(HEA1b) Sociology of Medicine, Health, and Illness II: Gender and Health

This session focuses on the theoretical, methodological, and empirical issues pertaining to the sociology of health and health care. Papers explore health inequities, individuals’ experiences of illness and/or interactions with health care services, intersections between work and health, health care professions, and organization of the health care system. Tags: Equality and Inequality, Health and Care, Policy

Organizers: Elena Neiterman, University of Waterloo, Michael Halpin, Dalhousie University; Chair: Jiaxin Gu, University of British Columbia

Presentations

Michael Halpin, Dalhousie University

When help is harm: Masculinity, self-improvement, and health in the looksmaxxing community

How does hegemonic masculinity harm men’s health? In this paper, we focus on Looksmax.org, an online community for men who are seeking to improve their appearance or become more attractive to potential partners. Looksmax.org hosts ratings threads, wherein users can post their pictures and have their physical attractiveness “objectively” rated by other members. In other parts of the community, users share tips for “looksmaxxing” (improving physical attractiveness), discuss body alterations (e.g., leg lengthening surgery), and exchange seduction tips. In this community, physical attractiveness is of the utmost importance because it is seen as the biggest determining factor for whether or not a man is single. For this paper, we qualitatively analyzed 8,072 comments posted to Looksmax.org. Our analyses focused on the most popular threads during a 6-month period of data collection that occurred in 2023. Our analysis was guided by analytic abduction. We present our findings in three themes. First, we demonstrate how users of Looksmax.org see physical attractiveness as something that can be quantifiable and objectively measured, which we refer to as a “quantifying gaze.” In this section, we show the extreme precision and nuance that men apply when assessing one another’s bodies in relation to hegemonic ideals. For example, users rate each other on a 10-point scale, deducting full and partial points for minor facial asymmetries, pronounced brow ridges, nose sizes, or uneven ratios between the size of the chin and the upper lip. Second, we show how the Looksmax community encourages users to seek substantial alterations to their bodies so that they can better conform to masculine ideals. For instance, shorter men are encouraged to undergo expensive and painful leg lengthening surgeries, while men with large noses are told to get rhinoplasties. In addition to these surgeries, users suggest a number of body altering practices. For example, some users practice “mewing,” which is pushing the tongue to the roof of the mouth in an effort to develop a more masculine jawline. As we argue, users’ quantitative assessments of masculine bodies are tightly coupled to these interventions, as such interventions are seen as the best means to “objectively” improve one’s appearance. Third, despite situating itself as a forum for self- improvement, we argue that the Looksmax community demoralizes its users. By demoralize, we mean that users learn that they are inadequate as part of their participation in the community. We document many examples of users discussing self-harm because they believe that their appearance made them permanently unattractive, while also detailing users who encourage others to self-harm. We discuss how these findings demonstrate the negative health consequences of hegemonic masculinity for men, and how some online masculine ‘support’ spaces demoralize and harm men.

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Non-presenting authors: Meghan Gosse, Dalhousie University; Finlay Maguire, Dalhousie University

Kai Jacobsen, Caleton University; Megan Linton, Carleton University

Privatizing and Prescribing Identity: How Canadian biotechnology firms capture queer, trans, and neurodivergent movements for profit

Contemporary health companies co-opt the rhetoric of identity politics and social movements in their marketing, transforming marginalized communities into profitable niche markets. This co-optation is fueled by Canadian state sponsored neoliberal biocapitalism, which incentivizes privatization through subsidies for biotechnology startups and pharmaceutical multinational corporations. In this landscape, health technology firms are increasingly functioning as primary care providers to fill the growing gaps in care created by contemporary austerity. In particular, the pivot to telehealth through the COVID-19 pandemic spawned numerous private investor-owned virtual care firms. Socialized health care within a capitalist state like Canada is always at risk for privatization and corporatization. These firms are able to capitalize on loopholes and outdated policies in Canada’s healthcare regulatory framework. One such company is PurposeMed, a venture-capital backed start-up that operates private virtual clinics for HIV PrEP medication (Freddie), gender-affirming care (Foria), and ADHD assessment and prescribing (Frida), and a pharmacy (Affirming Care). We analyze PurposeMed as a case study to illustrate broader trends in the creeping privatization of health care and the biomedicalization of everyday life. In this case study, we first describe the historical, political, and economic factors that led to the rise in private virtual clinics like those of PurposeMed. Then, we present the results of corporate mapping of PurposeMed, where we engage power structure research and subsequent social network theory to understand the corporate powers transforming health care in Canada. Finally, we conduct a critical discourse analysis of PurposeMed’s marketing and branding strategies, highlighting their exploitation of the existing digital networks and health information-seeking patterns of queer, trans, and neurodivergent communities to accumulate capital. We argue that PurposeMed exploits gaps in the underfunded and overburdened public health care system to turn marginalized individuals with unmet health care needs into a profitable niche market. The desired outcome for the private health system is the transformation of queer, trans, and neurodivergent bodyminds into productive, paying neoliberal subjects. Our historical and policy analysis demonstrates that healthcare privatization and commercialization in Canada is not an accident; rather, PurposeMed is the inevitable result of deliberate policy choices and austerity politics fueled by ableism, homophobia, and transphobia. While requiring individual private payment for services, PurposeMed also receives public funding. Our corporate mapping exposes a federal investment of $3.5 million of taxpayer money into PurposeMed’s services. Alongside this federal funding, a wide network of venture capital firms and private investors make up both PurposeMed specifically and the broader movement to privatize health care in Canada. Our critical discourse analysis reveals how PurposeMed’s online marketing strategy leverages digitally-networked communities to popularize their services and transform queer, trans, and neurodivergent bodyminds into commodities for harvest. By marketing their services as affirming, anti-oppressive, patient-centered, and holistic, PurposeMed and similar companies capitalize on people’s experiences of discrimination and harm in the public health care system to entice them into private healthcare. In doing so, PurposeMed frames paying out-of-pocket for healthcare as a strategy for empowerment and liberation rather than the result of government austerity and the failing public health care system. We conclude by calling for urgent scholarly attention to the communities targeted by creeping privatization of Canadian health care and the firms profiting from them. Further, we argue that queer, trans, and disabled communities need to turn to the histories of disability, health, and radical social movements to create grassroots community-based solutions to contemporary crises. Moreover, social movements must take seriously the need to dismantle contemporary capital accumulation practices, which manufacture the crises they seek to profiteer from. 

Nancy Nzeyimana Cyizere, Université Toulouse - Jean Jaurès & Institut national d'études démographiques (Ined)

Between a rock and a hard place: sex work, sexual health and the law in the French context

This communication is part of a doctoral research examining the vulnerabilities to HIV and aids of black people in continental France, whether natives or immigrants. To question the role of several environmental and psychosocial factors in the exposure to the risk of primary contamination to HIV or to a health deterioration towards AIDS, we conducted 70 interviews between January 2022 and February 2023 in the Paris (N=48) and Toulouse (N=22) metropolitan areas, with health and social sector “Professionals” and black “Individuals” aged 18 and above. On one hand, we questioned Professionals’ practices as a factor of improvement in access to health and social services or, on the contrary, of disadvantage. On the other hand, we questioned Individuals’ opinions and experiences with HIV (retrospective and current), their general health trajectories and their living conditions. Researchers and policy-makers alike have often understood sex workers’ overexposure to HIV (and other sexually transmitted infections) as an occupational hazard. Yet on the field, Individuals and Professionals alike identified nation-wide policies penalizing sex work and international migration (especially from the Global South) as the main culprits. Initially the 2016 law that penalizes the use of sex work has degraded their working conditions and their sexual health. Indeed, as (male) clients now take legal risks to visit sex workers, many insists on genital penetration with no condom. Despite being aware of the potential consequences or their sexual health, fewer sex workers are able to refuse these demands as the decline in the number of clients has reduced their income. Furthermore, the precarization of sex work affects workers unequally depending on their social and legal constraints. In particular, those who are in an unlawful situation regarding their administrative residency status are more sharply affected. First, they cant access legal employment meaning that their options for earning a livelihood are particularly limited. Secondly, they live with an acute fear of being identified by the police, arrested, detained and deported from France, which impede on their use of key resources such as associations and health centers. The ideologies that have shaped the current situation — described as catastrophic by community-based associations — have emerged from two different fields of political mobilization in contemporary France. The French state’s position on sex work aims to eradicate it from the territory and is first and foremost carried by a subset of feminist activists (called “abolitionist”), for whom sex work is the expression of patriarchal domination. The State’s anti-immigration policies result from the normalization of xenophobic and racist discourses in the media and the political class — such as “migrants abuse public resources”, “they don’t want to integrate” or “their culture is not compatible with ours” — that have created an “immigration problem” (“problème de l’immigration”), that ever more closed-off borders should help resolve. To understand the current gaps in the prevention, screening and treatment of HIV among sex workers, it is indispensable to analyze how the legal framework impacts their working conditions. The restrictive legal frameworks around sex work and international migration exacerbate any pre-existing social inequalities between clients and workers, as the latter’s earning potential and bargaining power have crumbled.

Marit Solbjør, Norwegian University of Science and Technology

"Prostate cancer screening is just a simple blood test" - how men in Norway view screening with PSA.

Screening for cancer has been normalized through slogans as “early detection saves lives” and the implementation of screening programs. Prostate cancer is the second most common diagnosed cancer worldwide, but prostate cancer screening with prostate specific antigen (PSA) is contested due to ambiguous evidence of whether benefits outrun negative consequences. Its low specificity could lead to high numbers of men having a diagnosis and treatment for cancer that would not cause death, and treatment could cause incontinence and impotence. Regardless of this, an increasing number of countries are implementing PSA as a screening test, but not Norway, where urologists are critical towards such screening. Opportunistic screening is frequently done by men at their GPs’, and the Prostate Cancer Association is campaigning for a population program. Such variation of standpoints to prostate cancer screening led us to investigate the perspectives of men in Norway on screening with PSA. Theoretically, cancer screening can be understood as part of the biomedicalization regime (Clarke et al 2010), where techno-scientific developments, the focus on health risks and biomedical solutions result in practices of the body that contribute normalization of medical intervention on individuals without symptoms. Discourses of cancer prevention has been focused on breast cancer and women’s bodies as vulnerable. Learning that ageing male bodies are at risk for prostate cancer, could also lead to vulnerability, but this is in opposition to what has been termed hegemonic masculinity in our late modern western societies: denial of vulnerability, emotional and physical control, reluctance to seek help, and the interest in penetrative sex. Men can be reluctant to participate in screening for prostate cancer if they fear losing their masculinity. Thus, contradictory discourses frame men’s decision making about participation in prostate cancer screening. In the present study we did 10 focus groups with a total of 48 men in Norway, aged 54-85 years old. Seven groups were men diagnosed with prostate cancer. Data were analyzed with thematic analysis following Braun and Clarke (2022). The main theme that we identified was that routine prostate cancer screening is simple and necessary for normalizing PSA testing. This was comprised by three subthemes: the ambiguous PSA test is better than no screening for a cancer striking many men; the simplicity of a blood test shows the cost-benefit of having the PSA test; and a regular screening program can make men take care of their health without risking masculinity. The men were positive towards screening for prostate cancer with PSA because they saw early detection as beneficial. But, in their interpretation, since other men would not use health services regularly, having a screening program for prostate cancer was important. Knowledge about the uncertainty of PSA values and overdiagnosis did not influence views on the benefit of screening. The simplicity of screening through a blood sample obscured the complexity of PSA testing of non-symptomatic men. In conclusion, men who participated in our study were part of a pro-screening discourse that see early detection as beneficial despite weaknesses of current test practices. Such approaches to screening contribute to biomedicalization and individuals embracing surveillance medicine to act as responsible citizens.