About the Book
Dying to Be Men by Dr. Will Courtenay explains exactly why men and boys are at greater risk of serious disease, injury and death than women and girls, and what needs to be done to change that. Based on scientific findings from a diverse range of fields, including extensive medical studies and new research by the author, the book clearly demonstrates that there is nothing "natural" about men dying more than five years younger than women.
Referencing over 2,000 studies, this book identifies 31 key differences between women and men that account for why men are more likely to die from all 10 leading causes of death. Men are less knowledgeable than women about health and less likely to take personal responsibility for their health. They also incorrectly believe they're less vulnerable to disease and injury, and think they're less overweight than they actually are — to name just a few.
Health behaviors are among these differences and the book identifies over 50 specific behaviors that increase the risks of men and boys. They make fewer doctor visits, use more tobacco, do less to control high blood pressure, have less healthy diets, and are more overweight than women and girls. They're also less likely to wear safety belts, obey speed limits, drive sober or stop at stop signs.
Dr. Courtenay enables us see that this problem is not simply men "behaving badly." In fact, men are behaving exactly the way they are expected to behave. Dying to Be Men illuminates how society — including parents, peers, schools, employers, the media, and the health care system — encourages the very attitudes, beliefs and behaviors in boys and men that are linked with increased health risks. "The very things that increase men's health risks are often dismissed with 'boys will be boys'," says Dr. Courtenay. "American men grow up learning unhealthy beliefs about manhood, like bravely and silently sustaining injury is admirable."
We teach boys that they should not need help or worry about safety, risking danger is manly, getting hurt is inevitable, and that they are invincible. Despite boys' greater risks, parents are less concerned about the safety of their sons than their daughters, actively discourage boys from seeking help and often punish them when they do, handle boys more roughly, expose them to more violence, and misperceive them to be stronger and less fragile than girls. All of which contribute to why boys mature into unhealthy men.
In comprehensively explaining men and boys' risks, Dying to Be Men pulls back the curtain on how masculinity directly influences men's health. The more traditional a man's beliefs about manhood, the greater his health risks. But masculinity does not just influence men. Masculinity pervades our culture and the institutions men participate in — including workplaces and health care systems that often ignore men's risks. Even doctors spend less time talking with male than female patients and less time educating men. Dr. Courtenay shows how cultural myths about manhood — like the myth that "men are the stronger sex" — contribute to why most men think their health is "very good" and better than women's. Dr. Courtenay also explains why certain men — like African American and Latino men, young men, and rural men — are at greatest risk.
Perhaps most importantly, Dr. Courtenay shows us exactly how we can help men and boys live longer, healthier lives. The book outlines best practices to improve men's health in a Six-Point H.E.A.L.T.H. Plan (Humanize, Educate, Assume the Worst, Locate Support, Tailor A Plan, Harness Strengths), which includes detailed strategies for improving the health of men and boys. Dying to Be Men is an illuminating, thought-provoking, and comprehensive examination of why the health risks of men and boys are so great and what needs to be done to remedy this pervasive problem. It is just the prescription needed for improving the health and well-being of men and boys — and the families and communities they live in.
From the Back Cover
Masculinity has a powerful effect on the health of men and boys. Indeed, many of the behaviors they use to "be men" actually increase their risk of disease, injury, and death.
In this book, Dr. Will Courtenay, an internationally recognized expert on men's health, provides a foundation for understanding this troubling reality. With a comprehensive review of data and literature, he identifies specific gender differences in the health-related attitudes, beliefs, and behaviors of men and boys and the health consequences of these differences. He then describes the powerful social, environmental, institutional, and cultural influences that encourage their unhealthy behaviors and constrain their adoption of healthier ones. In the book's third section, he more closely examines the health needs of specific populations of men, such as ethnic-minority men, rural men, men in college, and men in prisons.
Courtenay also provides four empirical studies conducted with multidisciplinary colleagues that examine the associations between masculinity and men and boys' health beliefs and practices. Finally, he provides specific strategies and an evidence-based practice guideline for working with men in a variety of settings, as well as a look to the future of men's health.
Medical professionals, social workers, public health professionals, school psychologists, college health professionals, mental health practitioners, academics and researchers from a broad array of disciplines, and anyone interested in this topic will find it to be an extensively researched and accessible volume.
PRAISE for Dying to Be Men
Dr. Will Courtenay's new book is truly the first of its kind. For all its academic excellence this lucid, easy to digest book is an alluring read for anyone concerned about men and boys. Beautifully written, it offers clear, concise and useful advice.
— William S. Pollack, PhD, ABPP, Associate Clinical Professor, Harvard Medical School; author of the New York Times bestseller, Real Boys.
It would be a truism to say that 'Will Courtenay wrote the book on men's health' since, well, this is it! By examining different groups of men – by age, class, region, and race – Courtenay deepens our understanding of that crucial linkage between gender and health.
— Michael Kimmel, PhD, Professor of Sociology, SUNY at Stony Brook, author of Guyland: The Perilous World Where Boys Become Men and Manhood in America
Will Courtenay's Dying To Be Men is the most readable discussion and comprehensive overview of boys' and men's health published to date. This book is a "must-read" resource for men's health advocates, gender scholars, public health policymakers, epidemiologists, medical professionals, and health educators. There is simply no better source on men's health in print.
— Don Sabo, PhD, D'Youville College, author of Men's Health and Illness: Gender, Power, and the Body and Masculinities, Gender Relations, and Sport.
Dr. Courtenay both takes stock of existing research and looks to the future by opening up fresh issues and proposing a new interdisciplinary global and relational approach fit for the twenty-first century. The result is a timely, accessible book that will be an invaluable resource for social scientists and health practitioners alike.
— Larry Cohen, Executive Director, Prevention Institute, author of Prevention is Primary
Dying to Be Men is the most comprehensive resource on men's health that I have encountered. Will Courtenay understands that men need more than information about their health – they need permission to care about it. Thus the empirical data and references are augmented by insightful analysis that contextualizes the growing body of research on men's health. The result is a powerful tool that educators, therapists, policy-makers and anyone else who cares about men can use to challenge the outdated and deeply destructive idea that 'real men' don't take care of themselves.
— Jackson Katz author of The Macho Paradox: Why Some Men Hurt Women and How All Men Can Help
This is absolutely the best book on men's health available today. The depth and breadth of Courtenay's research makes this an essential resource for anyone interested in promoting the health and well-being of men and boys. This is a unique contribution to the field that should be read by those in academia, clinical practice, and any man who wants the facts on how to live long and well.
— Jed Diamond, PhD, LCSW, Founder & Director, MenAlive, author of Mr. Mean: Saving Your Relationship from the Irritable Male Syndrome and Male Menopause
Will Courtenay has created an exhaustive and well organized review of two decades of scholarship on men's health. Dying to Be Men is the most important resource available for anyone interested in this issue, which is literally a matter of life and death.
— Christopher Kilmartin, Ph.D., Professor of Psychology, University of Mary Washington, author of The Masculine Self and The Pain Behind the Mask
At last, a collection of Will Courtenay's important research and writing on men's health, revised and brought up to date! It could not be timelier, given the urgent need for improved health care outcomes in the US. I will strongly recommend it to my students and colleagues.
— Ronald F. Levant, EdD, ABPP, 2005 President, the American Psychological Association, Professor of Psychology, the University of Akron, Editor of the journal, Psychology of Men and Masculinity, and author of A New Psychology of Men and Masculinity Reconstructed
Table of Contents
Part I: Why Men and Boys Get Sick and Die Young
- Chapter 1: Key Determinants of the Health and Well-Being of Men and Boys: An Overview
- Chapter 2: Behavioral Factors Associated with Disease, Injury, and Death Among Men and Boys
Part II: Why Men and Boys Do The Things That Make Them Sick and Kill Them
- Introduction: Who Are The 'Men' in 'Men's Health'?
- Chapter 3: Engendering Health: The Social Construction of Gendered Health Beliefs and Behaviors
- Chapter 4: Constructions of Masculinity and Their Influence on Men's Well-Being: A Theory of Gender and Health
Part III: Specific Populations
- Introduction: Ethnicity Matters
- Chapter 5: Rural Men's Health: Situating Men's Risk in the Negotiation of Masculinity
- Chapter 6: College Men's Health
- Chapter 7: Preventive Health Strategies for Men in Prison
Part IV: Emerging Research on Men, Masculinity and Health
- Introduction: Youth Violence? Let's Call It What It Is
- Chapter 8: Gender and Ethnic Differences in Health Beliefs and Behaviors
- Chapter 9: Masculinity and Gender Role Conflict: Influence on Men's Likelihood of Engaging in High-Risk Behaviors
- Chapter 10: Measurement of Men's Help Seeking
- Chapter 11: The Drive for Muscularity and Masculinity
Part V: Reaching Men
- Introduction: Making Health Manly: Social Marketing and Men's Health
- Chapter 12: Counseling Men About Their Health: An Evidence-Based Practice Guideline
- Chapter 13: Designing Effective Programs and Services for College Men: Applying The Six-Point HEALTH Plan and Other Evidence-Based Strategies
Part VI: Looking Forward
- Introduction: Teaming Up for the New Men's Health Movement
- Chapter 14: A Global Perspective on the Field of Men's Health
Mark S. Kiselica
Although traditional men are socialized to be providers for and protectors of others, they tend to be poor guardians of their own health. Compared to women, men are less likely to get routine physicals, and when they feel sick or are injured, men are more likely to ignore their symptoms and less likely to seek medical care. Similarly, when faced with emotional distress, men are less likely than women to seek professional assistance with their mental health concerns. Men are also more likely than women to engage in a host of health risk behaviors (e.g., smoking, substance abuse, drinking and driving, and poor diets) that are associated with a variety of diseases, injuries, and death.
Health experts consider the propensity of men to ignore their health needs, take risks, and have unhealthy lifestyles to play a key role in some adverse health outcomes in men. Consider just a few, related, alarming statistics. Rates of heart disease, cancer, stroke, and HIV/AIDS are higher for men than women. Men are more likely than women to suffer accidental injuries, work-related and fireworks-related injuries and deaths, unintentional drowning, motor-vehicle deaths, death by homicide, and suicide. Moreover, life expectancy is 5.1 years shorter for men than women. Many of these injuries, illnesses, and deaths could be prevented and the life span of males could be extended if men changed their attitudes about their lifestyles and about seeking help and talking with health care professionals.
Over the past 20 years, my attempts to study and understand health-related difficulties of men consistently took me to the work of Dr. Will Courtenay, a dedicated and passionate advocate for men and their health needs. Recognizing that Dr. Courtenay is also an accomplished scholar of men's health issues, I reached out to him, hoping that he would contribute his impressive expertise on the topic to The Routledge Series on Counseling and Psychotherapy with Boys and Men. Eager to synthesize his wide body of work on the subject, Dr. Courtenay enthusiastically agreed to compose Dying to Be Men: Psychosocial, Environmental, and Biobehavioral Directions in Promoting the Health of Men and Boys for this series. I am so glad that he did!
In Dying to Be Men, Dr. Courtenay takes us into the world of boys and men, alerting us to the troubling fact that too many males are killing themselves, sometimes slowly over the course of a lifetime through a series of poor lifestyle choices contributing to the development of life-threatening illnesses, and at other times, abruptly through impulsive risk taking, violent encounters, and suicide. Dr. Courtenay summarizes what is known about gender differences in diseases, accidents, and mortality, and he discusses the attitudes and behaviors that place males at risk for injury, illness, and death, including the role of masculine ideology in men's health. He provides a comprehensive analysis of the medical and psychological problems experienced by boys and men across the life span, and he offers gender-sensitive interventions for addressing these problems. No doubt, the wealth of information provided in this book can help all health care providers to enhance their efforts to promote the well-being of boys and men. I am deeply grateful for this information, and I am pleased and honored to have Dr. Courtenay's fine work as a volume in this series.
31 Key Factors Explain Why
Men Die 5 Years Younger Than Women
Why do men die younger than women? In Dying to Be Men, Dr. Will Courtenay examines over 2,000 studies and identifies 31 key factors that reveal differences between men and women that account for why men die younger.
The following key factors differ for men and women and contribute to men's greater risk for serious disease, injury and death.
Nearly all of these key factors can be modified or controlled to reduce men's increased health risks.
Over 50 Behaviors
Why Men Die 5 Years Younger Than Women
In Dying to Be Men, Dr. Will Courtenay reveals the main reasons men die younger than women. Men are more likely than women to engage in over 50 specific behaviors that research shows are conclusively linked with a greater risk of serious disease, injury and premature death. Below are the broad categories.
Health care utilization
These behaviors are the main reason why men die more than five years younger than women. They can all be controlled, which means the risks can be eliminated.
How We Teach Boys
The Very Attitudes and Behaviors That Kill Them
Three out of four children who die are boys. Each day, 18 boys aged 14 years or younger die in the U.S. Nearly all of these deaths are violent — the result of injury, suicide and homicide.
But the issue it is not just violence. Boys are more likely than girls to engage in over 50 behaviors that increase their risk for disease and injury. These behaviors can have life-long consequences. Boys are less likely to wear safety belts or bike helmets, use sun protection, and are more likely to carry weapons, use tobacco and drugs, and to drink alcohol heavily, for example.
Boys also eat more fat and salt, fewer fruits and vegetables, and drink more soda. Consequently, more boys are overweight and have prediabetes, abnormal cholesterol levels, and a cluster of factors linked with heart disease. These unhealthy behaviors typically continue into adulthood.
In Dying to Be Men, Dr. Will Courtenay demonstrates how we unwittingly teach boys the very attitudes and behaviors that increase their health risks. Parents, for example, are much less concerned about the safety of their sons, despite boys being at much greater risk. In fact, they are more likely to encourage risky activities among their sons than their daughters.
Many of these lessons boys learn are linked with rules about becoming a "real" man — which Dr. Courtenay calls the "Playbook for Manhood." A boy who lives by these rules, would:
- Takes risks without worrying about his safety
- Think he's invulnerable to any harm
- Be self-sufficient, and never ask for help
- Have little knowledge about health
- Keep his feelings to himself, with the exception of anger
- See violence as a normal part of everyday life
In fact, this is what we see in boys, far more often than in girls. Dying to Be Men identifies exactly how we, as a society, teach boys to live by these rules.
African American Men Experience
Disproportionate Risk For Disease & Death
We're hearing more about the gender gap in longevity, with women outliving men by more than 5 years. But in Dying to Be Men, author Dr. Will Courtenay demonstrates that the longevity gap between African American men and women — as well as Black and White men — is even bigger.
On average, African American men die 6 years younger than White men and 7 years younger than African American women. The gender gap among African Americans remains true for most diseases. Black men, for example, are almost twice as likely as Black women to die from cancer.
- Compared to White men, Black men experience disease earlier, suffer more severe disease, have more complications, and less access to medical care
- Black men are also less likely than White men to receive state-of-the-art treatments
- Black men are nearly 2½ times more likely to die from prostate cancer than White men and more than 5 times more likely than Asian men to die from the disease.
- African American men are 8 times more likely than European American men — and 24 times more likely than Asian American men — to die from HIV disease
- Homicide ranks among the 5 leading causes of death only for African American men — not for men of any other ethnic group.
- Despite their high risks, 45% of Black men do not have a doctor they see regularly, compared to 33% of White men — which contributes to why Black men are more likely than White men to be first diagnosed with advanced-stage cancer
- Among boys, 25% of Blacks and 17% of Whites have no usual source of health care
- Among men ages 20 to 29, Whites have 1½ times more doctor visits than Blacks
Dying to Be Men pulls back the curtain on how Black men's beliefs about masculinity directly influence their health. In general, the more traditional a man's beliefs, the greater his health risks — but not always. Some traditionally masculine traits can actually improve Black men's health.
So, what can we do about the poor state of the health of men and boys?
Dr. Courtenay devotes an entire section of the book to answering that very question.
The book provides irrefutable evidence that the leading causes of disease, injury and premature death among men and boys are clearly linked to well over 50 specific behaviors and health-related lifestyle habits — as well as over 30 other factors, including men's beliefs that influence health. The good news is, these beliefs and behaviors are controllable and can all be modified.
Dying to Be Men shows us exactly how we can help men and boys live longer, healthier lives. The book outlines evidence-based strategies to improve the health of men and boys in a model summarized under the following headings, forming an acronym that spells HEALTH:
A ssume the worst
L ocate supports
T ailor plan
H arness strengths
Based on this model, Dr. Courtenay provides detailed strategies for improving the health of men and boys in a variety of settings.
Included in this model are research-based communication strategies. The American Medical Association has reported that a lack of effective clinician–patient communication is a "health hazard" for many men and emphasized the physician's responsibility in breaking through the barriers that men's embarrassment about health matters can create. Dying to Be Men shows health professionals how to effectively improve communication with male patients — and to improve the health of men and boys.
About the Author, Dr. Will Courtenay
Will Courtenay, PhD, is an internationally recognized expert in men's health and in helping men, boys and fathers. The American Psychological Association calls him, "a leading psychologist in the field of masculinity" and "one of the leading scholars, researchers, and public policy shapers in the psychology of men." Dr. Courtenay has once again been selected for inclusion in "Who's Who in America, 2012" as a "foremost achiever in his field."
Dr. Courtenay is a consultant, speaker, distinguished author, psychotherapist, researcher, and radio host. As one of the world's leading experts — and innovators — in the field of men's health, he has a documented history of success in shaping and promoting this new field, as well as new perspectives on fatherhood, boyhood, and masculinity.
Dr. Courtenay received his PhD from the University of California at Berkeley and is a Licensed Clinical Social Worker. Dr. Courtenay has served on the clinical faculty in the Department of Psychiatry at Harvard Medical School, and the University of California, San Francisco, Medical School. He has consulted to the federal government, and academic institutions, medical centers, family planning clinics, and public health departments internationally.
For nearly twenty years, Dr. Courtenay has been researching psychological, social, and behavioral influences on the physical and mental health of men and boys, and has been developing effective interventions and communication strategies for helping men to live longer, healthier lives. He has written extensively on these subjects, and his published papers and book chapters have been referenced by researchers throughout the world in 1,400 other publications. In 2004, he received the "Researcher of The Year" award from the American Psychological Association.
Dr. Courtenay is the author of Dying To Be Men: Psychosocial, Environmental, and Biobehavioral Directions in Promoting the Health of Men and Boys (Routledge, 2011). He is currently writing another book on his recent research, postpartum depression in fathers.
In the still relatively new field of men's health, Dr. Courtenay is considered one of the foremost leaders. He was the guest editor for the first professional medical journal devoted to the subject, and chaired the first national conference on men's health. He went on to become the founding editor of the International Journal of Men's Health, the first professional journal of its kind.
Dr. Courtenay is a much sought after speaker and media resource. He is a powerful, effective voice about men's health and masculinity, and the changing roles of fathers, boys, and men, heard nationally on radio and television — including CNN, Good Morning America, World News, ABC, NBC — and seen in print — including NY Times, LA Times, Wall Street Journal, U.S. News & World Report, NPR, Newsweek, USA Today, and Chicago Tribune.
For more information about Dr. Will Courtenay,
Dr. Courtenay — known as "The Men's Doc" — is an internationally recognized expert in helping men and boys, a psychotherapist, and distinguished author and researcher. The American Psychological Association calls him, "a leading psychologist in the field of masculinity" and "one of the leading scholars, researchers, and public policy shapers in the psychology of men." Dr. Courtenay has once again been selected for inclusion in "Who's Who in America, 2012" as a "foremost achiever in his field." Dr. Courtenay is frequently interviewed and quoted in the media.
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