Men’s Strategies after a Heart Incident: A Class-based Masculinities Approach

Abstract

Men in economically advanced societies are more at-risk of premature mortality due to heart disease than women, and this risk is inversely proportional to their socioeconomic status (SES). In Canada, many public health reports indicate that cardiovascular disease represent about one third of all causes of death and that men’s mortality rates from these diseases are two times higher than women, making it the main contributor to health inequality. Underprivileged men have been identified as being less receptive to cardiac rehabilitation guidelines, yet research promoting heart healthy behaviours has often neglected the social mechanisms that influence the lifestyle of this population. This study aims to understand the social variation in dispositions and commitments toward body care of men from two contrasting socioeconomic groups who have suffered from a cardiovascular incident requiring hospitalization. It draws primarily on Pierre Bourdieu’s socio-cultural theory of practice and his concept of bodily habitus in order to understand distinctive lifestyle patterns in the context of cardiac rehabilitation. Qualitative data was collected through 60 semi-structured interviews of an average duration of 90 minutes. Participants were Francophone men (average age of 57.3) from the Outaouais region of the Province of Québec, Canada. A thematic content analysis showed strong social variation in terms of lifestyle and identified different dispositions towards body care in the context of heart disease. Results are organized according to three key strategies for human flourishing following a heart incident that are relevant to understand the dispositions to adopt (or not) heath practices in the context of cardiac rehabilitation: (a) achieving a sense of security; (b) preserving autonomy; and (c) maintaining dignity. The comparison between socioeconomic groups highlights the incompatibilities of healthcare services and rehabilitation programs with the priorities of underprivileged men. It also flags the potential ethical and political dimension of healthcare by examining notions of health citizenship. In conclusion, the thesis discusses the socio-political characteristics of cardiac rehabilitation programs, and the usefulness of class-based masculinities as an alternative point of view to understand health implications of lifestyles.