Men's health: an intersectional and multilevel framework for understanding syndemic patterns of health.

Men occupy a privileged position within gender power relations: the male body has been the default reference point for biomedical research and therapeutic development (with the historical exclusion of women from medical trials), and men dominate health services leadership and exercise well documented medical misogyny. Yet despite their privileged position, many aspects of men's health outcomes are neglected and undertheorised because they are not examined through an intersectional gender lens. Although consideration of gender and masculinity is important for understanding men's health, research thus far has focused predominantly on men's harmful health behaviours, overemphasising individual determinants of health, and a deficit-based approach. Little attention has been paid to the influence of structural determinants of men's health risks and vulnerabilities, or the gender-specific health outcomes of worsening social and economic inequalities. In this first paper of a Lancet Series on men's health, we present a conceptual framework for understanding men's health from an intersectional perspective, highlighting how structural, social, and commercial determinants of health, intersectionality, and syndemic theory can be combined to analyse men's health at different socioecological levels. We illustrate the framework using four selected case studies that show how the health outcomes of marginalised men are influenced by complex interactions. We provide a working definition of men's health that reflects existing literature and builds on the conceptual framework and case studies. Promotion of gender justice and health equity requires moving beyond one-dimensional approaches that construct men as problematic individuals, and towards better understanding and action on the broader set of power systems and structural determinants underpinning men's health.