A give-'em-hell approach to life can lead to hard drinking and fast driving, which in turn cause about half of male adolescent deaths, according to new research into men's attitudes to health and well-being.
Men Talking, a report published by the North Eastern Health Board, has identified such typical macho behaviour as a factor in how men perceive their health, illness and the seeking of medical help. Their upbringing and the macho principle lead them to equate illness with weakness, which has far-reaching implications for their physical, mental and emotional health.
That men live unhealthily is suggested by the fact that, in the north-east region, 31 per cent of them drink more than the recommended 21 units of alcohol a week; 17 per cent would drive after two or more drinks; 39 per cent of 11- to 17-year-olds said they had been drunk in the previous month; and 30 per cent of all men and 25 per cent of nine- to 17-year-olds smoke. They also eat more saturated fats, exercise less and are more likely to die in road traffic accidents than men in the rest of the Republic.
The report quotes some of the men it interviewed. One 30- year-old said about masculinity: "You have this thing in your head . . . you have to be big and strong and you can't be seen to be weak." A 44-year-old said: "It's conditioning. He might cry to himself, but he doesn't like to make it open. He's supposed to be the head of the family and hold the whole thing together."
The report's joint researchers and authors, Anne Stakelum and Jennie Boland, believe the way men behave is "inextricably tied to an outer web of sex roles and gender expectations, which inadvertently result in men themselves reconstructing the myth of masculinity".
The myth of masculinity seems to have a lot to answer for. One man sought help for a health problem only when it stopped him from working; it appears that being able to work and being healthy are still mutually bound up in the male psyche.
Men take few preventative health measures; any health screening was the result of previous illness, school medicals or pre-employment checks. They may go to the doctor only out of fear - by which time it may be too late.
"I had a friend who had testicular cancer, and I found it strange that he allowed the growth to become the size of probably a peach. That is something that did not happen overnight, and he lost both his testicles as a result," said one 47-year-old man.
The report also deals with risk behaviour; specifically, speeding and drink-driving. It found that young men, in particular, accept the risks associated with speeding either because they enjoy them or because they believe, from intuition or calculation, that an adrenaline buzz outweighs the possible costs.
"Once you think about it, well after you do it, you say, 'Jesus, I shouldn't have done that,' but at the time you just hop in and floor it," according to one young farmer.
Men say the biggest influence on their behaviour is not health-promotion campaigns but the risk of being stopped by the Garda.
The report also spells out the emotional price of macho behaviour. Men who lose their jobs, and therefore their status, are not equipped to deal with the loss of self-esteem. Their emotional health has not been sufficiently nurtured to allow them to value themselves outside work.
With more and more women sharing the role of provider, men's traditional yardstick is less useful. With no new way of evaluating themselves, their sense of self-worth is called into question.
Some of the men Stakelum and Boland interviewed suggested that suicide could be viewed as a selfless rather than a selfish act. Often, went their reasoning, they stick out the rough times in silence; if they succeed, well and good. If they don't, they can save their families by removing themselves and the burdens they have become.
Fathers who were victims of domestic violence or who were seeking custody of their children spoke repeatedly, and often emotionally, of the pain they experienced as a direct result of being separated from their children. It was only within this group of men that suicide attempts were openly discussed.
When a couple separate, the men appear to receive a double dose of emotional rejection because, unlike women, the majority also lose access to their children.
"Take the young fellow who is let go from his job . . . and he has a young family, he has to keep . . . running," said one 18-year-old F┴S worker. "Depression is getting him down, and he can't keep the family. There is no other way out for him."
The picture is bleak, but open to change, says Stakelum, as machismo is a social rather than a biological phenomenon.
Paul Robinson, the chief executive of the North Eastern Health Board, says the solution lies in changing our culture, at as early a stage as possible. "All of society must look at how we can break this problem. We must look at how young boys are raised to be men, at men's attitudes to themselves and society's attitudes to men."
The board commissioned the study partly because it was aware of men's poor health status compared with that of women, and partly because there had been little research in the area.
"It is original, because it is based on what men have to say about themselves, and we can interpret that to improve the situation," he says.
In response to its findings, the board plans to appoint its first co-ordinator of men's health, who will ensure that men have access to health services and that men's health issues are dealt with at board level.
There is much to be done nationally, however, if men's health is to be taken seriously. Stakelum and Boland recommend the drawing up of a national policy for men's health, similar to that adopted for women in 1995.
The Government, academics and health-research bodies should work together to challenge macho ideologies, as well as supporting national health-awareness campaigns. These could be general or focused on doctors' surgeries, to provide men with information tailored to their lives.
In the short-term, there are some obvious structural changes that could be made, such as "de-feminising" general practices, to make men feel more comfortable about visiting their doctors.
There also needs to be more research into the link between traditional notions of masculinity and men's health, however. Only then can we plan for the long term.