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“Shorter life expectancy among men in general, if likely avoidable, would clearly be an issue of public health importance based on the magnitude of potential population impact. However, men as a group have more wealth, influence, and prestige, so this difference would not be a social injustice and, therefore, not a health disparity or equity issue.” That statement was written in a paper published in the American Journal of Public Health in 2011. The title of the paper is “Health Disparities and Health Equity: The Issue Is Justice [https://pmc.ncbi.nlm.nih.gov/articles/PMC3222512/],” and it has been downloaded over 97,000 times [https://ajph.aphapublications.org/doi/full/10.2105/AJPH.2010.300062] according to the publisher’s website and cited over 1,400 times [https://scholar.google.com/scholar?hl=en&as_sdt=0%2C5&q=Health+Disparities+and+Health+Equity%3A+The+Issue+Is+Justice&btnG=] according to Google Scholar. The lead author of the paper is Paula Braveman [https://profiles.ucsf.edu/paula.braveman], who is currently a professor emeritus at the University of California – San Francisco. In writing the paper, Braveman was accompanied by six co-authors, all of whom have doctoral letters after their names. Remarkably, none of those letters created immunity from the anti-male prejudice expressed in the statement that the authors signed off on. Putting aside all the nasty and inaccurate things said about boys and men in humanities journals, Braveman’s statement is one of the most irresponsible things that I have ever read about men’s well-being in a health or medical journal. Her statement is shocking in its dismissiveness, its irrationality, and its inhumanity. It was published 15 years ago, but it is still relevant, because it helps to explain how we arrived at our current situation in which group identities are prioritized over individual flesh-and-blood human beings. It helps to make sense of why substantially more funds [https://jameslnuzzo.substack.com/p/nih-funding-mens-womens-health] and initiatives [https://jameslnuzzo.substack.com/p/us-mens-and-womens-health-offices] have been dedicated to women’s than men’s well-being, even though male life expectancy has been significantly shorter than female life expectancy [https://jameslnuzzo.substack.com/p/life-expectancy-in-the-united-states] for many years. The misguided ideas expressed in Braveman’s statement come from critical theory [https://newdiscourses.com/tftw-critical-theory/], critical race theory [https://newdiscourses.com/tftw-critical-race-theory/], and intersectionality [https://newdiscourses.com/tftw-intersectionality/]. The injection of these ideas into the public health domain can be traced back to the founding of the Commission on Social Determinants of Health within the World Health Organization in 2005, including the Commission’s 2008 report titled, “Closing the gap in a generation: health equity through action on social determinants of health [https://www.who.int/publications/i/item/WHO-IER-CSDH-08.1].” The report included a section on “gender equity,” which only discussed women’s health. In the past year, men’s health has received increased attention in the public policy sphere [https://www.auanet.org/about-us/media-center/press-center/2026/a-new-era-for-mens-health-begins-aua-proud-to-support-landmark-office-of-mens-health-legislation], and continued progress seems likely. As this progress is made, investigations into how discussions of sex and public health became so historically one-sided ought to also be conducted. The individuals who created the one-sided narrative ought to be known, and their ideas ought to be dissected. Here, my purpose is to identify Paula Braveman and her colleagues as some of the individuals responsible for the years-long denial of boys’ and men’s health issues, and to explain why Braveman’s statement is incorrect, as to ensure a proper defence is readily available the next time that such a statement is made. So, let us reiterate Braveman’s statement and then dissect it. Reiterating Braveman’s statement First, Braveman said that male life expectancy is not an area of public health importance. Second, Braveman said that the reason that male life expectancy is not an area of public health importance is because it is not a social justice, health disparity, or health equity issue. Third, Braveman said that the reason that male life expectancy is not a social justice, health disparity, or health equity issue is because “men as a group have more wealth, influence, and prestige” than women. Dissecting Braveman’s statement Braveman’s statement is problematic on many fronts. First, Braveman incorrectly assumed that for a topic to fall within the purview of public health that it must be a social justice, health disparity, or health equity issue. Yet, the field of public health existed well before Woke concepts like “equity” and “social justice” became popular among activist academics. Furthermore, Braveman’s notion that men’s health and life expectancy are of concern to public health only if certain socioeconomic or sociopolitical conditions or qualifiers are met also is misaligned with the history of public health. Therefore, Braveman’s view is not a health or medical view, it is a misguided philosophical and sociopolitical view. Second, Braveman illogically classified all men as being the same. Braveman said that men as a “group” have more wealth, influence, and prestige than women. However, this was a sweeping generalization that ignored the range of life experiences of many men. One example is homelessness, which is a topic that falls within the domain of public health. In the U.S., men are approximately 70% of the unsheltered homeless [https://jameslnuzzo.substack.com/p/homelessness-united-states]. Homeless people have little or no wealth, influence, or prestige. Third, when discussing shorter male life expectancy, Braveman added the qualifying phrase “if likely avoidable.” In doing this, Braveman seems to have expressed doubt as to whether shorter life expectancy among males is avoidable or preventable. However, this deterministic view of the sex difference in life expectancy is misaligned with historical data [https://jameslnuzzo.substack.com/p/life-expectancy-in-the-united-states]from the U.S. Since 1900, the sex difference in life expectancy has been as large as 7.8 years in the 1970s and as small as 1-2 years in the early 1900s. If the sex difference in life expectancy was due purely to biological factors, then one might expect the size of the sex difference to remain roughly the same over time. Yet, the large sex difference in life expectancy in the 1970s is believed to have been due to high rates of cigarette smoking among men, which caused them to develop lung cancer and ischemic heart disease at higher rates than women. Cigarette smoking is a modifiable risk factor of early mortality, as are many other causes of early male mortality – for example, poor diet, lack of physical activity, and drug and alcohol abuse. Thus, Braveman’s deterministic view of male life expectancy ignores the role of preventive health actions that can alter how long someone lives. In fact, what makes Braveman’s qualifying phrase particularly egregious is that it is the specific role of the field of public health to address the preventive health measures that can enhance the quality and length of people’s lives. Intersectionality Another problem with Braveman’s statement is that it contradicts itself, given that Braveman’s guiding philosophy is one that includes intersectionality [https://newdiscourses.com/tftw-intersectionality/]. The contradiction is that many individuals who fall within the intersectionality framework based on race are boys and men. Thus, Braveman simultaneously wanted to virtue signal by saying that public health should be focused on only so-called oppressed, marginalized, or minority groups, without understanding that many of the males who she disregarded with her blanket statement about life expectancy are members of these minority groups. For example, in the year that Braveman’s article was published, there were 20.4 million black males in the U.S., accounting for 6.5% of the total U.S. population. There were also 8.3 million Asian or Pacific Islander males, who accounted for 2.6% of the total U.S. population, and 2.1 million American Indian or Alaskan Native males, who accounted for 0.6% of the total U.S. population (see Table IV here [https://stacks.cdc.gov/view/cdc/231839]). Life expectancy for black males in the U.S. in the year that Braveman’s article was published was 72.2 years [https://stacks.cdc.gov/view/cdc/231853]—the lowest of any demographic group other than perhaps American Indian and Alaskan Native men. What’s more, these demographic data do not account for boys and men who might fit into other intersectional categories – for example, Hispanic males based on ethnicity, non-heterosexual males based on sexual orientation, or mentally or physically impaired males based on disability status. After all these intersectional categories are accounted for, the only males of non-interest to Braveman are heterosexual white males who do not have a disability. Boys Another concerning aspect of Braveman’s statement is its implications for boys. Braveman referred to “men” rather than boys. Nevertheless, all men start life as boys, and boys’ early life experiences have a great impact on their lives as adults. And one reason that male life expectancy is shorter than female life expectancy is because of the disproportionate number of deaths that occur among boys and young men. In other words, one cannot disentangle male life expectancy from boys’ health. Yet, Braveman’s statement implied that public health should also not take an interest in boys, because, one day, all those boys will supposedly have greater “wealth, influence, and prestige” than their female counterparts. However, boys have no power; they are entirely dependent on their parents and other adults in society. Moreover, compared to girls, boys exhibit many worse health outcomes and educational outcomes, such as higher school dropout rates [https://www.tandfonline.com/doi/full/10.1080/13685538.2019.1645109] and greater rates of communication disorders [https://www.tandfonline.com/doi/full/10.1080/13685538.2019.1645109], autism spectrum disorder [https://www.tandfonline.com/doi/full/10.1080/13685538.2019.1645109], Tourette Syndrome [https://www.tandfonline.com/doi/full/10.1080/13685538.2019.1645109], accidental drownings [https://aibm.org/research/deaths-from-drowning-the-facts/], suicide [https://jameslnuzzo.substack.com/p/suicide-in-the-united-states-in-2022], etc. Conclusion: personal accountability In conclusion, misguided philosophy underlies why boys’ and men’s well-being have not been given appropriate focus by big public health. Paula Braveman’s statement provides a prime example of this. Her statement was prejudicial, stereotyped, and not evidence-based. For this dereliction, Braveman and her co-authors should be held personally accountable. Braveman’s paper was presumably approved by multiple peer reviewers and the journal’s editor. Those individuals are also responsible, albeit to a different degree. International groups like the World Health Organization [https://jameslnuzzo.substack.com/p/bias-against-mens-issues-within-the] are also to blame, because they set the tone for global- and national-level health policies. Countless numbers of other health officials and academics have also played a role, as they have pushed Woke Medicine [https://jameslnuzzo.substack.com/p/woke-medicine-terminology] in recent years. Finally, women’s health advocates, like those who wrote the recent National Academies’ grand plan [https://jameslnuzzo.substack.com/p/national-academies-plan-for-womens-health] for the future of women’s health, are also responsible, as they have continually exhibited a childish inability to express concurrent care for both women and men. Men and women should not be viewed as enemies caught in a zero-sum game. They are Nature’s pair, and they are meant to flourish together. As this positive, forward-looking message begins to gain traction, one need not shy away from simultaneous discussions about problematic ideas from the past, and the individuals who created and spread those ideas. Moving forward, fear of personal accountability can serve as a formidable deterrent against the publication of wrongheaded ideas—ones that we do not want to read again in our fairer and healthier future. Related Content at The Nuzzo Letter SUPPORT THE NUZZO LETTER If you appreciated this content, please consider supporting The Nuzzo Letter with a one-time or recurring donation. Your support is greatly appreciated. It helps me to continue to work on independent research projects and fight for my evidence-based discourse. To donate, click the DonorBox logo [https://donorbox.org/the-nuzzo-letter]. In two simple steps, you can donate using ApplePay, PayPal, or another service. Thank you. Thanks for reading The Nuzzo Letter! Subscribe for free to receive new posts and support my work. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit jameslnuzzo.substack.com [https://jameslnuzzo.substack.com?utm_medium=podcast&utm_campaign=CTA_1]
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