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BARRIERS TO THE IMPLEMENTATION OF THE NATIONAL POLICY FOR
COMPREHENSIVE MEN’S HEALTH CARE: UPDATED PERSPECTIVES
ON MASCULINITIES, TECHNOLOGIES, AND EPIDEMIOLOGICAL
CHALLENGES
Luis Fernando do Nascimento1
Abstract: The National Policy for Comprehensive Men’s Health Care (PNAISH), implemented in
2009, represents an important milestone in Brazilian public health. However, more than a decade
after its launch, signicant barriers persist that compromise its effectiveness. This article presents an
integrative literature review that analyzes the sociocultural, institutional, and epidemiological factors
that hinder the implementation of PNAISH, incorporating updated perspectives on masculinities,
technological innovations, and epidemiological data from the period 2023-2025. The research identied
that hegemonic masculinity continues to be a central obstacle, now understood in light of concepts
such as toxic masculinity and its implications for mental health. Additionally, it was observed that
emerging technologies such as telemedicine and articial intelligence have signicant potential to
transform access to men’s health, although their implementation is still limited. It is concluded that the
effective implementation of the National Policy for Comprehensive Men’s Health (PNAISH) requires
a multifaceted approach that integrates the deconstruction of gender stereotypes, the strengthening of
primary care, the incorporation of technological innovations, and an intersectional perspective.
Keywords: men’s health; health policies; masculinities; health technologies; primary care.
1 Bachelor’s degree in Nursing, Postgraduate degree in Occupational Safety
INTRODUCTION
Men’s health in Brazil emerged as a formal concern of the health system with the creation
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of the National Policy for Comprehensive Men’s Health Care (PNAISH) in 2008, ofcially launched
on August 27, 2009 by Ordinance No. 1,944 (Ministry of Health, 2008). This policy was developed
in response to a worrying epidemiological scenario, in which men presented signicantly higher
morbidity and mortality rates when compared to women, especially from preventable causes (Leite
et al., 2010).
The need for a specic policy for men emerged from an important observation: most health
services, especially primary care, were almost exclusively focused on women, children, and the
elderly, leaving the male population in a vulnerable situation (Ministry of Health, 2008).
The National Policy for Comprehensive Men’s Health Care (PNAISH) was designed with the
objective of “promoting the improvement of the health conditions of the male population of Brazil,
contributing effectively to the reduction of morbidity and mortality in this population, through the
rational confrontation of risk factors” (Ministry of Health, 2008, p. 31).
Brazil has established itself as the only country in Latin America with a specic health
policy for men, an important recognition that men’s health requires differentiated attention and
tailored strategies. However, more than a decade after its implementation, studies indicate that the
National Policy for Comprehensive Men’s Health (PNAISH) still faces signicant challenges in its
operationalization (Medrado et al., 2025).
Recent data from 2025 reveal a paradoxical scenario: although Primary Health Care (PHC)
recorded 106 million visits to men up to September 2025, there is still a great lack of awareness
among the population about the existence of the National Policy for Comprehensive Men’s Health
Care (PNAISH). Additionally, experiences considered successful in involving men in health care
coexist with structural challenges related to administrative and nancial crises in the health system
and the impact of urban violence (Medrado et al., 2025).
In this context, this article proposes to revisit the barriers that compromise the effectiveness of
the PNAISH, incorporating updated perspectives on three fundamental dimensions: (1) sociocultural
barriers, now understood in light of contemporary concepts of hegemonic and toxic masculinities; (2)
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institutional barriers that persist in the health system; and (3) the opportunities presented by emerging
technological innovations of the last two years (2023-2025), such as telemedicine and articial
intelligence.
METHODOLOGY
This study constitutes an integrative literature review, following the methodological
assumptions described by Whittemore and Kna (2005). The integrative review is the broadest
methodological approach among reviews, as it allows the inclusion of experimental and non-
experimental studies for a complete understanding of the phenomenon analyzed, combining data
from theoretical and empirical literature.
Strategy Search
The research was conducted in electronic databases, including LILACS (Latin American and
Caribbean Literature in Health Sciences), SCIELO (Scientic Electronic Library Online), and Google
Scholar, with complementary searches in government portals and documents from the Ministry of
Health. The descriptors used were: “men’s health,” “national policy for comprehensive men’s health
care,” “masculinity,” “primary care,” “telemedicine for men’s health,” “articial intelligence for
prostate cancer diagnosis,” and “toxic masculinity.”
Criteria of Inclusion and Exclusion
Scientic articles, public policy documents, technical reports, and studies published between
2005 and 2025 were included, with priority given to publications from the last two years (2023-2025).
Studies that lacked thematic relevance or that exclusively addressed international contexts without
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applicability to the Brazilian scenario were excluded.
Analysis Data
The data were organized into thematic categories: (1) Sociocultural Barriers and Masculinities;
(2) Institutional Barriers; (3) Epidemiological Scenario; (4) Technological Innovations; and (5) Future
Perspectives.
RESULTS AND DISCUSSION
Barriers Sociocultural: Hegemonic and Toxic Masculinities
A large part of men’s non-adherence to comprehensive health care measures stems from
deeply rooted cultural variables. The hegemonic pattern of masculinity, historically constructed by
patriarchal culture, reinforces practices based on specic beliefs and values about what it means “to
be a man.” In this model, illness is often perceived as a sign of weakness that men do not recognize
as inherent to their own biological condition (Schraiber, Gomes, & Couto, 2005; Figueiredo, 2005).
In this social construct, men consider themselves invulnerable, strong, and virile,
characteristics that distance them from self-care and expose them more to risky situations. For them,
seeking health services represents signs of weakness, fear, anxiety, and insecurity, characteristics
incompatible with hegemonic masculinity and that would bring them closer to representations of
femininity (Gomes, Nascimento, & Araújo, 2007; Leite et al., 2010).
Recent studies (2024-2025) have deepened the understanding of this phenomenon through
the concept of “toxic masculinity.” As pointed out by Rocha (2025), hegemonic masculinity is a
socially constructed symbolic reference that structures the idealized identity of what it means to be a
man, representing a symbolic space that profoundly inuences health behaviors. Toxic masculinity,
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in turn, refers to the rigid and harmful expectations associated with the male role, which affect both
men themselves and society in general.
The consequences of toxic masculinity for men’s mental health are signicant. Studies from
2025 associate the rigidity of gender roles with higher rates of suicide, depression, and anxiety among
men (Her, 2025). The repression of affection, homophobia, excessive competition, and violence are
manifestations of this unhealthy culture. In this context, the deconstruction of these patterns and the
promotion of new, more plural and healthy ways of being a man become fundamental public health
strategies.
Associated with male invulnerability is the difculty men have in verbalizing what they feel.
Talking about health problems can be seen as a demonstration of weakness and feminization in front
of others. They also cultivate the “magical thinking” that they will never get sick (Figueiredo, 2005;
Gomes, Nascimento, & Araújo, 2007). Additionally, there is the fear that the doctor will discover
something serious, leading to denial: “what you look for, you nd,” and therefore, not seeking help
means not having a disease. The shame of exposing oneself to a healthcare professional, whether male
or female, also constitutes a signicant barrier.
Lack of time, coupled with the impossibility of leaving work activities, shame, and the fear
that revealing a health problem will result in job loss, constitutes another signicant obstacle. Work
also represents a factor that keeps men away from health services or compromises the continuity of
already established treatments (Schraiber, Gomes, & Couto, 2005; Costa-Júnior & Maia, 2009; Leite
et al., 2010).
Finally, most of the health promotion and prevention campaigns disseminated by the Ministry
of Health have historically been aimed at women, children, and the elderly. This has led men to believe
that primary health care units (PHCUs) are services primarily intended for these groups, generating
a feeling of not belonging to these spaces (Figueiredo, 2005; Gomes, Nascimento, & Araújo, 2007;
Couto et al., 2010).
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Barriers Institutional
Beyond sociocultural barriers, the implementation of the National Policy for Comprehensive
Men’s Health Care (PNAISH) faces signicant structural and institutional challenges. Recent studies
indicate that the integration of men’s health with elderly health, although well-intentioned, may result in
the invisibility of the specic men’s health agenda (Medrado et al., 2025). Additionally, administrative
and nancial crises in the health system, as well as the impact of urban violence, hinder access to and
continuity of care.
The need to incorporate an intersectional, intersectoral, and interinstitutional perspective
to operationalize the axes proposed by the National Policy for Comprehensive Men’s Health Care
(PNAISH) is widely recognized (Medrado et al., 2025). This implies considering the multiple identities
of men (race, class, sexual orientation, gender identity) and the interactions between different sectors
of society (education, work, security) in promoting men’s health.
Scenario Current Epidemiological Data
The male morbidity and mortality prole in Brazil remains worrying. Non-communicable
chronic diseases (NCDs) are the leading cause of death, with men presenting a signicantly higher
risk compared to women. In 2023, 56.1% of premature deaths (between 30 and 69 years of age)
due to NCDs occurred in the male population, while only 43.9% occurred in women (Public Health
Observatory Library, 2025).
Illnesses Cardiovascular
Cardiovascular diseases (CVDs) are the leading cause of death, accounting for approximately
30% of all deaths in Brazil. In 2022, 52.5% of CVD deaths were men (210,181 deaths) and 47.5%
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were women (189,946 deaths), with the majority of deaths occurring in the 65 years and older age
group (Public Health Observatory Library, 2024). High blood pressure, frequently underdiagnosed
in men, is one of the main risk factors. Sedentary men have up to a 70% higher risk of developing
cardiovascular problems compared to those who are active (CNN Brazil, 2025).
Cancer of the prostate
Prostate cancer is the most common type of cancer among Brazilian men. The National Cancer
Institute (INCA) estimates that Brazil will register approximately 72,000 new cases in the three-year
period 2023-2025 (ANS, 2025). Mortality from this disease has been consistently increasing: in 2024,
17,587 deaths were recorded, representing a 21% increase over the last decade (2015-2024), with an
average of 48 deaths per day (O Norte Online, 2025).
Despite the high incidence and mortality rates, early diagnosis offers an excellent prognosis.
Studies indicate that prostate cancer has a cure rate of over 90% when diagnosed in its early stages
(Grupo Luta pela Vida, 2025). This reinforces the critical importance of screening and awareness
campaigns, particularly during “Blue November”.
Behaviors Risk
Men exhibit a signicantly higher prevalence of health risk behaviors. Abusive alcohol
consumption is particularly concerning, with 63.04% of those who abuse alcohol being men in
2023 (Public Health Observatory Library, 2025). Additionally, sedentary lifestyles, inadequate diets
(predominantly high in fatty and ultra-processed foods), and lack of physical activity are modiable
risk factors that signicantly contribute to male morbidity and mortality.
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Health Sexual and Reproductive
Male sexual and reproductive health, historically shrouded in taboos, has gained greater
visibility in recent years. Erectile dysfunction (ED), for example, affects more than half of men over
40 and is increasingly understood not only as a sexual problem, but as an important warning sign for
systemic diseases such as cardiovascular disease and diabetes (O Globo, 2024).
The 82% increase in consultations for erectile dysfunction in the Brazilian public health
system (SUS) over the last six years indicates both a greater demand for help and a gradual breakdown
of the stigma associated with this problem (Estadão, 2025). This represents important progress,
although much remains to be done to normalize discussions about men’s sexual health.
In the eld of family planning, male participation remains incipient. The responsibility for
contraception falls mainly on women, and there is an urgent need for greater engagement of men
in discussions and decisions about reproductive health. The role of the urologist as an educator and
promoter of male reproductive health is fundamental to reversing this situation (Groner, 2025).
Sexually transmitted infections (STIs) are also a major concern. Campaigns for 2025 highlight
topics such as STI prevention, vaccination updates (especially HPV and hepatitis B), sexual health,
and reproductive planning as priorities on the men’s health agenda (Ministry of Health, 2025).
Innovations Technological and Transformative Potential (2023-2025)
The last two years have witnessed signicant technological advancements that present
considerable potential to transform access to and quality of men’s healthcare.
Telemedicine
Telemedicine has emerged as a powerful tool to overcome geographical and access barriers.
Data from 2024-2025 indicate that **87% of patients** opted for initial virtual consultations, and
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**93% use telemedicine** to manage their prescriptions (Instagram, 2025). The integration of
telemedicine with articial intelligence has become essential, particularly to expand access to care in
remote regions (Medicinasa, 2025).
Despite its potential, telemedicine is still a reality for only **10% of Brazilian municipalities**,
highlighting a signicant infrastructure gap that needs to be overcome (G1, 2025). The lack of
technological infrastructure and connectivity in less developed regions constitutes a major obstacle to
the universalization of this type of care.
Intelligence Articial
Articial Intelligence (AI) has shown promise, especially in the diagnosis of prostate cancer.
AI algorithms can analyze histopathological images and clinical data to identify tumors with greater
precision and speed, reducing processing time and improving early detection (OncoGuia, 2024). A
new AI system developed in 2024 uses clinical data and test results to identify cases of prostate cancer
that pose a signicant health risk (UNESP, 2024).
AI also has the potential to assist in risk stratication, allowing healthcare professionals to
identify men who are more likely to develop chronic diseases and implement personalized preventive
interventions.
DISCUSSION INTEGRATED
An integrated analysis of the presented data reveals a complex and multifaceted scenario.
On one hand, deep sociocultural barriers rooted in historical constructions of masculinity persist,
continuing to distance men from self-care. The contemporary understanding of these phenomena
through concepts such as hegemonic and toxic masculinity offers new perspectives for interventions
that seek to deconstruct these harmful patterns.
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On the other hand, the epidemiological scenario remains worrying, with high morbidity
and mortality rates from chronic diseases that could be prevented or better controlled through more
effective public health interventions. The consistent increase in mortality from prostate cancer, despite
its high curability when diagnosed early, illustrates the gap between available scientic knowledge
and its practical application.
Simultaneously, the technological innovations of the last two years open up promising
possibilities.
Telemedicine and AI present signicant potential to overcome some of the traditional
barriers to accessing healthcare. However, the uneven implementation of these technologies (with
telemedicine available in only 10% of municipalities) threatens to deepen existing inequalities in
access to healthcare.
The implementation of the PNAISH, therefore, requires a truly multifaceted approach that
integrates: (1) strategies for deconstructing gender stereotypes and promoting new masculinities; (2)
strengthening primary care as the gateway to the system; (3) strategic incorporation of technological
innovations with attention to inequalities in access; (4) an intersectional perspective that considers the
multiple identities of men; and (5) intersectoral actions involving education, work, and security.
CONCLUSION
More than a decade after the launch of the National Policy for Comprehensive Men’s Health
Care, Brazil continues to face signicant challenges in its implementation. Sociocultural barriers,
deeply rooted in historical constructions of masculinity, persist as central obstacles. The contemporary
understanding of these phenomena through concepts such as hegemonic and toxic masculinity,
and their impacts on men’s mental and physical health, offers new perspectives for more effective
interventions.
The epidemiological scenario remains worrying, with men presenting signicantly higher
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morbidity and mortality rates than women, particularly from preventable chronic diseases. However,
the last two years have witnessed promising technological advances that show considerable potential
to transform access to men’s healthcare.
The effective implementation of the National Policy for Comprehensive Men’s Health
(PNAISH) therefore requires an integrated approach that combines the incorporation of technological
innovations with the continuity of actions to deconstruct gender stereotypes, the strengthening of
primary care, the adoption of intersectional perspectives, and the development of intersectoral policies.
Only through a multifaceted and coordinated approach will it be possible to transform the current
scenario and ensure that all Brazilian men have access to comprehensive, equitable, and quality health
care.
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