Beliefs about the way men are supposed to behave may stand in the way of healthful behaviors and men getting the care they need.

Men lag behind women when it comes to health. They die younger -- although the life expectancy gap has narrowed in the United States. Heart disease among women has been getting some overdue attention, but the fact remains that men start having heart attacks and strokes in large numbers about a decade earlier than women. Each year in the United States, almost four times as many males as females die by committing suicide. And over twice as many men as women die from alcohol-related deaths.

Biological differences probably explain some of these disparities. It's widely believed that men get heart disease at a younger age than women because they don't benefit from the protective effects of estrogen, the female sex hormone. Health insurance coverage and access to health care may be another factor: a larger percentage of men have no health insurance.

But it's impossible to ignore another major gap between the genders. Study after study has shown that men are much more likely than women to engage in behaviors that are bad for their health. More men than women smoke and drink excessively. The unbelted car driver or passenger is more likely to be male, as is the person who skips routine health screenings.

Why do men behave this way? Evolution and adaptation may be part of the explanation. Certain behaviors -- and the impulses behind them -- are useful at one time and place (ignoring pain when you need to hunt for food, for example) but counterproductive in another (ignoring pain so you put off seeing the doctor).

But there's a school of thought, with some interesting research to back it up, that points a finger at gender roles and prevailing attitudes about how men are supposed to behave. The notion is that men act recklessly, don't heed health advice, and are reluctant about getting medical care because they're conforming to masculine ideals.

Taking Measure

Of course, those ideals aren't set in stone. But in the United States, Britain, and a few other countries, researchers have found that masculine norms include self-control, self-reliance, taking risks, competitiveness, and seeking dominance. Researchers have developed questionnaires to measure how strongly men hold these beliefs and to see what sort of effect their beliefs have on health attitudes and behaviors. In 2007, for example, University of Nevada researchers reported the results of a study that ranked 172 men based on their score on the Bem Sex Role Inventory, one of the standard gender-attitude questionnaires. Those with high masculinity scores were more responsive to a skin cancer message that appealed to controlling fears (for example, wearing sunscreen regularly will relieve worry about getting skin cancer) than to a message about ameliorating the danger (wearing sunscreen regularly will reduce your exposure to ultraviolet light).

James Mahalik, a Boston College psychology researcher, has developed a longer questionnaire that asks men about their attitudes toward women and gay people, as well as about independence, assertiveness, and other traditional masculine beliefs. Mahalik and his colleagues reported the results of a study in 2007 that used an abbreviated version of his questionnaire and asked some additional questions about the health-related behaviors of other men and of women. High scores on the masculinity index correlated with low scores on health behaviors: no surprise there. And perceptions about what other men do had an influence on the behavior of the men in the study. Mahalik was surprised that perceptions of women's behaviors didn't. Other research has found that fears of being viewed as feminine cause men to avoid health-promoting behaviors if they believe those behaviors are the norm for women.

Masculine Medical Care

Research based on questionnaires always raise an eyebrow: are people answering truthfully? And there's a "well, duh" factor here: of course men who believe that it's masculine to take risks are going to take more chances with their health by drinking, smoking, and not wearing seat belts.

Still, it seems clear, as Mahalik and others have argued, that there might be some gains in men's health if doctors and health officials were more attuned to masculine attitudes. Men themselves might help with this by becoming more aware of their masculine hang-ups.

If a man believes that eating fruits and vegetables is "eating like a woman," he might not do it. But if it's presented as a way to help him succeed at work and give him more energy, he might. Some men are reluctant to seek medical attention because of masculine ideas about independence and pain tolerance. But if going to the doctor is presented as a way to preserve or regain some other aspect of their masculinity -- say, being able to compete or work again -- they might seek medical help sooner.

It's a matter of making health and medical care culturally sensitive, although in this case, the culture is men and their ideas about masculinity.