National Policy for Comprehensive Men's Health Care: 15 years of important advances and persistent challenges

The 1988 Federal Constitution embodied health as a right for all Brazilian citizens, and the subsequent expansion of the Brazilian National Health System (SUS) enabled the country to respond in large part to the population’s health needs against a backdrop of deep social and regional inequalities. In just three decades, the SUS has significantly expanded service coverage, reaching areas and sectors historically neglected by public health policies. It has also strengthened investment in technology, increased staffing levels and intensified human resource training and development in the sector^1,2.

An analysis of the last 35 years shows that innovations have extended beyond the creation of new care models, highlighting the importance of establishing political, legal, organizational and management structures with clearly defined roles for federal and local governments when it comes to the governance, planning, financing and provision of health care services¹. The strain imposed by demographic and epidemiological changes has demanded a transition to a more comprehensive model of care focused on health promotion, intersectoral and interprofessional work and the determinants of health to obtain a better understanding of the health-disease-care process.

Viewed from a broader perspective of health, gender issues are understood to have a profound multifaceted influence on health, constituting one of the key social determinants that mold the experiences of people and populations. Socially constructed gender norms and stereotypes permeate all aspects of life, from access to health services to care-seeking behaviors and health outcomes, requiring the adoption of specific public policies that are tailored to their idiosyncrasies³.

However, as a field of scientific knowledge and health practice, the study of the intertwining issues of gender and health is rapidly developing, beginning with a strong focus on women’s sexual and reproductive health.

Since the 1990s, drawing on gender and masculinity studies, the broadening theoretical perspective of men’s experiences and the relationship between these experiences and health practices has driven an increase in academic output in this area both internationally and in Brazil. New studies investigating the intersection between men, gender and health have emerged alongside thematic issues of public health periodicals - like the supplement presented here - and scientific journals focusing on this topic.

In the field of scientific knowledge production, the first studies on the relationship between men and health were conducted in the United States, looking at differences in morbidity and mortality rates between men and women, revealing male disadvantages. At the time, the interpretation of these findings seemed contradictory, since, despite patriarchal privilege, morbidity and mortality was worse in men across all ages and socioeconomic groups.

This seemingly contradictory situation drove research on the relationship between men and health. Starting in the 1980s, attempts were made to overcome the strictly biological and/or epidemiological approach, gradually incorporating perspectives that recognize men as social and relational subjects. During this process, normative models were questioned, and the gender perspective was adopted in analyses of men’s health, emphasizing the importance of linkages between masculinities and health^4-6.

One of the central concepts of this debate is hegemonic masculinity, which refers to the dominant ideal of what it is to be a man. This model not only subordinates women but also marginalizes men who do not fit the ideal - such as black men, homosexual men, men with disabilities and peripheral men⁷. Masculinity is associated with heterosexuality, whiteness, purchasing power, virility, aggressiveness, productivity, self-sufficiency and denial of vulnerabilities. Repressing emotions and silencing fragility thus become likely hallmarks of the masculine imaginary⁷.

The construction of male identity based on rigid gender norms engrained from childhood has contributed to men’s detachment from health services. How men are socialized directly influences their care practices, which are often marked by constant exposure to risk, denial of all kinds of suffering and resistance to showing fragility, which in turn sustain a distorted ideal of strength and invulnerability that associates care and seeking help with weakness⁸.

The concept of what it means “to be a man” varies according to historical and territorial context and a host of social markers, including class, generation, race/ethnicity, sexual orientation, education level, religiosity, worldview, disability and gender identity. The intersectional approach therefore helps provide a multidimensional understanding of the health-disease process and the exercise of masculinity. The use of this approach has grown in studies of gender and public health, as Couto and Dantas assert⁹:

[...] intersectionality has gained ground in public health studies; gender, generation, race/ethnicity and class are being considered because they offer ample possibilities for enriching theoretical reflection in this field, adding to the understanding [...] of access to health resources and the use of services. (p. 861)

On the whole, developments in men’s health and the relationship between masculinities, gender and health in the field of knowledge production have not had the same impact in the public policy field. This is perhaps one of the biggest challenges facing researchers, policymakers and public policy managers.

Internationally, few countries currently have policies addressing men’s health from a gender perspective. According to White et al.¹⁰, all bar one of the countries that do are from the Global South, understood as countries that share a history of colonization and social and economic inequalities.

Brazil is the only country in Latin America to have a national men’s health policy: the National Policy for Comprehensive Men’s Health Care (PNAISH), which celebrated its 15^th anniversary in 2024 – hence this commemorative and reflective supplement. Its overarching aim is:

[...] to improve the health of Brazil’s male population, effectively contributing to the reduction of morbidity and mortality among this population, by addressing risk factors and vulnerabilities, promoting access to comprehensive health care actions and services, respecting different expressions of masculinity¹¹.

It is worth noting that the creation of the PNAISH was influenced by academic studies of men and masculinities and by the political and social action of both governmental and non-governmental organizations, some of which adopted a feminist or pro-feminist position. This positive influence enabled the drafting of a policy whose general objective recognizes the relevance of the social determinants of health and the diversity made possible by the expression of masculinities¹².

The guidelines and specific objectives set out by the PNAISH provide the opportunity to develop a host of actions that are a source of tremendous socioepidemiological potential. These actions are not intended to oppose or compete with the health agendas of women, children, older people or any other part of life cycle, but rather enhance them, with a view to increasing the SUS’s capacity to deliver effective comprehensive health care to all population groups throughout all stages of the life cycle.

To gain a better understanding of the complexity of this challenge, it is essential to recognize that, just as our public health system cannot objectively fail to notice the disparity illustrated by a 40% higher cardiovascular disease mortality rate among men¹³, the greater involvement of men in violence (both as victims and perpetrators) – a serious public health problem in our country that includes gender-based violence – also needs to be observed and addressed within the SUS adopting an intersectoral approach.

Built around five “core components”, the first of which is “Access and Welcoming”, the PNAISH seeks to put men in contact with health services, professionals and information, with the aim of building a bond of trust that enables care for a population that accounts for only one quarter of all individual primary health care (PHC) appointments in the country (data from the Primary Care Health Information System - SISAB).

The 2nd core component, “Responsible Sexuality and Family Planning” – this terminology was introduced during Jair Bolsonaro’s ultra-conservative administration, even though the terms “sexual health”, “reproductive health” and “reproductive planning” are more appropriate and widely used in the field of public health¹⁴ – brings the need for men to engage in relevant issues such as deciding whether or not to have children (and the responsibility assumed as a result), prevention of sexually transmitted infections and other sensitive current issues to the center of the debate. Other issues include the indiscriminate use of medications and high levels of pornography consumption and its effects on male sexual practices.

The 3^rd core component, “Paternity and Care”, has been widely disseminated through the Partner Prenatal Strategy (EPNP) and respective procedure, which has gained scale both due to the array of dissemination initiatives and its prominence on the agenda of primary care professionals. It constitutes yet another strategy for promoting access and individual health care for all men, as well as for raising awareness of and training in maternal, child and collective care in general. This component also encompasses important labor issues, such as extending paternity leave and guaranteeing the acceptance of attendance certificates for fathers who accompany their children to health services.

The 4th core component, “Prevalent Diseases in the Male Population”, which were mentioned in the example above, uses disease prevention and health promotion strategies to raise awareness of the importance of healthy habits and longitudinal care in reducing morbidity and mortality from primary care sensitive conditions and other health problems that benefit from timely health care seeking behavior.

Finally, the 5^th core component, “Prevention of Violence and Accidents”, proposes the mobilization of various sectors of society and health professionals and managers to address this problem, which disproportionately affects the male population. This component emphasizes gender-based violence, with major efforts being expended by the current federal government to prevent this problem.

When it comes to access and welcoming, which cuts across the other components, PHC is the backbone of the PNAISH, acting as a unique point of entry to the SUS with the capacity to establish a continuous link with the male population, promoting easy access and welcoming in an environment that overcomes significant cultural and social barriers.

Primary health care is uniquely positioned to recognize men’s specific needs, increasing adherence to preventive and therapeutic care, developing educational and preventive actions to promote healthy lifestyles, and coordinating comprehensive care across all levels. In addition, PHC has the potential to establish a strong bond of trust between health professionals and patients, encouraging men to actively participate in their health care.

However, a decade and a half after the launch of the policy, challenges in implementing, strengthening and achieving the objectives of the PNAISH in the political and organizational context of the SUS persist, as shown by various works in this supplement¹⁴. Actions that address men’s health remain limited, especially in PHC services, and need to be prioritized on the public health policy agenda^15,16.

Key obstacles include the normalization of stereotypes of masculinity, such as the denial of vulnerability and resistance to seeking care; inequalities in access to health care, evidenced by the low demand for unscheduled consultations among men, especially in PHC services; the institutional fragility of the PNAISH, marked by the shortage of human and financial resources, especially in states and municipalities; and difficulties reaching vulnerable male groups^14,17.

Strategies for training professionals to deal with the specificities of men’s health remain limited and clinical protocols and welcoming strategies targeting this group are scarce¹⁷.

To maximize the impact of PHC on men’s health and ensure that the policy achieves its objectives in a comprehensive and equitable manner, it is important to develop a strategic plan for the implementation of PNAISH guidelines, tailoring actions to local needs, training professionals in the five core components and adopting an intersectional approach. The latter involves the promotion of spaces for training, public participation and intersectoral discussions around masculinities and access to men’s health care to create a more democratic SUS and contribute to the development of strategies that are more sensitive to individual singularities.

Intersectoral coordination across the education, social welfare and labor sectors, as well as the mobilization of communities benefitted by PHC, ensures that actions are aligned with the demands, needs and expectations of the male population. In addition, the use of indicators to monitor the development of health actions so that they can serve as a driving force for change is an important initiative to support the planning and management of workers and managers interested in implementing men’s health actions in the territories.

Furthermore, while PHC services already have specific, albeit limited, funding, and can therefore develop men’s health actions, it is essential to allocate additional funding to strengthen the management of the PNAISH at state and municipal level. This investment could help improve the quality of both management and care in the territories, enabling managers, professionals and patients to increase the adoption of more inclusive, welcoming and effective men’s health care practices and helping to overcome major cultural and institutional barriers still present in health services.

It is necessary to persist in encouraging self-care and valuing new ways of living masculinity, deconstructing the taboos that still associate men’s health care with being “a lesser man”. Encouraging the recognition of emotions, breaking historically imposed silences and promoting active participation in health services is essential for men to take a leading role in ensuring their physical, mental and emotional well-being.

From this perspective, disseminating and raising awareness about the policy is essential. Promoting an informed debate on the PNAISH in management spaces, organized civil society and forums for public participation in the SUS is essential, not only to ensure effective implementation, but also to develop a well-grounded critique and constantly improve the policy.

The effective implementation of the PNAISH also catalyzes a process of health service reorganization, especially in PHC services, improving the quality of welcoming and the affiliation of men to multi-professional teams, thus achieving better overall health outcomes. The policy also promotes the formation of coordinated care networks with well-defined patient flows across different levels of care, favoring the comprehensiveness and effectiveness of care delivered by the SUS.

The PNAISH is therefore a strategic policy that not only improves men’s health but strengthens the foundations of the SUS. The widespread dissemination, implementation and constant evaluation of the policy are therefore essential if the system is to make progress towards increasingly inclusive and equitable care committed to the rights of the entire population of Brazil.

This supplement therefore constitutes a significant milestone in valuing and increasing the depth and breadth of the investigation of men’s health in Brazil, especially as it celebrates the 15th anniversary of the PNAISH. By bringing together twenty articles (carefully selected from the 118 abstracts received by the Journal) reviewed by experts (who sought to prioritize qualitative studies and ensure a regionally representative distribution and thematic diversity), this publication not only recognizes the growing importance of this topic but also offers robust evidence for the circulation of up-to-date, critical knowledge that is committed to transforming men’s health care practices.

Broadly speaking, it can be said that the articles address three dimensions of the PNAISH. The first refers to the social constructions of masculinity and their effect on men’s health, with the articles showing how traditional models of masculinity continue to strongly influence the way men perceive and experience their health. These constructions have a particular impact in the field of mental health, on preventive care and on parenting practices, constituting obstacles to accessing health care and permanence in health services.

The second dimension groups together studies that address care strategies and actions aimed specifically at men, with an emphasis on the role of PHC. The articles outline successful experiences such as conversation circles, reflective groups, thematic workshops and territorialized approaches, which promote spaces for listening, welcoming and deconstructing gender paradigms. These devices prove to be fundamental in strengthening men’s affiliation with services and promoting changes in the way they relate to their own bodies, emotions and daily care.

Finally, the third dimension encompasses the implementation of the PNAISH and the institutional and intersectoral challenges faced. The articles highlight funding shortages, weakness in professional training strategies and the need to improve coordination with other health policies, including cross-cutting issues such as race, class, sexuality and gender identity. They also point to possible ways of strengthening the PNAISH, based on evidence from innovative practices tailored to the specific needs of men.

More than a commemorative issue, this publication represents a joint effort by the Office for the Coordination of Men’s Health Care (part of the Department of Comprehensive Health Care Management of the Ministry of Health’s Primary Health Care Secretariat - COSAH/DGCI/SAPS/MS) and researchers and experts in the field of men’s health to broaden the debate, help shape public policies that are sensitive to the specific health needs of men and promote equity of access to care for this population.

We therefore invite researchers, health professionals, policy makers and managers, and members of civil society to explore the articles in this supplement, recognizing their important contribution to strengthening the SUS as a whole and PNAISH in particular technically and scientifically and to advancing the national health promotion agenda, which critically and transformatively considers the ways of being, living and caring of the male population in Brazil.

• Brandão CC, Salerno AAP, Medrado B, Barros EAS, Albuquerque FP, Fernandes Filho HP, Lyra J, Magalhães RS, Pinto TR, Figueiredo WS. National Policy for Comprehensive Men's Health Care: 15 years of important advances and persistent challenges. Interface (Botucatu). 2025; 29 (Supl. 1): e250311 https://doi.org/10.1590/interface.250311

References

• ¹ Castro MC, Massuda A, Almeida G, Menezes-Filho NA, Andrade MV, Souza NKVM, et al. Brazil’s unified health system: the first 30 years and prospects for the future. Lancet. 2019; 393(10195):1231-40.
• ² Paim J, Travassos C, Almeida C, Bahia L, Macinko J. O sistema de saúde brasileiro: história, avanços e desafios. Lancet. 2011; 377(11):11-31.
• ³ Galvão ALM, Oliveira E, Germani ACCG, Luiz OC. Determinantes estruturais da saúde, raça, gênero e classe social: uma revisão de escopo. Saude Soc. 2021; 30(2):e200743.
• ⁴ Scott JW. Gender: a useful category of historical analysis. Am Hist Rev. 1986; 91(5):1053-75.
• ⁵ Couto MT. Gênero, masculinidades e saúde [tese]. São Paulo: Universidade de São Paulo; 2016.
• ⁶ Medrado B, Lyra J. O gênero dos/nos homens: linhas de uma proto-genealogia. Cienc Saude Colet. 2012; 17(10):2579-81.
• ⁷ Connel R, Messerschmidt JW. Masculinidade hegemônica: repensando o conceito. Rev Estud Fem. 2013; 21(1):241-82.
• ⁸ Rosostolato B. O homem cansado: uma breve leitura das masculinidades hegemônicas e a decadência patriarcal. Rev Bras Sex Humana. 2018; 29(1):57-70.
• ⁹ Couto MT, Dantas SMV. Gênero, masculinidades e saúde em revista: a produção da área na revista Saúde e Sociedade. Saude Soc. 2016; 25(4):857-68.
• ¹⁰ White A, Connel R, Griffith DM, Baker P. Defining “Men’s Health”: towards a more inclusive definition. Int J Men's Soc Community Health. 2023; 6(1):e1-e9.
• ¹¹ Brasil. Ministério da Saúde. Portaria nº 3.562, de 12 de Dezembro de 2021. Altera o Anexo XII da Portaria de Consolidação GM/MS nº 2, de 28 de Setembro de 2017, para dispor sobre a Política Nacional de Atenção Integral à Saúde do Homem (PNAISH). Diário Oficial da União. 15 dez 2021; Sec. 1.
• ¹² Medrado B, Lyra J. Por uma matriz feminista de gênero para os estudos sobre homens e masculinidades. Rev Estud Feministas. 2008; 16(3):809-40.
• ¹³ Brasil. Ministério da Saúde. Vigitel Brasil 2020: vigilância de fatores de risco e proteção para doenças crônicas por inquérito telefônico. Brasília: Ministério da Saúde; 2021.
• ¹⁴ Brandão CC, Albuquerque FP, Takarabe JM, Soares IMSC, Salerno AAP, Celio CP, et al. Gestão federal da Política Nacional de Atenção Integral à Saúde do Homem: uma perspectiva histórico-crítica. Interface (Botucatu). 2025; 29:e240378. doi: 10.1590/interface.240378.
  » https://doi.org/10.1590/interface.240378
• ¹⁵ Mozer IT, Corrêa ACP. Gestão do processo de implementação da política de saúde do homem. Rev Enferm. 2016; 24(1):e9483.
• ¹⁶ Scussel MRR, Machado DM. Política nacional de assistência integral à saúde do homem: uma revisão integrativa. Rev Fam Ciclos Vida Saude Contexto Soc. 2017; 5(2):235-44.
• ¹⁷ Rocha FCS, Martins ERC, Spindola T, Costa C, Alves RN, Moraes PC. Acolhimento da população masculina sob a percepção dos profissionais de enfermagem: desconstrução da invisibilidade. Res Soc Develop. 2020; 9(12):e6791210708.

Edited by

• Editor
  Antonio Pithon Cyrino

• Associated editor
  Manoela Carvalho

Publication Dates

• Publication in this collection
  16 June 2025
• Date of issue
  2025

History

• Received
  28 Apr 2025
• Accepted
  05 May 2025