National Men's Health

Developing a Men’s Health Policy for Australia: Setting the scene

This paper outlines why the Government is developing a National Men’s Health Policy, what the Government wants the Policy to achieve, and gives information on the consultation process and how you can have your say.

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The Commonwealth Government has made a commitment to develop a National Men’s Health Policy to ensure that the planning and delivery of health services better meet the needs of Australian men. This paper outlines why the Government is developing a National Men’s Health Policy, what the Government wants the Policy to achieve, and gives information on the consultation process and how you can have your say.

What is this paper about?
What will the policy cover?
Will the government develop a women’s policy, too?
What is the international context?
Has Australia had a men’s health policy before?
Why has the government committed to a men’s health policy?
Men at different ages across the lifecourse
Groups with special needs
What might the policy look like?
Want to know more and have your say?

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What is this paper about?

The Government is undertaking consultations to develop the National Men’s Health Policy with consumers, the community, health service providers, and state and territory governments. This is to make sure the Policy meets the varied needs of Australian men—in the cities, in the country, across their lifespan.

This paper provides an outline of some of the health issues impacting on men, and ideas for possible ways forward, and is the first stage in the consultation process. Your comments and feedback are invited, and will form an important part in moving to the next stages of consultation and policy development

What will the policy cover?

The Policy will have a particular focus on reducing barriers that men experience in accessing health services, tackling widespread reticence amongst men to seek treatment, improving male-friendly health services and raising awareness of the range of preventable health problems that disproportionately affect men and which result in generally poorer health outcomes for Australian men. The Policy will also address men’s sexual and reproductive health issues.

The Policy will address the needs of groups of men who experience poor health outcomes, in particular Aboriginal and Torres Strait Islander men and men living in rural and remote areas.

What does the government want to see from the policy?
The Government wants to improve the health of Australian men throughout their lives by making sure that the health system is responsive to their needs and supports men in taking more care of their own health.

Will the government develop a women’s policy, too?

The Government has also announced that it will develop a National Women’s Health Policy. The men’s Policy and the women’s Policy will be based on similar principles, but will be gender specific and recognise the different health outcomes and needs of men and women.

The Policies will be complementary. They will be about making sure that the health system is responsive so men and women can access health services and health information that is appropriate to their individual needs. The two Policies will be based on the principle that gender is a key determinant of health, and that the experience of being male or female in our society affects our health and how we manage it. Each Policy will incorporate a gender specific action plan identifying practical activities to improve health outcomes across people’s life span.

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What is the international context?

In 2002 the World Health Organization (WHO) released the Madrid Statement which recognised the importance of gender equity. In part it says:
‘to achieve the highest standard of health, health policies have to recognize that women and men, owing to their biological differences and their gender roles, have different needs, obstacles and opportunities.’

Consistent with this, the Government’s approach to developing the Men’s Health Policy is that it will be based on a principle of gender equity. To achieve gender equity in health, both men and women need health policies that target their specific or unique needs.

Has Australia had a men’s health policy before?

This will be the first time that Australia will have a National Men’s Health Policy. A draft policy was developed in 1996 by the Labor Government. The new National Men’s Health Policy will build on the principles in the 1996 draft policy which were developed after consultation across Australia.

The guiding principles of the 1996 draft policy were that it should be based on a social view of health which recognised that health is affected by social circumstances, including gender; that it should be developed with broad consultation which included state and territory governments; that it should be evidence based; and that it should meet the needs of men at different stages of their lives.

Why has the government committed to a men’s health policy?

While life expectancy for men is increasing and death rates for almost all causes have decreased dramatically across age groups, many of the risk factors which cause chronic illnesses remain high amongst men. These risk factors include tobacco smoking, physical inactivity, poor diet and alcohol misuse. The prevalence of overweight and obesity has increased markedly over the last two decades.¹

• Life expectancy at birth for men is 78.7 years and women 83.5 years. Over the past 20 years life expectancy has improved by 5.8 years for males and 4.3 years for females.²

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• The leading causes of death where males make up the highest proportion are:
  • Prostate cancer (100%)
  • Tumours of the male genital organs (100%)
  • HIV disease (93.2%)
  • Hanging, strangulation and suffocation (82.9%)
  • Intentional self-harm (78.9%)
  • Accidental drowning and submersion (76.6%)
  • Transport accidents (74.7%)
  • Bladder cancers (72.2%)
  • Cancer of the oesophagus (69.0%)
  • Melanoma of skin (67.7%)

Males are also over represented in deaths for lung cancer, emphysema and liver diseases.³

• The burden of disease describes the overall impact of diseases and injuries to the individual and society. Causes that make a greater contribution to the burden of disease amongst males than females include:
  • Lung cancer
  • Adult onset hearing loss
  • Suicide and self inflicted injury
  • Prostate cancer
  • Road traffic accidents
  • Alcohol abuse
  • Melanoma

Males also experience 70 per cent of the burden of disease for injuries including 78 per cent of the burden for suicide, 73 per cent for road accidents and 71 per cent for homicides and violence.⁴

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Men at different ages across the lifecourse

Risk factors and health issues for boys and men are often different to those for girls and women; they also change across the lifecourse.
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Boys aged 0– 14 years

Boys have a higher risk of injury than girls at every age after infancy. Boys 6 –14 years are diagnosed with significantly higher rates of ADHD and conduct disorders than girls of the same age.⁵

Young males aged 15 – 24 years

Transport accidents and suicide are leading causes of death in young males. While suicide in young males has declined, the death rate remains almost three times higher than for females. Alcohol and illicit drug use are also major contributors to the burden of disease in this age group. With increasingly early ages of first sexual encounters, sexual health issues affecting this age group include contraception, sexually transmitted infections and sexual identity and gender diversity.⁶

Working age males aged 25 – 64 years

Some of the leading causes of death and morbidity in men of working age can be linked in part to behavioural risk factors such as excessive drinking, smoking, risky driving and risky leisure activities, eating less healthily and making less use of medical services. Heart disease, work related accidents, and circulatory diseases affect significantly more men than women in this age group.

Sexual health is an important issue for this age group, with one in five men over the age of forty experiencing erectile dysfunction.⁷

Older males aged 64 and over

High proportions of male deaths in this age group are from heart disease, respiratory disease and lung cancer. Prostate cancer is also significantly more prevalent in older men. While suicide rates for women are lowest in this age groups, suicide rates for men increase.⁸

Groups with special needs

Particular population groups experience greater health problems across all age groups because of where they live or their backgrounds. These include men from rural and remote areas, Aboriginal and Torres Strait Islander men and men from disadvantaged backgrounds.

Other groups of men also experience a higher proportion of health problems and differential health outcomes due to social, cultural or biological reasons.
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Aboriginal and Torres Strait Islander men

The health of Aboriginal and Torres Strait Islander men is worse than any other subgroup in Australia. Life expectancy of Aboriginal and Torres Straight Islander men is estimated at approximately 17 years less than average life expectancy for all Australian men (59 years and 76 years respectively for the period 1996-2001).⁹ There is also a 6 year gap in life expectancy between Indigenous men (59 years) and Indigenous women (65 years).

The Australian Government has committed to closing the gap in life expectancy within a generation for Indigenous Australians, and halving the gap in mortality rates for Indigenous children under 5 years within a decade. The National Men’s Health Policy will have a special focus on Aboriginal and Torres Strait Islander men’s health and well-being.

Social and emotional wellbeing is a serious issue for Indigenous men. During the period 2000-04, using data available from Western Australia, South Australia, Queensland and the Northern Territory, the mortality rate for Aboriginal and Torres Strait Islander peoples from mental health conditions was 1.8 times higher than for other Australians (2.5 for males and 1.3 for females). Excess mortality was highest for the 35-54 years age-group.

Historically, Aboriginal and Torres Strait Islander men have had meaningful, active roles with authority and status. The kinship system ensured that men had clearly defined responsibilities and obligations, men were responsible for the management and maintenance of traditional obligations, sacred objects, spiritual matters, performance of rituals, providing leadership, educating the young, and were custodians of the law. Aboriginal and Torres Strait Islander men have been displaced, and do not have the confidence, opportunity or facilities available to help them improve their health status or position within their family or community.

During the period 2004-05, Indigenous men were more likely than Indigenous women to drink at long-term risky or high risk levels (19 per cent compared with 14 per cent). This was evident in all broad range age groups under 55 years. Excessive alcohol consumption also accounted for the greatest proportion of the burden of disease and injury for young Indigenous males aged 15-34 years. Alcohol was responsible for the greatest amount of burden among the 11 risk factors considered as part of the study on The burden of disease and injury in Aboriginal and Torres Strait Islander peoples (2003).
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During the period 2001 to 2005, from data available for Western Australia, South Australia, Queensland and the Northern Territory, some of the disparities between Indigenous males and Indigenous females in the 35-54 age group were that:

• Indigenous males died from intentional self harm at 4.7 times the rate as Indigenous women;

• Indigenous men died from ischaemic heart disease at 2.6 times the rate Indigenous women; and

• The death rate for Indigenous males was more than twice the death rate for Indigenous women for other selected forms of heart disease, malignant neoplasm of the digestive organs, transport accident, psychoactive substance abuse and assault.

Indigenous men’s health has not shown the same improvements as Indigenous women’s health. Between 2001 and 2005 in the Northern Territory, there was significant decline in recorded mortality rates for Indigenous females only. Over the period, there was an average yearly decline in recorded deaths of around 20 deaths per 100,000 population for Indigenous females—this is equivalent to a reduction in the death rate of around 15 per cent. Mortality rates for Indigenous males did not show the same improvements as Indigenous women in the Northern Territory.

Men in rural and remote areas

Certain groups of men face specific risks. Men in rural regions often have limited access to health services, recreational and support facilities. Suicide rates among male farm owners and managers are around twice the rate of the national average.¹⁰ Work for rural men is often physically demanding and potentially hazardous, particularly as they often work in isolated areas or on their own.

Cultural factors and beliefs also contribute to differences such as rural men who are overweight believing that being a ‘big bloke’ is an advantage and sign of strength.¹¹

Social, cultural and other factors

Male socialisation and masculinity, social connectedness and work-life balance significantly impact on health. Prevailing images of masculinity, such as risk taking and engaging in physically demanding and onerous work often under unacceptable health and safety standards, can influence behaviour and impact on health outcomes.

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What might the policy look like?

It is proposed that the National Men’s Health Policy be built around four foundation principles:

1. Gender equity.
2. A focus on prevention.
3. A strong and emerging evidence base.
4. An action plan to address need across the life course.

Gender equity

Internationally, gender issues are being specifically taken into account, and incorporated in health policies.¹² This is supported by the WHO 2002 “Madrid Statement”¹³. Gender equity means that men and women are given equal opportunity to realise their health, and that gender is also a determinant of health.¹⁵

A gender equity approach to health implies removing the unfair and unnecessary health inequities that exist as a result of what it is to be a male or a female in society. A gender equity approach recognises the different challenges that face men and women in managing their health, including their different health requirements and the different barriers they face in access to services.

A focus on prevention

The Policy will have a prevention focus with action plans to address behavioural risk factors. It will incorporate as appropriate other conceptual frameworks such as bio-medical, social determinants of health, health inequalities, health risk, settings and social learning and the other supportive Government strategies such as the National Chronic Disease Strategy.

Evidence base

A lot is known about men’s health, including which groups are most disadvantaged and how men access health services. However, there are gaps in the knowledge, especially around how men can best address their personal risk factors and make changes to their health. The Policy needs to build on the knowledge that already exists and identify areas where more information is needed.

A focus across the life course

A life course approach explores the distinctive series of roles and experiences that an individual progresses through from birth to death.¹⁶ A lifecourse approach contextualises key developmental and transition points in people’s lives, and the pathways between the different life phases. It also recognises the cumulative effects, both positive and negative, of experiences over time. This approach incorporates sexual and reproductive health.

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Want to know more and have your say?

The consultation process for the Men’s Health Policy is commencing now. A staged approach is planned, with opportunities for feedback and comments along the way.

Consultations will include Aboriginal and Torres Strait Islander men, and other men with poorer health compared to the rest of the population.

An Expert Advisory Group is being set up under the Australian Population Health Development Principal Committee and will guide the development process. The Australian Population Health Development Principal Committee is a subcommittee of the Australian Health Ministers’ Advisory Council. The Expert Advisory Group will have representatives from each state and territory.

The consultation process will formally start with a forum in Canberra, to which men’s health stakeholders will be invited. A draft Men’s Health Policy will be developed following this. There will then be opportunity for feedback to ensure it addresses the areas that are important to men’s health, where there is evidence that national action can make a difference (or emerging evidence) and to make sure it is relevant to those men with the poorest health, such as Aboriginal and Torres Strait Islander men, or men who are socially disadvantaged.

Consultation will then take place in each state and territory prior to finalisation. There will also be opportunities for men at the local level to get together and talk and provide feedback if they would like to. The Government is keen to ensure that everyone can have a say and that the Policy is a practical way of meeting men’s health needs, wherever they live.

The National Men’s Health Policy is expected to be finalised in 2009.

Information about development of the policy, including this paper, is available on the Department of Health and Ageing’s website. This website will be updated with new information and papers as the consultation progresses.

The web address is: www.health.gov.au/menshealthpolicy
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If you want to provide any feedback or comments log onto the website for details about how to do this.

Footnote

1. Australian Institute of Health and Welfare, 2006. Australia’s health 2006, AIHW cat. no. AUS 73
2. Australian Bureau of Statistics, Cat 3302.0 – Deaths, Australia, 2006, released 9.11.2007
3. Australian Bureau of Statistics, Cat 3303.0 – Causes of Death, Australia, 2006, released 14.3.2008
4. Begg S, Vos T, Barker B, Stevenson C, Stanley L, Lopez AD, 2007. The burden of disease and injury in Australia 2003. Canberra: Australian Institute of Health and Welfare.
5. Australian Institute of Health and Welfare 2005. A picture of Australia’s children. Canberra.
6. Australian Institute of Health and Welfare 2007. Young Australians: their health and wellbeing 2007. Canberra.
7. Australian Bureau of Statistics, Cat 3303.0 – Causes of Death, Australia, 2006, released 14.3.2008 Australian Safety and Compensation Council, Compendium of Workers Compensation Statistics 2004 to 2005. Available online at www.ascc.gov.au. Holden CA, McLachlan RI, Pitts M, Cumming R, Wittert G, Agius P, Handelsman DJ and de Kretser DM. Men in Australia, Telephone Survey (MATeS) I:
   A National Survey of the Reproductive Health And Concerns Of Middle Aged and Older Australian Men. Lancet 2005; 366: 218-24
8. Australian Bureau of Statistics, Cat 3303.0 -Causes of Death, Australia, 2006, released 14.3.2008 Australian Bureaus of Statistics, Cat. 3309.0 – Suicides 1994-2004, released 14.3.2006
9. Australian Bureau of Statistics, Cat 3303.0 – Causes of Death, Australia, 2006, released 14.3.2008
10. Australian Centre for Agricultural Health and Safety, NSW Farmer’s blueprint for maintaining the mental health and wellbeing of the people on NSW farms, Available at http://www.beyondblue.org.au/index.aspx?link_id=59.566&tmp=FileDownload&fid=365 [accessed 8 November 2007]
11. O’Kane G, Craig P, Sutherland D 2008 Riverina men’s study: An exploration of rural men’s attitudes to health and body image. Nutrition & Dietetics 2008; 65: 66-71.
12. Banks, I. 2004. ‘New models for providing men with health care’ in The Journal of Men’s Health and Gender, Vol 1 (2-3), p 155-158.
13. World Health Organization Mainstreaming Gender Equity in Health: the need to move forward- The ‘Madrid Statement’ in Banks, I. 2004. ‘New models for providing men with health care’ in The Journal of Men’s Health and Gender, Vol 1 (2-3), p 155-158.
14. Doyal, L., Payne, S. and Cameron, A. 2003. Promoting gender equality in health, University of Bristol, pg 40.
15. Doyal, L., Payne, S. and Cameron, A. 2003. Promoting gender equality in health, University of Bristol.
16. Hankivsky O, 2007 ‘More Than Age and Biology: Overhauling Lifespan Approaches to Women’s Health’ in Morrow M, Hankivsky O & Varcoe, C (Eds), 2007 Women’s Health in Canada, Critical Perspectives on Theory and Policy, University of Toronto Press, Toronto.