Why COVID-19 policy should explicitly consider mens health

In this opinion feature, researchers from Vanderbilt University in Nashville, TN, explain why COVID-19 policies in the United States should explicitly consider implications for men’s health during the pandemic.

Having a gendered response to COVID-19 might have led to the pandemic having far less of an impact on health and the U.S. economy. This gendered response should include women’s disproportionate social and economic burdens and men’s higher rate of mortality.

There is a current and urgent need to prioritize men’s health related to the COVID-19 response, yet neither the strategy of the former administration nor that of the current administration considers these gendered patterns.

When people discuss gender, the focus is almost exclusively on women. However, men have been dying at far higher rates than women since the earliest days of the pandemic.

Women experience more economic and social hardship, but men die more. The point is not one of competition. There is a need to explicitly consider gender in our national response to the pandemic, and including gender should include men.

From as early as 2019, reports on COVID-19 cases in China found that as many as 75% of the deaths were in men. In March 2020, reports from Italy documented that 4 out of 5 deaths among the first 827 people who died were in men.

In the U.S., the pattern of COVID-19 being more fatal for men than women has held. These gender inequities are even greater when we consider age and race.

A Centers for Disease Control and Prevention (CDC) report of vaccine dissemination in the first month found that only about 40% of those who received the first dose were men. This pattern of vaccine distribution has persisted in recent months, as people have started to receive their second doses.

The vaccine dissemination plan prioritizes groups who are more likely to contract the virus and die from it, such as older adults, people with chronic conditions, and essential workers.

Using this same logic, it seems that men should be prioritized, too. A year into the COVID-19 pandemic, the U.S. hit the grim benchmark of 500,000 deaths — the majority of which were in men.

Given these points, why have we not considered adapting the COVID-19 response to help men more effectively?

Following data that demonstrated these gender differences in mortality, there were a number of articles that sought to explain these differences through behavior and perceptions of masculinity.

A number of articles highlighted behavioral differences between men and women in testing, mask wearing, and resistance to COVID-19 guidelines and mandates.

Some articles also stated that men are less likely to believe that COVID-19 will seriously affect them and that men who assert a traditionally masculine gender identity are less likely to get the COVID-19 vaccine.

Others have argued that men’s higher mortality rates are due to biological differences such as differences in immune response. Some argued that they are due to both behavior and biology.

Although these factors may be part of the explanation, social, economic, and healthcare system factors also play critical roles in ways that make forming a more complete explanation more complex.

In the U.S., we have often framed the problem of men’s disproportionate COVID-19 death rates as resulting from men’s misbehavior, perception of masculinity, and biology.

These explanations are most consistent with our cultural beliefs about men and men’s health. With these explanations, the logical solutions are to:

  • get men to change their behaviors (such as mask wearing)
  • change men’s attitudes and beliefs (for example, those on COVID-19 severity and perceptions of masculinity)
  • increase healthcare utilization (such as COVID-19 screening and vaccination)

However, explanations that consider the larger social, economic, and public health context may paint a fuller picture. For example, this may include accounting for structural barriers in the healthcare system, such as appointment issues and issues with medication, that are associated with increased severity risk of COVID-19.

Outside of COVID-19, it is noteworthy that Healthy People 2030 — a U.S. Department of Health and Human Services and Office of Disease Prevention and Health Promotion initiative — much like previous versions of Healthy People, includes 35 objectives explicitly focused on women’s health but only four objectives explicitly focused on men’s health.

It also is noteworthy that looking at gender and race simultaneously, rather than separately, illustrates that the disproportionate impact of the virus is concentrated in Hispanic men and non-Hispanic Black men.

Not focusing on gender and men is undermining our efforts to emerge from the pandemic because we are not explicitly considering one of the groups with the highest rates of mortality: people who are both Black or Hispanic and men.

Although articles that discuss men’s worse COVID-19 outcomes in the U.S. are available, no explicit, specific steps have been taken to reduce the burden of COVID-19 on men.

There could be a public health messaging, health promotion, and vaccination campaign specifically targeted to men. For example, the White House strategy of using trusted community locations such as churches could intentionally target male-dominated work and recreational sites to address misinformation and offer vaccinations.

To optimize men’s willingness to receive the vaccine, another step could be to work with subgroups of men to identify spokespeople that they trust to provide balanced and accurate information to help men make informed decisions about vaccinations and other protective behaviors.

Messaging campaigns should avoid shaming men or placing the responsibility on men to seek information.

It will be critical to use communication vehicles that men already utilize and trust to not only counter disinformation but also tap into reasons they may be intrinsically motivated to engage in behaviors that are beneficial not only to themselves but also to the health and economic well-being of others.

As we mark the 1-year anniversary of when the U.S. implemented policies to mitigate the impact of the COVID-19 pandemic on its population, we reflect on what might have happened had we considered men’s higher rates of COVID-19 mortality compared with women’s.

There is no reason for the effort to improve men’s health to take away from women’s health needs. The two priorities are not in competition.

Recognizing gender differences is important. Men and women have different health priorities, health needs, and targets of intervention. Working to promote both men’s and women’s health can promote everyone’s health.

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