to the genre's account of testicular cancer and coronary heart disease. This discussion demonstrates the importance these books place on the individual in achieving good health outcomes. To situate these arguments, however, it is first necessary to outline competing perspectives on health care and health promotion.

Advice, information, and actual screening for cancer and heart disease are all forms of health promotion. In Western nations, there are competing ideological perspectives on how health promotion should be effected. The "traditional approach," founded on a conventional biomedical model (Watson, 2000), emphasizes the importance of the individual in living active, healthy lifestyles in order to minimize the incidence of morbidity or early mortality. From this perspective, health care strategies ought to be directed at the individual, with emphasis on the individual changing his (or her) behavior (Watson, 2000, p. 126). Critics of this approach to health policy assert that an over-emphasis on individual responsibility fails to recognize the broader structural factors which might influence "good health" outcomes, such as class, wealth, gender, and race (Davison & Smith, 1995; Nettleton & Bunton, 1995; Watson, 2000; Ziguras, 1998).

From a men's health perspective, the assertion that good health is not simply the product of individual choice is borne out by the fact that less wealthy men, less educated men, and men of color have some of the poorest health outcomes in Western nations, with a lower life expectancy and higher mortality rates from many diseases. For example, according to the U.S. DHHS (1998, p. 6), "Men with family incomes less than $10,000 were more than twice as likely to die of lung cancer as those earning at least $25,000." Furthermore, in 1996 the life expectancy for white males at birth is 73.9 years, compared to 66.1 years for black males (DHHS, 1998, p. 200).

A popular alternative to the traditional, individually focused model of health care policy is the "New Public Health" (Luck et al., 2000; Petersen & Lupton, 1996; Schofield, 2000). According to Petersen and Lupton (1996), the "new public health takes as its foci the categories of 'population,' and 'the environment,' conceived of in their widest sense to include psychological, social and physical elements" (p. ix). Health promotion ought to focus not just on personal responsibility, but also in making changes to "social, economic and ecological environments" (Burrows et al., 1995, p. 2).

In 1992, both the U.S. and British governments released health care policy statements that emphasized the primacy of individuals in taking responsibility for good health, rather than governments first addressing the broader social, economic, and environmental factors that influence health outcomes (Howell & Ingham, 2001; Luck et al., 2000; Watson, 2000). As Watson (2000, p. 18) observes, policy statements like these "coincided with global concerns about containing the escalating cost of health care." In like manner, Howell and Ingham (2001, p. 331) note that from a U.S. government perspective, "[s]elf-help was preferable to government handouts and entitlements.' Health promotion that emphasizes individual responsibility reinforces "neo-conservative laissez faire ideologies" (Howell & Ingham, 2001) about who should bear the responsibility for health care. From a neo-conservative point of view, health care should be a private, and thus by logical inference, a self-funded, affair (Peterson, 1997; Watson, 2000). (3) As I demonstrate in the ensuing discussion of cancer and heart disease, men's health is both a product and instigator of this ideology (cf. Rimke, 2000). In making such claims, I am not arguing that it is the authors' intention to produce particular ideological messages. They may merely reflect a prevailing ideology about health care.