Men’s Health Policy Information Paper Executive Summary
Social Determinants of Health
A variety of factors influence people’s health, including genetics, conditioning and personal behavioural choices, however, a growing body of evidence shows that health and illness are, to a large extent, influenced by our environment or context.
Environmental factors in the human environment include the cultural, political, economic, psychological and spiritual contexts of our lives. These factors are known as the social determinants of health.
Social determinants of health for consideration could include:
Health behaviours: It is important to consider context in producing health behaviours. Encouraging individuals to eat more fresh vegetables and fruits will be unsuccessful in remote environments where these are not readily available and costs are prohibitive.
Socioeconomic characteristics: It has been estimated that socioeconomic disadvantage has contributed to 19% of the mortality burden for men.2 There is strong evidence that associates low socioeconomic status with poor health and increased exposure to health risk factors. For example, in 2004–05, Indigenous people with low levels of educational attainment were more likely than those who had completed Year 12 to regularly smoke, to consume alcohol at risky/ high risk levels, and to engage in low levels of exercise, and were less likely to eat fruit or vegetables on a daily basis.3
Broad features of society: Broad features of society, such as policies and decision making authorities, impact on socioeconomic circumstances and physical environments which, in turn, influence people’s health behaviours, their psychological or mental states and factors relating to safety. All of these contributors may then influence biomedical factors, producing further health effects.
Employment: Employment is a central consideration for most men for most of their lives. Un/under-employment and educational achievements are closely correlated. Boys who do not complete, or who underachieve at secondary or tertiary based training, are more likely to be un/under-employed. The lower wages and un/under-employment related to inferior formal qualifications results in lower socioeconomic status (SES). This lower SES is universally associated with poorer health outcomes across the life span.
Social integration: Social integration, the comfortable insertion of a person within society, together with social inclusion, and social support feature prominently in the growing research of the social determinants of health.4 It is frequently pointed out that men’s supportive networks are less extensive than women’s, leaving men more at risk of depression.
Education: Education is a key determinant of health as it provides individuals with the skills and knowledge that can be used to improve their health and access appropriate services. Only 71% of young men remained in education until year 12 in 2004, this was even less for Indigenous young people (40%).5 Forty-two per cent of Indigenous people remain in the lowest quintile of incomes.6
Health service use: The existence of services does not mean that they are being used well, or by those who can substantially benefit. Data shows that men generally use the bulk of health services at a lower rate than women. A general practice survey of Australian men found that around one in four had not visited a GP in the last 12 months, compared with one in ten females.7
Traditional studies on men’s health care access has relied on the assumption that men under utilise the health system due to beliefs around masculinity. However, linking men’s cultural identity to patterns of service use is misleading. Services that have targeted men and adopted a ‘man friendly’ profile have proved popular. Mensline, for example, the Australian telephone counselling service, receives 80,000 phone calls each year, mainly from men, including many from rural areas.
The use of health care services by Australian men could be influenced by a number of other factors including individual health care status, differing levels of service provision and/or barriers to access, such as services not being available in some areas, lack of transport, the cost of health care, language and cultural barriers, or services not being open at times where men can readily use them, e.g. in the evenings or on weekends.
Health expenditure: Current health system expenditure for men is 17% lower per person than for women ($2,377 vs $2,781), however approximately 7% of this difference was in relation to maternal conditions and the remaining difference largely reflects that fact that there are more women than men in the older age groups where expenditure is highest.8
2 AIHW, 2008. Australia’s Health 2008, Cat.no.AUS 99, p.154
3 AIHW, 2008, The Health and Welfare of Australia’s Aboriginal and Torres Strait Islander Peoples, 2008, Canberra, Cat No. 1704.0
4 Berkman and Kawachi 2000
5 AIHW, 2008. Australia’s Health 2008, Cat.no. AUS 99, p. 154
6 Griew, R, Tilton, E, Cox, N with Thomas, D, 2008, ‘The link between primary health care and health outcomes for Aboriginal and Torres Strait Islander Australians’, unpublished.
7 Malcher G, Men’s Health, GPs and GP’s4Men, Australian Family physician, Vol 34, No ½, Jan/Feb 2005
8 AIHW, 2008, Australia’s Health 2008, Cat. no. AUS 99, Canberra