In addition to risks related to education, employment, family, and the criminal justice system, low-income men have poorer health outcomes. Notable disparities in chronic diseases—including diabetes, hypertension, and cancer—as well as physical victimization, violence, and lower life expectancy, may be linked to factors disproportionately affecting low-income men and, particularly, men of color. These income and racial disparities are highlighted in the Healthy People initiative, the U.S. Department of Health and Human Services’ decennial project that proposes numerous health goals, including the increase of health equity among all groups of people. The Healthy People 2010 report notes that, in general, “population groups that suffer the worst health status are also those that have the highest poverty rates and the least education” (HHS 2000, 12). Some scholars argue that social causes (e.g., concentrated poverty, residential segregation) are the main explanations for health disparities and the cumulative effect of poor health over the lifespan (Fiscella and Williams 2004). Related to the disadvantages outlined in previous sections, access to affordable health care is less likely for low-income men. They are more likely to be uninsured, to live in neighborhoods with few medical facilities or private physicians, and to have poor health-seeking behaviors (Rich 2000).
Nearly 50 million people, or 16.3 percent of the U.S. population, were uninsured in 2010.12 Younger Americans are particularly likely to be uninsured; just over a quarter of people between the ages of 18 and 44 lacked coverage in 2010. Among low-income working-age men with no bachelor’s degrees, this number jumped dramatically to 51 percent.13 Among the national population, whites had the highest percentage of individuals with insurance coverage, with only 11.7 percent of the population lacking insurance. In contrast, African Americans and Hispanics were uninsured at rates of 20.8 and 30.7 per cent, respectively.14 The latter’s high rate reflects the high number of immigrants in the Hispanic community, in particular undocumented immigrants who lack access to health care. In addition, in 2009 African American males had a lower life expectancy than white males, at 70.9 years compared with 76.2 years (Miniño 2011). This disparity in life expectancy between African American and white men has been true for the past century; African American men trailed by nearly 15 years in 1900 (Arias 2011). The consistency of this health gap likely indicates persistent environmental factors that have harmed African American males uniquely. Hispanic males in the United States, in contrast, have longer life expectancies than white males. In 2007, Hispanic males were expected to live to age 78.2, two-and-one half years longer than white males (Arias 2011).
Attitudes toward Health, Healthy Behavior and Health Care
Ethnographic and other qualitative research provide insight into men’s attitudes toward health and health care. One qualitative study asked African American men—including those with HIV/AIDS, trauma survivors, and the homeless—about their perceptions of health and what influences health. The men in the study emphasized complete well-being—physical, mental, social, and spiritual—not just illness or the absence of disease. The authors conclude that men may be more likely to engage with health providers who take a similarly comprehensive view toward health (Ravenell 2010). On the other hand, actual behavioral choices around physical activity, diet, safety, and substance use contribute to poor health (Leigh 2004). Finally, although not limited to those of low-income men, perceptions of health care discrimination in the United States are higher among immigrants than U.S.-born adults, and higher among African Americans and Hispanics than whites (Lauderdale et al. 2006). This could affect the health-seeking behavior of these men.
Stress is an integral part of many low-income men’s experiences. In one study, men identified four primary sources of stress that affected their health and overall well-being: lack of income, racism, unsafe unhealthy communities, and relationship conflicts (Ravenell, Johnson, and Whitaker 2010). Differences in the ways men and women cope with stress may contribute to men’s high substance use, avoidance of health-protective behaviors, and increased behaviors harmful to health (Williams 2003). In research relevant to neighborhood and community stress, Rich and Grey (2005) examine factors precipitating victimization among 49 African American, Caribbean, and Puerto-Rican men hospitalized in Boston following an assault, stabbing, or shooting. The authors conclude that informal street rules centered around “respect” contribute to retributive violent acts, especially when coupled with disillusionment or distrust of the formal law enforcement system. As a result, many individuals feel that if they fail to retaliate against their attackers, they are putting themselves at future risk for additional injury—thus repeating a likely cycle of violence and victimization (Rich and Grey 2005).
Health, Economic Well-Being, and Family
Studies show close links among health, income, and family. For instance, the high prevalence of drug use and abuse in many inner cities contributes to depressed economic well-being (individual and collective), poor health and risk of death at an early age, and weakened family relationships (B. Johnson et al. 1990). Links between health and social support have also been found. In one study, differences in hypertension between African Americans and whites were greater among those without social support than among those with support. Between Mexican Americans and whites, ethnic differences were only observed among those with social support: Mexican Americans with social support had a lower risk of hypertension than their white peers (Bell, Thorpe, and LaVeist 2010). Another study examined links between marriage and health. The authors found modest evidence that for children, their parents’ marriage bestows health benefits that endure into young adulthood, although findings were somewhat stronger for females than for males (LaVeist, Zeno, and Fesahazion 2010).
Health’s central role in men’s lives and well-being, and its influence on family, education, employment, and even risk of contact with the criminal justice system, warrants further study. Likewise, how family, education, employment, and risk of contact with the criminal justice system influences health is important to understand. Several questions concern ways to improve men’s access to health care and improve their health-seeking behaviors. To what extent would expanding health care access improve the health of low-income men? What strategies and approaches would help improve men’s health-seeking behaviors?