Global challenges of health policies aimed at the male population: an integrative review

Paula, Cácia Régia de; Lima, Flavio Henrique Alves de; Pelazza, Bruno Bordin; Matos, Marcos André; Sousa, Ana Luiza Lima; Barbosa, Maria Alves

doi:10.37689/acta-ape/2022AR00015877

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Review Article • Acta Paul Enferm 35 • 2022 • https://doi.org/10.37689/acta-ape/2022AR00015877 copy

Global challenges of health policies aimed at the male population: an integrative review

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

To analyze scientific publications regarding the challenges for the construction and insertion of health policies aimed at the male population in Brazil and in the world.

Methods

This is an integrative literature review with the inclusion of studies that discussed men’s health policies. Search was performed in July 2020 and January 2022 in the Public/Publish MEDLINE (PubMed), Scopus, Embase and Web of Science databases. Articles in Portuguese, Spanish and English were included, without restriction of publication date. The searches were obtained by crossing the bases with the following descriptors: Men’s Health, Health Policy, Men.

Results

A total of 1,709 articles were identified. After the selection and analysis process, 29 studies made up the sample. It was found that 79.5% of studies were conducted in Brazil, 6.9% in the United Kingdom, 3.4% involving countries on the Asian continent, 3.4% in Ireland and Australia, 3.4% in Scotland and 3.4% in the European Union. They were published between 2008 and 2021. From the analysis, the following categories emerged: Lack of knowledge and recognition of male policies; (De)construction of male policies.

Conclusion

Regardless of the country, gender stereotypes and the inability of managers, health professionals and men themselves to recognize the policy were the main challenges in the construction and insertion of policies for the male population. It is considered necessary to legitimize comprehensive care for men as a social movement and governmental policy, aiming at improving the quality of management and clinical practice.

Men’s health; Health policy; Men; Police formation

Article	Objective	Study design	Conclusions/final considerations
A1⁽¹⁾	Describe the specifics of men’s health care within FHS, according to the manager’s view, the demand of men assigned to the assessed units and the practices developed by the teams.	Product of a project entitled “Fortalecimento e disseminação da Política Nacional de Atenção Integral à Saúde do Homem”. Qualitative research used interviews.	With regard to men’s health, there is still much to be done: structure/ambience adequacy for primary care; motivation and development of promotion actions against the most frequent diseases in this population.
A²⁽⁴⁾	Check how male users assess first contact access in primary care.	Cross-sectional, analytical study, with a quantitative approach.	The man still does not see primary care as a gateway, and efforts are needed to ensure mainly first contact access.
A³⁽⁶)	Describe strategy (focused on social determinants, gender and health inequalities) and how this could make a difference for men’s health.	Not mentioned.	Need to develop a robust evidence base to support work in men’s health. If there is political will, the European strategy could clearly have a major impact across the European continent.
A4⁽¹²⁾	Trace the profile of men who sought care in the North Health District I units of the city of Natal/RN and verify the knowledge about the existence of PNAISH (Política Nacional de Atenção Integral à Saúde do Homem – Brazilian National Policy for Comprehensive Care to Men’s Health.	Exploratory, descriptive, quantitative research.	Men do not seek services for preventive purposes. There is a need for greater dissemination of PNAISH and for it to be, in fact, implemented in health units, enabling the development of programs that contribute to the provision of comprehensive and humanized care, considering the uniqueness of the male universe.
A5⁽¹³⁾	Analyze patterns of changes in men’s health from 2006 to 2010 through demographic and epidemiological indicators.	This is an epidemiological, descriptive study that used secondary data from indicators used as a diagnostic parameter for human health to create PNAISH, namely: demographic and morbidity and mortality indicators.	It was found that the most recurrent health problems in the male population are preventable. From the implementation of actions proposed by PNAISH, such as health education, it will be possible to modify the behavioral and cultural profile of this population, which, in turn, causes negative consequences to their health.
A6⁽¹⁴⁾	Analyze documents from the Municipal Health Department (MHD) of Cuiabá and actions of the management team member that guided the implementation of PNAISH, taking gender as a theoretical framework.	Descriptive study, with a qualitative approach, case study type.	The use of management instruments (Annual Work Plans (AWP) and Annual Management Reports (AMR)) signal their importance in conducting actions, through their coherence with PNAISH. Financial resources were identified as responsible for insufficient actions.
A7⁽¹⁵⁾	Describe the strategies and limitations, referring to axes II and V, reported by the municipalities to calculate the indicators proposed by the national program for monitoring actions and goals foreseen in the municipal plans referring to health promotion and the implementation and expansion of the men’s health care system.	A part of a larger research, whose objective was to assess the initial actions of PNAISH implementation. Qualitative with the use of interviews.	The data reflect a limited capacity of municipalities to meet the demands imposed by the strategy implementation and the critical situation of monitoring health promotion actions and expansion of men’s health care system. A lack of synchrony can be observed between the municipalities and the person responsible for the elaboration of basic guidelines, necessary to organize services at the municipal level, which affects the component of monitoring the actions.
A8⁽¹⁶⁾	Discuss the articulation between epidemiological information systems. Scientific production and health policies of human health care.	Quantitative-qualitative research (secondary database, official documents of the Ministry of Health and literature review in the SciELO virtual library)	Need for greater articulation between the use of epidemiological information systems with the field of scientific production, aiming at improving the elaboration, assessment and monitoring of policies aimed at men’s health, as outlined in the methodology of the PNAISH legal document, and proceed to the critical incorporation of a relational perspective of gender.
A9⁽¹⁷⁾	Learn how health professionals interpret and implement national government health policy guidelines in actions aimed at improving men’s health in Scotland.	Qualitative analysis of mixed methods (documentary and interview).	Health policies are formulated at the central level, without consulting professionals who are responsible for developing actions in the service.
A10⁽¹⁸⁾	Identify and analyze some of the discourses that support PNAISH.	Qualitative and documentary research.	PNAISH still presents itself as a transformative project under construction. It was implemented and has been implemented “on behalf of men”. The victimization and blaming of men for their own illness are a striking feature of PNAISH. We must break with the concept of man, reduced to “bodies with penis and prostate” and rescue their social and political dimension as agents of social transformation and protagonists of their own care, having in health services allies for prevention and health promotion.
A11⁽¹⁹⁾	Discuss some of the ways in which the genre crosses the PNAISH propositions, taking as a reference a discursive context in which terms such as “comprehensiveness” and “equity” are used.	Documentary research, part of a master’s research linked to an interinstitutional and multifocal research project inscribed in the fields of gender and cultural studies, discussing some of the ways in which gender crosses the PNAISH propositions.	The importance and originality of PNAISH in emphasizing men’s health still show institutional barriers, cultural issues and care models heavily based on modes of care that explore the concepts of equity and comprehensiveness, both discursively and in daily practices.
A12⁽²⁰⁾	Analyze the meanings attributed to PNAISH by the social subjects directly involved in the implementation of this policy.	Part of a larger research, whose objective was to assess the initial actions of PNAISH implementation. Triangulation of methods was used, articulating epidemiological and socio-anthropological approaches and using the techniques of questionnaire, narrative, semi-structured interview and observation based on ethnographic principles, in addition to document analysis.	PNAISH can be perceived as episodic, eventual, also having a temporary and casual involvement of professionals. It may be something that has little to do with it, being relegated to other specialties, or it may be seen as unnecessary as it would already be contemplated in the principles and guidelines of primary health care. It can also be understood as an additional demand, and difficult to achieve because it finds barriers in the same impediments as other health policies.
A13⁽²¹⁾	Understand how PNAISH reaches health services, in particular, Primary Care services, considered the gateway to the Unified Health System (SUS - Sistema Único de Saúde), from the point of view of its professionals and observing their daily practices.	Research with a qualitative approach, with a case study design, and is part of a larger project entitled “Avaliação das Ações Iniciais da Implantação da Política Nacional de Atenção Integral à Saúde do Homem”, developed from 2010 to 2012.	The implementation ran into the absence of institutional conditions, such as an organizational structure, a consolidated care network, in which users are served by services with different degrees of complexity within the system, and resources in general, especially human resources.
A14⁽²²⁾	Analyze the male discourse about difficulties in self-care through the reports of male participants in a health education group, focusing on men’s health.	Intervention research with men’s testimony, of qualitative character of descriptive exploratory type.	The importance of developing strategic actions with the objective of promoting the approach of the male public to the health service and self-care of users, especially in the scope of primary care, within the scope of PNAISH. Giving new meanings to actions involving men’s health and changing the professional attitude to serve this population can trigger in the male audience the feeling of belonging to the space of health promotion, protection and recovery.
A15⁽²³⁾	Arguing that basing men’s health within a broad gender discourse is important for building evidence base and advances in male health promotion.	Does not make reference.	It suggests that a critical lens on gender should be applied to the work of promoting men’s health because it provides strategies for researchers, professionals and policies to move towards men’s health.
A16⁽²⁴⁾	Establish issues about men, health and public policies for the viability of the debate on the subject, based on theoretical and empirical references related to these issues.	Does not make reference.	It points to the complexity involved in the elaboration, implementation and assessment of health policies aimed at gender equity. The need for the Brazilian policy aimed at men’s health to be articulated with other policies is highlighted so that the gender matrix is transversal in the field of health.
A17⁽²⁵⁾	Problematize the incorporation of the dimension of masculinities as a promoter of management strategies in the Brazilian PNAISH.	Does not make reference.	It is essential to include a focus on gender identity, sexual orientation, generation, disability and ethnic-racial condition in the continuing education actions of public health workers and managers. Similarly, an intersectoral articulation between different policies and points of attention in health networks is necessary so that Latin American men are socially recognized as citizens based on their specificities and their historical and social context.
A18⁽²⁶⁾	Analyze the conceptions that health professionals have about specific demands and behaviors of the male population assisted in health services.	Part of a project that used the triangulation of methods, articulating epidemiological and socio-anthropological approaches and using questionnaire, narrative, semi-structured interview and observation based on ethnographic principles.	The PNAISH’s concept of gender is used by health professionals in order to justify socially expected standards in terms of men’s behavior.
A19⁽²⁷⁾	Describe and analyze the perception of FHS nurses about the importance of PNAISH, as well as their perspectives to implement this policy.	Qualitative, exploratory, descriptive and field study. A broader study that studied nurses’ perception of FHS on male health care in the productive phase. Interview.	Nurses believe that men not only deserve but also need to be assisted by health programs that seek to reduce morbidity and mortality rates and their exposure to risk factors, strengthening the maintenance of the family structure, and, because they constitute a significant portion of the population, since the male age group contemplated by the policy forms the country’s productive and political force.
A20⁽²⁸⁾	Analyze men’s health care strategies from the perspective of health professionals.	Part of a research that investigated male care promotion focused on sexual health, reproduction and fatherhood. Its methodological design was mixed (approaches and techniques from qualitative and quantitative perspectives).	It is difficult to involve men in the care of their health, so that professionals discuss three main strategies: (1) care for men in the shortest time, reducing waiting times and offering materials (condoms, hygiene material, etc.) in exchange for establishing bonds and services between men; (2) displacement of health professionals to care for men in their work spaces, adapting languages and materials; and (3) meeting the specific demand for contraception.
A21⁽²⁹⁾	Analyze the relationship of men with the care to their health.	Qualitative research of descriptive exploratory nature that covers the collection and systematic appreciation of descriptive materials. Interview.	The culture of men as being strong hinders their search for health services. Men are unaware of the existence of PNAISH.
A22⁽³⁰⁾	Describe the actions developed by the study and research group on masculinities and health at this university, during the first State Week of Men’s Health Care, with the aim of contributing to the PNAISH implementation.	Qualitative: experience report with problematizing approach.	On the one hand, the male population’s lack of knowledge in relation to health promotion and disease prevention, but, on the other hand, the great challenge to implement educational actions that aim to break the self-care deficits of these individuals, as well as those who work in the health area.
A23⁽³¹⁾	Explore the interfaces between the unenacted proposal of the Brazilian National Policy for Comprehensive Health Care for Adolescents and Young People (Política Nacional de Atenção Integral à Saúde de Adolescentes e Jovens) and the PNAISH.	Qualitative with documentary review.	Political texts express the interests and understanding of the field of knowledge of actors from each of the analyzed segments, constituting cultural policies with potential for establishing certain meanings in the attention and health care of different population groups.
A24⁽³²⁾	Highlight the negotiations and disputes between knowledge and powers in the history of PNAISH.	A qualitative study used interviews taken from multicentric research entitled “Homens e serviços de saúde II: rompendo barreiras culturais, institucionais e individuais”.	To analyze the irruptions of the man-subject of health rights is to perceive them also being launched at the “same” that is repeated by the threats that still keep their position of exteriority of public health services archived.
A2⁵⁽³³⁾	Review key data on men’s health globally and explore explanations for men’s outcomes, including health practices, service use, and health and masculinity literacy.	Does not make reference.	Human health policies and strategies are essential at local, national, regional and global levels. They can serve to raise the profile of the issue, provide a framework for action, and provide a benchmark for assessing impact and holding services accountable for their performance.
A26⁽³⁶⁾	Reach consensus on human health policy based on the opinions and recommendations of leaders and people interested in men’s health.	The Delphi research method was used.	The research findings require policy change and development and, more importantly, make a coordinated effort to elevate men’s health in Asia by implementing the policy in places where it is not implemented.
A27⁽³⁷⁾	Describe the history of men’s health policy development in Ireland and Australia, outline the objectives, methodologies and key principles used for policy development, and highlight key priorities for policy action.	Does not make reference.	The publication of national men’s health policies in Ireland and Australia represents a significant milestone in the ongoing evolution of the field of men’s health. Policies provide a clear plan and an unequivocal evidence base for dealing with human health in each country.
A28⁽⁴⁴⁾	Analyze the challenges experienced by nurses in the implementation of PNAISH.	Descriptive, qualitative study	The challenges for the policy implementation are related to the inoperability of government actions, weaknesses in municipal management, underfunding and discontinuity of actions.
A29⁽⁴⁵⁾	Analyze the process of building the PNAISH, with a view to recognizing the participation of the various social actors in the formulation of this public policy.	Qualitative research with documentary and interview	The conduction of the PNAISH construction process, when trying to seek a consensus, produced the erasure of differences and identities. In the process of policy construction, participation occurred in a fragmented way, without dialogue or exchange, with the removal of its agents from each other.

Escola Paulista de Enfermagem, Universidade Federal de São Paulo R. Napoleão de Barros, 754, 04024-002 São Paulo - SP/Brasil, Tel./Fax: (55 11) 5576 4430 - São Paulo - SP - Brazil
E-mail: actapaulista@unifesp.br

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[1] Corresponding author: Cácia Régia de Paula E-mail: cregia@ufg.br