The US age-adjusted mortality rates for the total population and by gender are presented in Fig. 1.4. Although there has been a continuous decline in the age-adjusted mortality rates for the past seven decades for women and men, the age-adjusted mortality rates are higher for men when compared to women and when compared to the US population. Furthermore, regarding the men’s health literature in the USA, research on men of color (e.g., African Americans, Hispanics, Asians, American Indian or Alaskan Native, Pacific Islanders) is scant [8, 26]. Yet, men of color account for a considerable amount of the reported gender difference in mortality [9, 29]. African American men have the highest rates of age-adjusted mortality, and Asian men have the lowest, with White men and Hispanic/Latino men falling between these two groups (Fig. 1.5). These data support the need for additional research in the USA focusing on the health of racial/ethnic men, particularly African American men.

Chronic medical conditions encompass the majority of the leading causes of mortality for males in the USA, with heart disease and cancer being the top two leading causes of death for men (Table 1.1). Over one-third of adult men have some form of heart disease [30], and nearly one in two men will develop cancer at some point in their lifetime [31]. It is important to note that only three of the leading causes of death for men are not considered to be directly related to chronic diseases: unintentional injuries (including drug overdose), suicide, and influenza/pneumonia. These statistics are noteworthy because there are significant opportunities to consider behaviors that might impede the progress or delay the onset of chronic conditions.

Race and ethnicity can be useful proxies for a man’s exposure to health-harming environments and substances, social disadvantage, and health-promoting resources [32]. Understanding the poor status of men’s health and premature death includes considering how racialized and gendered social determinants of health shape men’s lives and experiences, particularly through economic and environmental factors [13, 14, 27]. The differences among males by race and ethnicity are highlighted in Table 1.1. Heart disease is the leading cause of death for all racial and ethnic groups of males except Asian/Pacific Islanders, for whom cancer is the leading cause of death; these leading causes of death have remained the same for decades. Hence, only modest progress has been achieved in advancing men’s health and addressing disparities in mortality in men’s health in the USA. Improving the quality of lives of men in the USA could lead to improved life expectancy and a higher ranking when compared to males from other international countries.

It has been established that the bulk of factors associated with the leading causes of death among men can be linked to the social determinants. Gender is one of the most important social determinants of health and health-related behavior, particularly for men, but the study of men’s health and well-being have not always conceptualized men as gendered beings [33–35]. A gendered analysis of male behavior can further our understanding of the larger contextual influences upon men’s lives, social roles, and other factors that influence men’s health [36–38].

Gender is one of the most commonly collected but least understood variables in research [39]. Despite the volume of research that has examined the role that masculinity plays in men’s health outcomes, we still know relatively little about specific social–biological pathways through which gendered arrangements become embodied as differences in health among men or between males and females [39]. Gendered processes—social relations and practices associated with biological sex—are the complex array of social relations and practices attached to gender that are rooted in biology and shaped by environment and experience [33, 39]. Thus, most health outcomes for men are the result of factors associated with both sex and gender, but researchers often fail to consider both. Furthermore, gender is both a structural characteristic that helps to define systems of social inequality and an individual level experience. It is critical to explore how it is understood, experienced, and practiced daily at both levels [40–42]. The theories that have been used to explain men’s health rarely examine the unique mechanisms and pathways that explain differences between men and women or among men [7].

Health scientists and practitioners should also consider the impact of psychosocial stress on men’s lives and men’s health. Stress is a socially patterned and contextual phenomenon affected by cultural, economic, and social factors and structures [43–44] that shape the social gradient in health [45–47]. Much of the literature on stress and coping in men builds on an interactional model of stress that highlights the social and cultural context of stress and coping [48] and argues that perceptions of stressors are the primary determinants of behavior and health status [49].

Stress directly and indirectly contributes to high rates of unhealthy behaviors, chronic disease, and premature mortality among men [6]. Psychological research on men’s health and masculinity often presents stress as an acontextual, psychological construct with universal mechanisms and pathways [49], yet characteristics (e.g., race, ethnicity, life stage) that are socially meaningful in their societal context [50, 51] shape what aspects of life are deemed stressful. Research has highlighted the importance of examining how social and cultural expectations of men and women shape their behavioral strategies for coping with stress; these patterns may help explain not only racial disparities in health outcomes but how these patterns vary by gender as well [46, 48, 52]. What remains unclear, however, is how men’s conceptions of various aspects of masculinity may shape men’s physiological or behavioral response to stress [6, 48, 53, 54].

Across disciplines theories of masculinity have historically presumed that there is one, universally accepted definition of masculinity [29, 55]. However, what masculinity means to men and the salience of different aspects of masculinity that change over the adult life span [56] may vary by race, ethnicity, socioeconomic status (SES), and geographic location [57]. Each phase of the life cycle can be distinguished in part by a man’s efforts to fulfill role performance goals [36, 53]: educational and professional preparation in the preadult and early adult years, being a provider for himself and his family in the middle adult years, and dignified aging as men move into and through older adulthood [53, 58]. These goals represent social and cultural pressures that change as men age, and these strains are rooted in efforts to perform certain masculinities and fulfill social roles and responsibilities [50].

According to Pyke [59], this focus on the primacy of the success of the male career legitimizes hegemonic notions of masculinity and gender inequality. Men who are unable to attain the masculine hegemonic ideals of white, heterosexual middle- and upper-class men may make use of other constructs of masculinity and personal assets to conceptualize and enact what they deem the most important aspects of masculinity [59]. This is an important distinction to make because it highlights how manhood is inherently racialized and class bound [60], which has direct implications on provisions of healthcare for the man, his family, and his community.

The Patient Protection and Affordable Care Act (ACA) of 2010 is a piece of US legislation that was written to provide access to healthcare for all American citizens. A key element of the approach to provide universal healthcare coverage was to expand Medicaid coverage for low-income wage earners. As a result, the ACA would have the potential to have a greatly positive impact on men’s health in the USA because men who did not qualify for state-sponsored health insurance prior to ACA could now have access to some form of coverage. In many cases, the financial barriers to healthcare services have been reduced considerably by ACA.

There are also other provisions in ACA that could improve health outcomes among underserved men and reduce and eliminate existing racial/ethnic disparities. These include free coverage of preventive care services, investments in the development of health teams and medical homes to manage chronic conditions in minority communities, and greater emphasis on methods to improve language services and community outreach in underserved communities. The extension of affordable insurance coverage through the new health insurance marketplace in 2014 was designed to ensure that individuals have a choice for quality, affordable health insurance. Subsidies were also to be provided so that all Americans who desired health insurance could afford it. Lastly, the ACA increased funding for community health centers, which provide comprehensive medical care for everyone regardless of their ability to pay. These provisions would allow health centers to double the number of patients that they see over the next several years. This is particularly salient for underserved communities as the majority of the 20 million patients receiving healthcare at community health centers are low income, uninsured, or are members of racial/ethnic minority groups [61].

While these policy-level solutions target all Americans, low-income minority men have perhaps the greatest potential to benefit given the social and economic constraints that impair their ability to seek timely and appropriate medical care. It is also important to note that the benefits of ACA are not limited to men of color born in the USA. Males make up the majority of undocumented immigrants, with a large segment of this group being classified as Hispanic or Latino. Undocumented immigrants are not penalized or required to purchase health insurance; however, immigrant men may qualify for state and local health programs such as community health and migrant clinics under the ACA [62]. This access to healthcare could have implications for millions of minority immigrant men whose primary access to healthcare prior to ACA was the emergency room [63].

The ACA is a pathway that can enhance the health of men overall; however, the future remains unclear about the manner and degree to which this law improves men’s health. A caveat is that each state in the USA can select its level of ACA coverage. As such the states with the greatest need for Medicaid expansion have only adopted portions of the ACA. States with the highest level of unemployment, poverty, and poor health outcomes for men (e.g., Alabama, South Carolina, Louisiana, Mississippi, and Texas) have refused to expand Medicaid in the manner outlined in the ACA. Millions of minority native and immigrant men will continue to have restricted access to healthcare because of the financial and legal barriers to health insurance that provide opportunities for preventative rather than acute care [64].

Men’s health will move forward as the national healthcare narrative changes, yet there must be a national commitment to men’s health over the life span. This must involve a greater commitment of resources via the federal government to fund research and provide specified training of researchers and clinicians who will focus on men’s health. As important, the narrative must change concerning where healthcare is generated for men. The doctor’s office is absolutely integral to healthcare delivery, yet public health, healthcare organizations, and schools must improve the awareness, particularly for young boys and men, that health and health maintenance is produced outside of the doctor’s office [65]. Aggressive investment in all facets of men’s health research, practice, and promotion will position the USA to make significant advancements in the health of males from infancy to advanced age across the globe.

Advancing our knowledge of men’s health and health disparities is critical to improving the lives of men worldwide. This involves a sustainable public health and medical infrastructure that is conducive and appropriate for men. Below are some recommendations that should be considered by researchers, policymakers, and practitioners. First, understanding men’s health and men’s health disparities requires an interdisciplinary approach. Currently much of the work is viewed through individual disciplinary perspectives, which limit our ability to critically think about men and their lives with a wider and perhaps more comprehensive conceptual framework [29]. The contexts in which men live are comprised of social, economic, and political structures that intersect to shape life chances in ways that influence behaviors that can have implications for men’s health indicators and outcomes. Such an initiative requires health scientists and practitioners to consider the health of men as a function of both individual and environmental factors. A focus on comprehensive men’s health must be more than a pursuit to understand biological mechanisms associated with gender-specific diseases such as prostate cancer and erectile dysfunction. There is considerable room to explore the environments and ways in which men live that elevate their risks for disability, disease, and premature death. Such exploration extends beyond disciplinary boundaries and calls for investigator teams comprised of individuals from the health sciences, social sciences, and the humanities. Interdisciplinary teams are well poised to address some of the complex issues associated with men’s health, thereby increasing the likelihood that health indicators and outcomes would markedly improve.

Second, the effort to understand and improve men’s health requires a consideration of the existing theoretical frameworks. Sound theories afford scholars the opportunity to provide evidence-based information that can lead to health-promoting strategies and policy-relevant solutions targeted toward explicating disparities among and improving the lives of men. Three theoretical frameworks that are fundamental to advancing men’s health and men’s health disparities, intersectionality, life course, and environmental affordances, will be discussed briefly.