Dying to be noticed

"What are we to say about a group whose risk of dying from heart disease is increased by a factor of 2, whose risk of dying from chronic respiratory disease is increased by a factor of 3, from cirrhosis of the liver and alcoholism 3 to 5, suicide almost 4 and for almost all causes of death a ratio of 1.7. Well it happens I am not referring to the Aboriginal population. These are the ratios of male to female mortality in Queensland."

Ian Ring, Director,
Epidemiology and Health
Information Branch,
Queensland Health.

The facts about the appalling state of men's health have been well known for many years, but until now, governments have been remarkably uninterested in addressing the issue. Finding that any social grouping has significantly below-average health usually rings alarm bells. Why has men's health been overlooked?

Richard Fletcher, lecturer in Health Studies at University of Newcastle, says that government health planning "makes a distinction between mathematical inequality, which is adding up numbers, and inequity, which is to do with justice. Because groups like women's groups, Aboriginal groups and ethnic groups have made strong claims that they are being discriminated against, their figures are seen in the area of equity, whereas men haven't been jumping up and down saying they're being discriminated against, so their figures are seen as just a mathematical inequality."

The Australian Men's Health Conference held in Melbourne in August was an important step towards acknowledging that men's health is not just a mathematical problem, but a serious social issue.

Their own fault?

In her press release announcing the conference, Health Minister Carmen Lawrence said "This conference will identify ways of targeting health promotion strategies to persuade men to take better care of their health and well-being". The suggestion that the poor state of men's health is their own fault was just below the surface of most of the promotion of the conference, and was also reflected in the topics selected for discussion.

Several papers were devoted to the self-destructive behaviours of men, such as drinking, dangerous driving and not seeking medical care. As Carmen Lawrence said, the conference focused "on the behavioural issues that are having negative impacts on men's health". While it's true that men don't look after themselves well, the societal pressures that lead men to behave like this were not high on the conference agenda.

This attitude would never have been applied to a conference devoted to health problems of women, or aborigines, or any other "disadvantaged" group. If we look at the problem of girls smoking, we don't say that the girls choose to smoke, so it's their own fault. We look at the external factors, like advertising, that lead them to self-destructive behaviour.

This issue came up early in the conference. The delegates were asked what they thought was the most important action to take to address men's health problems. By far the most pressing need identified was to change models of masculinity. That is, to address all the social expectations that lead men to believe that to be a man means to behave self-destructively.

Richard Fletcher suggested that we could start delivering messages about different ways to be male through men's organisations such as Lions Clubs, Rotary and the R.S.L.

Not a medical issue

Although there was much discussion of specific medical subjects such as prostate cancer and overweight, the conference did highlight the fact that mental health and social issues are the key issues for men. Violence and suicide are amongst the greatest threats to men's lives, and these are not medical problems.

Alan Huggins, Research Fellow at the School of Public Health, Curtin University, said that dedicating so much of the conference to prostate cancer and other specific medical issues was a waste of time. He said that instead of blaming men for drinking and violence problems, we need to research the causes. Men had "sat on their backsides and done nothing", while women had organised themselves 30 years ago to improve their lot. "They have succeeded in redefining what it means to be a woman. As a result, their health status has improved." Men had to restrict themselves to the macho Australian stereotype or suffer the consequences of being marginalised. "Men often kiss and cuddle their daughters into their 20s but stop showing affection to their sons before they've entered high school" he said: "That's where the isolation for men comes in." He said that men need to learn how to discuss their feelings, their health, and to seek services and support networks to help them.

A talk by Bradley Lewin was a reminder that many men are not "sitting on their backsides doing nothing". He works at the Woden Youth Centre, and runs groups aimed at getting boys to think about the way relationships can develop destructive patterns of behaviour. The 8 week course revolves around consid ering the stages an imaginary relationship goes through. By using a fictional relationship as the example, the boys are willing to talk about the feelings involved at the different stages. For many of these boys it is the first time they have been able to put labels on their feelings of happiness, sadness, fear, anger, jealousy, and the rest of the spectrum. Most have never realised that they are capable of emotions other than happiness and anger. Unfortunately these groups are only offered to boys who have been in trouble, such as bad behaviour at school, and Bradley's first task is to convince them that what they are doing is for their benefit, and not a punishment. Bradley has experienced being a street kid himself, and believes that if more boys could attend groups like these they would be less likely to get involved in violence and suicide.

At the end of the conference, comments from the floor stressed the need to recognise the importance of the work being done voluntarily, outside the health system, helping men in crisis. Cheers went up when a delegate asked that the conference acknowledge the work being done around the country by men's groups.

Focus on men

Dr Alex Wodak, director of Alcohol and Drug Services at Sydney's St Vincent Hospital, pointed out that although twice as many men as women have drug addictions, it is women who continue to be targeted by health promotion campaigns. He believes health policies should target men as a special group. Dr Wodak also stressed that alcohol and drug abuse frequently result in dangerous behaviour, often ending in jail, hospital or the morgue.

Other speakers stressed the need to study potential gender influences in health issues that are not traditionally considered gender-specific. Richard Fletcher used the example of asthma. Young boys suffer much more asthma than girls. By adulthood more women than men have asthma. "Here is an area crying out to be investigated." he said "The change in relative prevalence may be hormonal, behavioural or both, but such a dramatic change should be grounds for investigation."

Where to next?

It was generally felt that the conference was a genuine effort by Carmen Lawrence to further the cause of men's health. Dr Alex Wodak noted that it is a female Health Minister who is putting men's health on the agenda for the first time. Male health ministers have been fearful that attention to men's health issues would be seen as detracting from women's health services, probably with disastrous electoral consequences.

There seems to be little support from the Labor party as a whole for a focus on men's health, so there is a real risk that if Dr Lawrence loses the Health portfolio, the momentum could be lost.

One of the main outcomes of the conference was a set of recommendations to be put to the govern ment, the main one being that a National Committee on Men's Health be convened so that the issue could take on a life of its own. At the time of writing, a steering committee is being established, and forums around the country are being planned.

The Committee could become a focus for lobbying for men's health initiatives. However, amongst delegates who work within the health system, the feeling was that the Committee might not achieve its potenial due to lack of funding. At a time when health budgets are being cut, issues that are not seen as vote winners have low priority.

Of course, there is no reason why it should not be a vote winner. Improving men's health has obvious benefits to everyone - not only men. It's up to all men - and the wives and sisters and mothers and lovers and friends of men - to make it clear that men's wellbeing is a vote-winner.

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