Abstract:
Globally research shows that men have worse health than women; on average men present lower expectancy of life at birth and show more health risk behaviours. A range of investigators have established the importance of gender and masculinity in men’s health. Gender construction is a dynamic process; and health care systems represent a particularly important institutional influence in the construction of gender and health. Currently in Chile there are few studies about the health beliefs of men, and encounters between men and health services usually begin only when men are sick. Hence, a better understanding of men's relationships with their health and the health system is important, leading to the research question: What is the relationship of Chilean men with their health and with the public health care system? Using a constructivist paradigm, an ethnographic study was conducted in a socioeconomically vulnerable community in Santiago de Chile. Fieldwork lasted seven months, involving participant observations, interviews and focus groups with two groups: a group of men belonging to a soccer club and a group of health workers belonging to a primary health centre. Chilean men participants understood their health as the ability to remain active and work, and to fulfill the culturally assigned role of provider to the family. All behaviours associated with health and illness are related to the relief of physical symptoms that prevent them remaining active; in this construct there is no room for the expression of emotional problems, neither for disease prevention or health promotion behaviours, since they do not relate to the relief of physical problems. Consequently, men access the formal health system only for the relief of physical symptoms, delaying seeking advice for as long as possible. Men’s reluctance to access the Chilean primary health care system is compounded by perceived barriers, including the absence of health programs tailored to them. For their part, health workers consider men to be "irresponsible" with their health, perceiving a lack of interest from men to maintain their health and, consequently, they do not generate programs or interventions targeted to this group. These findings highlight the complexity of masculinity as a social determinant of health, providing information that can inform the design of health strategies specific to the needs of Chilean men, and to better focus health policies and service delivery.