摘要：Research shows that constraining aspects of male gender norms negatively influence both women’s and men’s health. Messaging that draws on norms of masculinity in health programming has been shown to improve both women’s and men’s health, but some types of public health messaging (e.g., Man Up Monday, a media campaign to prevent the spread of sexually transmitted infections) can reify harmful aspects of hegemonic masculinity that programs are working to change. We critically assess the deployment of hegemonic male norms in the Man Up Monday campaign. We draw on ethical paradigms in public health to challenge programs that reinforce harmful aspects of gender norms and suggest the use of gender-transformative interventions that challenge constraining masculine norms and have been shown to have a positive effect on health behaviors. Unintended and harmful consequences can lurk behind even the most promising and innovative public health interventions. 1,2 The Public Health Education and Health Promotion Section of the American Public Health Association (APHA) awarded the media campaign Man Up Monday first prize in the creative print category at the 2012 APHA Annual Meeting. 3 This innovative print media campaign, which was implemented in southeastern Virginia in 2012, sought to increase the percentage of men tested for sexually transmitted infections (STIs) by leveraging community media campaigns that called for men to “man up” after weekend risk taking by attending clinics to get tested for STIs ( Figure 1 ). In pilot testing, the program resulted in an impressive 200% increase in the number of men that tested for STIs. 4 Open in a separate window FIGURE 1— Print marketing material for the Man Up Monday campaign. Source . http://www.mondaycampaigns.org/man-up-monday . At first glance, the campaign has used public health best practices. For example, Man Up Monday draws on the documented favorable conditions of Mondays for behavior change 5 to facilitate a shift in men’s health-seeking behaviors. It also deploys language that is relevant to young men 6 and uses savvy advertising to appeal to the target population by conveying the image that STI testing is hip. Man Up Monday advertisements include a photo of boxer shorts or condoms and have taglines such as, “If you hit it this weekend, hit the clinic Monday” ( Figure 2 ). The ads ask men to “man up,” a colloquialism indicating the adoption of masculine ideals such as courage and being strong-willed. 6 By suggesting that it is manly to get tested for STIs and linking this specific gender ideology to health behaviors, the program recognizes and deploys male gender norms to change men’s behaviors—an oft-recommended strategy for furthering health and well-being. 7–9 Open in a separate window FIGURE 2— Print marketing material for the Man Up Monday campaign. Credit: http://www.mondaycampaigns.org/man-up-monday . However, interventions using approaches that leverage gender norms require careful consideration as researchers have documented the detrimental effects of narrowly defined gender norms and gender inequality on the health of men, women, and children. We define gender norms as “those qualities of femaleness and maleness that develop as a result of socialization rather than biological predisposition.” 10 (p146) In most societies across the globe, men as a group enjoy social and institutional privileges over and above women as a group. 11 However, masculine norms do not only lead to higher social status but they also come with a price for men’s health, often referred to as “costs of masculinity.” 11 Paradoxically, to be perceived as masculine and thus to achieve the higher social status and power afforded to “real” men, men are pressured to and rewarded for adopting certain traits (e.g., being aggressive, virile with many sexual partners, unemotional, in control, adventurous, risk taking, dominant) that result in vulnerability to negative physical and mental health consequences. 12–14 Furthermore, adoption of inequitable beliefs and adherence to traditional norms of masculinity have been found to be associated with violence, 15–18 risky sexual behaviors, 12,19,20 and sexual and intimate partner violence against women, 20–22 which in turn negatively affect the health of men, women, and children. Even though the Man Up Monday campaign leverages best practices, it is crucial to thoughtfully and constructively critique messaging strategies used in programs such as this one to advance and refine the development of future gender-related health interventions. Even well-intentioned, carefully designed programs can have unintended consequences and may need improvement. We argue for the importance of gender-transformative health interventions that “transform gender roles and promote more gender equitable relationships between men and women,”7(p4) rather than those that reinforce the norms of masculinity that have been shown to harm health. We start by reviewing the recent history of efforts to address gender norms in the name of improved health for both women and men; we then define some of the pitfalls and ethical implications of current approaches that deploy reinforcing instead of gender-transformative notions of manhood; we end by offering a path forward for public health interventions that seek to intervene on masculinities in the name of improved health.
