Structural Health and the Politics of African American Masculinity

Abstract

This commentary describes ways in which notions of African American men’s “health” attained by individual choice—embedded in the notion that African American men should visit doctors or engage in fewer risky behaviors—are at times in tension with larger cultural, economic, and political notions of “health.” It argues that efforts to improve the health of Black men must take structural factors into account, and failure to do so circumvents even well-intentioned efforts to improve health outcomes. Using historical examples, the article shows how attempts to identify and intervene into what are now called social determinants of health are strengthened by addressing on-the-ground diagnostic disparities and also the structural violence and racism embedded within definitions of illness and health. And, that, as such, we need to monitor structural barriers to health that exist in institutions ostensibly set up to incarcerate or contain Black men and in institutions ostensibly set up to help them.

“Down in the Sewers”: Perceptions of Depression and Depression Care Among African American Men

“…For instance, most extant studies do not include institutionalized individuals, such as those in psychiatric hospital or prisons. It is also more difficult to recruit African Americans who reside in inner cities or in poor rural areas, as they are not readily accessible to researchers who conduct household surveys (Metzl, 2013;U.S. Department of Health and Human Services, 2001).…”

Am I My Brother’s Keeper? African American Men’s Health Within the Context of Equity and Policy

“…In fact, these attempts to improve the lives of African American men may actually be bolstered by the very structures and institutions that are in place. For example, African American men work disproportionately in unsafe working conditions and reside disproportionately in prisons (Alexander, 2010;E-Race, 2013;Metzl, 2013). Evidence also suggests that tobacco, gun, and fast-food companies sell even more cigarettes, guns, and unhealthy foods to lower income African American men in urban areas (Metzl, 2013;Terhune, 2006).…”

“…For example, African American men work disproportionately in unsafe working conditions and reside disproportionately in prisons (Alexander, 2010;E-Race, 2013;Metzl, 2013). Evidence also suggests that tobacco, gun, and fast-food companies sell even more cigarettes, guns, and unhealthy foods to lower income African American men in urban areas (Metzl, 2013;Terhune, 2006). This calls for increasing awareness on the part of health care providers, public health scholars, policy makers, and laypersons of these structural forces that produce, sustain, and even benefit from these barriers.…”

“…In other words, how have their experiences informed how they view the world and interface with the society at large? This is a critical question because it speaks to how African American men perceive themselves and describes the challenges they have had when interacting with the U.S. health care system (Braithwaite et al, 2009;Hammond, 2010b;Jack & Griffith, 2013;Metzl, 2013).…”

Community violence and African American male health outcomes: An integrative review of literature

“…Many African American men live in disadvantaged communities marked by strenuous poverty, residential instability, joblessness, violent crime and educational shortages (Simning, Wijngaarden, & Conwell, 2012). African American men are also more likely not to have regular care, live in food deserts, work in unsafe environments and engage in unhealthy behaviours like tobacco use and alcohol consumption (Metzl, 2013). Dwelling in these communities, leave African American men at risk for adverse experiences that impact their health behaviours and outcomes.…”