By Helen Osborne, M.Ed., OTR/L
President of Health Literacy Consulting
On Call Magazine, December 31, 2008

The differences between men and women go beyond anatomy and physiology. One very important one is the way men and women take in, process, and use health information. Joe Zoske, MS, MSW, says gender is a component of health literacy and cultural competence.

Zoske is the administrative coordinator of the BSW Social Work Program at Siena College in Loudonville, New York. He brings his interests in health, literacy, and gender to teaching about men’s health and health communication. When people think of culture, he says, they commonly consider race and class. But cultural competence also includes gender and Zoske feels there is more work to be done in that area. He believes that our healthcare system doesn’t speak effectively to men. Therefore outreach methods fall short, resulting in significant health disparities.

In general, Zoske believes that men’s overall health literacy is poor. He explains that boys often grow up without learning much about their own anatomy and physiology. We tend to be more concerned how we perform — taking risks, being daredevils, and proving our manhood. The result is that as men, we don’t know much about how our bodies are supposed to work, or when they are not working as well as they should.”

Men are raised with inhibitions or “rules of manhood” that may keep them out of the healthcare system, Zoske explains. He says that most health messages are expressed in a “feminine form.” The basic public health theme, he says, is, “Notice your body, pay attention when something isn’t working well, and seek help when needed.” But, Zoske says, this statement doesn’t really speak to guys. He points out that men may be deaf to their body’s symptoms because they are brought up to ignore factors such as vulnerability and pain. As far as seeking help, many men are taught not to show fear or admit when something is wrong. And in regard to seeking help, Zoske says it goes against a man’s sense of being self-reliant. A man, he says, is supposed to be “Mr. Fix-It.”

The miscommunication that comes out of these attitudes is more than just a nuisance. Indeed, it can seriously jeopardize a man’s health. Zoske cites studies showing that, at every age, men are at higher risk of death than women. He says statistics of any measure of mortality and morbidity are “off the chart” for men compared to women.

Zoske makes a compelling case why more work is needed to bring men into dialogues about health, and he offer recommendations about how to do that.

Teach men about their bodies. Studies show that men don’t ask doctors nearly as many questions as women do. Zoske thinks this may be in part because men don’t know how their bodies are supposed to work. He recommends that providers, “Presume men know less about their bodies than you think they do — because they probably do.” Zoske sees this when he teaches men about prostate cancer. He says that most men haven’t a clue where their prostate is. “There is a disconnect with health information and a man’s personal experience with his own body” says Zoske.

Understand male psychology. When a health professional asks a man, “Does this hurt?” or “How bad does this hurt?” he might respond, “It doesn’t hurt” or “I can take it.” Zoske says this reply is based more on a man’s sense of manhood than his desire to be healthy.

A more effective way of engaging a man in a dialogue about symptoms is to begin with a normalizing statement such as, “Most men I see with this condition say there is quite a bit of pain.” This lets the man know that he is like others with the same condition. Then say something along the lines of, “You haven’t complained and are doing a good job managing the pain.” This affirms his masculinity and recognizes his efforts to help. After both these statements, he then is more likely to accept your invitation, “Let’s work on this together so it is easier for you to manage.”

Frame information in terms of social roles. Zoske says that men often think of themselves as providers (work), protectors (family), and players (sports and such). Therefore, an effective way to communicate health messages is by framing it in terms of safety, strength, and performance.

Clarify words. Zoske says that men and women differ in their use of language. Men are often raised to hide emotions, except for anger. Therefore, they might not have a wide range of words to describe physical or emotional well-being. To help, Zoske recommends listening between the lines and feeding men words to describe their experience. For instance, if a man says, “I’m really upset about this,” tease out what he means. This could be done by saying something like, “Give me an idea of what you mean by ‘upset.’ Are you referring to worry or anger?”

Talk in terms of numbers. Since men traditionally like to compete and can often rattle off statistics about favorite sports teams, Zoske recommends using similar strategies for health. One way is to frame health in terms of numbers, not just well-being. This could be keeping track of blood pressure, weight, or other numeric goals.

Use metaphors. True or not, there is a common assumption that men get their cars fixed more often than they go to doctors. Zoske says this can be used to an advantage in talking about healthcare. Using metaphors that compare the human body to a machine with interconnected parts is one way to help men understand the things they need to know. For example the kidneys could be compared to oil filters as they both filter out impurities in fluids. If a car metaphor isn’t appropriate, listen for other usable reference points. “Men will give us clues. We just need to listen for them,” says Zoske.

How to find out more

Joe Zoske, MS, MSW, is the Administrative Coordinator of the BSW Social Work Program at Siena College in Loudonville, NY. You can contact him directly by email at jzoske@siena.edu.

• Men’s Health Network, PO Box 770 Washington, D.C. 20044. http://www.menshealthnetwork.org. This is the lobbying organization for men’s health in the U.S. which also promotes National Men’s Health Week.
• Osborne, H. “In Other Words… What’s the Difference? . . . Does Gender Matter When Communicating About Health?” On Call magazine, December 2004. Available at http://www.healthliteracy.com/article.asp?PageID=3787
• Senay, E & Waters, R. (2004). From Boys to Men: A Women’s Guide to the Health of Husbands, Partners, Sons, Fathers, and Brothers. Scribner: NY
• “Talking Health to Men,” Health Literacy Out Loud Podcast #12. Available for free at www.healthliteracyoutloud.com
• Zaman, F. and Underwood, C. (March 2003). The Gender Guide for Health Communication Programs. Center Publication No. 102. Baltimore: Johns Hopkins Bloomberg School of Public Health / Center for Communication Programs. Available at http://www.jhuccp.org/pubs/cp/102/102.pdf
• Zoske, J. Men’s Health & Wellness: 50 Health Promotion Ideas for Educators, Planners, and Practitioners. 1998. Contact Zoske directly at: Siena College, Social Work House, 515 Loudon Rd, Loudonville NY 12211.

Helen Osborne, MEd, OTR/L, is president of Health Literacy Consulting. Her column appeared regularly in On Call. Helen speaks, writes, consults and podcasts about health literacy. To learn more, you can subscribe to her free “What’s New in Health Literacy Consulting” e-newsletter or contact her by e-mail at Helen@healthliteracy.com.