Can we get healthier outcomes from Aussie men?

Nicola Roxon, Minister for Health in the Australian Government, is spearheading development of a men’s health policy.

A number of documents are being produced, and the Minister has provided a website setting out many of them. A form is provided which encourages men and women to contribute ideas. This article expands on some of the points made in Development of a National Men’s Health Policy: An Information Paper from the Department of Health and Ageing.

The paper suggests that, asked about a men’s health policy, some used to say “Yes, but what about women?” Fortunately those days are gone. We know that one of the main factors in getting men healthier is for them to have women encouraging, supporting and assisting them. And of course governments have long provided for women’s health needs, which are in many ways different from those of men.

In this piece I aim to set out some of the main barriers preventing men from leading healthier lives. And then to suggest some ways in which we can move towards a healthier male population.

When you hear the word MAN, what do you think of first? Take a moment to reflect, or jot down a couple of phrases. Often the following ideas come to mind:

Work, strength, sport, muscles, families.

The paper says that men’s health is important for economic reasons. Healthier men contribute better to workplaces and make fewer demands on health services. Men are also making more contributions to families as single fathers, “access dads” and carers. Men also volunteer in large numbers as lifesavers, fire-fighters, SES volunteers and similar. Of course, healthier men are happier and so better health is important for humane reasons, too.

Men, work and social disadvantage

The government paper talks about socio-economic effects (SES) as a huge determinant on health. Overworked men, like busy executives and managers, usually can’t find time to exercise properly or eat carefully. At the other end of the scale, many men are homeless and can’t afford proper housing, food or exercise. Older, poorer men are socially isolated and find it hard to get social support. Socio-economic disadvantage has contributed to 19 per cent of the mortality burden for men.

Unemployment is associated with lower levels of happiness and mental health problems. And lower SES is universally associated with poorer health outcomes across the life span. (p.8)

I found when writing my book, Fathers, Sons and Lovers, that most men define themselves through work. To have healthier men, we need to look hard at workplaces. Often workplaces have been made more suitable for women; better childcare facilities, provision for maternity leave, stress leave. We need to think about men in workplaces too. In all my working life to date (I am semi-retired) I never once took stress leave. It isn’t masculine to do that. I wonder how many men use stress leave, compared with women?

Though some men take a few weeks’ paternity leave, it isn’t convenient for organisations to have men taking large amounts of leave for personal reasons. Society needs men (as well as many women) to keep on working; and, when needed, to fight in the service of their country.

Men, four-wheel drives and the recession

There is a high percentage of men in the sectors hit hardest by the current recession: manufacturing; design and construction; banking and finance; and certain parts of the travel industry.

Auto manufacture and auto retailing are two prime examples of male-heavy occupations. In the USA and Australia, the auto  industry is in crisis after years of clinging to outmoded, gas-guzzling four-wheel drives. Called in Sydney “Balmain bulldozers”, these are environmentally unsound and hazardous for all who are hit by them. Do we need them on our roads in Sydney, Melbourne and Brisbane?

During a recession, men with poor general education are hit hardest because they have little capacity to survive repeated rejection. Men with poor literacy and computer skills have limited job futures. Guys with poor ability to communicate and work with others different from themselves (such as women, gays, and foreign-born workers) may be the worst off of all.

All of this makes survival  for men harder, especially men stuck in old-fashioned forms of masculinity: the “she’ll be right, mate” style, perhaps. Those who are mentally younger, more adaptable, and more literate, seem more resilient.

Why men get poorer health outcomes

This brings us to another big issue. A man’s understanding of “what a man does” of course affects his health. If men must always be strong, then it’s harder for him to admit he’s unwell. The paper says:

Men’s consultations tend to be more superficial, shorter and occur later in the disease process. Men are reluctant to engage in preventative health consultations (check-ups) during their early and middle years. (p.9)

Let’s imagine that the GP is a man (many are; not all) A man finds it difficult to admit weakness to another man. There’s no use pretending I am better than anyone else! I talk to the GP about a sore toe and then - as if it’s an afterthought - out comes my concern about my prostate or a sore bum.

On the other hand, the paper says men attend emergency departments at a higher rate than women in every age group except the over-75s. (p.9) Society needs men to fight wars, earn money, support families. We also expect men to be massively interested in, and seeking sex. Nobody cares much about men with problems of depression, arms worn out by using machinery, repetitive strain injury. Men feel they have to soldier on.

Health: saints and sinners

It seems that the people who go to church the most, need religion the least. On the other hand, the sinners never go to church. It’s the same with health: some men are health nuts, others don’t seem to care. In the eastern suburbs of Sydney, where I live, people are very concerned about their appearance. Some are obsessed about “how do I look?” and panic over every new wrinkle. While they are sweating in the gym, others sweat all day in hard jobs and then sit in the pub, sometimes smoking as well. Some men do manage to live healthy lives but I believe far more would fall into either the “anxiously fit” or “the who-gives a ****” categories.

Special groups

Indigenous males feature prominently in the men’s health discussion papers. I would like to see attention given also to another group: new settlers. We are getting a trickle of refugees from Sierra Leone and Zimbabwe whose countries are in deep trouble. Their men and boys, we find, have had very limited education. Their understanding of a range of things is slight: yet they need to know about hepatitis, HIV-AIDS, TB, diphtheria; even the common cold. I seek not to denigrate them but to draw attention to their special needs.

Large numbers of other men have their own special needs: men with diabetes; men wrestling with issues of separation and divorce; men with HIV-AIDS and so on. Improving men’s health will mean attending to these special groups as well as looking after the needs of men as a group.

There are few positive generalisations about men. We are used to reading about women, with tales of the glass ceiling; women’s balancing act between family, husband and work; women and violence, women and rape … We are unused to people writing about men as a group unless someone is complaining that all men are failing to do something or other. And these failings include everything from not doing the house work to leaving the toilet seat up.

Men after divorce

Let’s look at one group for a moment. Men after divorce face a very tough struggle. They must hang onto their job, as they tend to become a chequebook for a family they don’t see very often. Many resent paying child support and find their kids are cautious towards them. It’s hard for them to be warm and supportive of their kids when they themselves feel they are breaking up. Yet many of us have found that, with the support of patient friends, we can resist becoming vindictive and wait for the days in which our kids come back to us.

Living a healthy life, taking care with diet and exercise instead of sinking into bitterness, with these obstacles is indeed a challenge; it’s all a challenge. But many have managed to do it successfully. Resilient males can survive better and be better husbands, lovers, and dads.

Healthy diet

Ask men what they like and you’ll probably get an answer. “Sex, of course.” Men who vow they are not interested in sex are looked on with distrust - religious priests and brothers, for instance. But men also love to eat. We form eating habits in our youth and enjoy our food, most of us. As we get older we tend to become less active. And we keep eating much the same amount. So here I am well over 50 (oh OK, I’m 63 and a bit) and I have to limit my fried food. I do better to ban ice cream from the house because I pig out. It all ends up on the tummy! Many of us struggle to eat sensibly and find food which is nourishing, quick to prepare and at a reasonable price. And many men are cooking for themselves these days. We need more help with interesting ways to present healthy food.

Raising boys to be healthier

Many of the above point to an obvious issue - raising boys. The paper says that boys learn living habits as they grow up which can encourage them to eat well and exercise. Or they can learn to like junk food and slump at the TV. Either way, boys are accumulating lifetime habits which might make or break their health outcomes.

Poor education is also associated with unemployment and under-employment and this, in turn, leads to worse health outcomes. The Australian Government has concluded a program which I took part in, which helped teachers understand the pressures on males. In December 2008 there was great sadness over a knife fight on a train in Sydney in which boys could not back down. One was knifed to death. Much more can be done to teach boys better ways of being male. It is unlikely that the football boofheads in the sports pages will help very much. Most footballers are perfect models of what a boy should be - not.

Junk food ads

For some reason it seems difficult to ban ads for junk food at those times when kids are preparing to eat. Could this be the power of the manufacturers and sellers of fast food? How many times have we wished for governments who will do what’s best for kids, not for lobbyists and pressure groups! What’s the problem here? Oh, I see - lots of money being used to influence everyone in sight.

And to conclude

We must congratulate Minister Nicola Roxon and the Rudd Government for bringing a men’s health policy to the fore. Much work remains to be done to help articulate men’s needs and help men live healthier lives:

First, let’s try to talk positively about men as a group, just as we talk about and encourage women as a group.

Second, let’s work harder at giving boys positive ideas about being a good man who helps others and maintains good eating and exercise habits. Resilient men survive better and can contribute more to society.

Third, it’s time to cut out all the ads for junk food which crowd the airwaves. Bite the bullet please Ms Roxon, and take the axe to these ads. We will all be grateful to you if you do.

Australia has just begun to see the start of the recession. Much more needs to be done to study those who are hardest hit and what can be done to assist them. Data is inconclusive, for it has hit hard, very fast. But further research seems likely to show that males are represented very heavily among its victims. Let’s start by getting men and health providers talking more productively.

Some statistics presented in the policy are as follows:

• 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.

The leading causes of death where males make up the highest proportion are:

• prostate cancer (100 per cent);
• tumours of the male genital organs (100 per cent);
• HIV disease (93.2 per cent);
• hanging, strangulation and suffocation (82.9 per cent);
• intentional self-harm (78.9 per cent);
• accidental drowning and submersion (76.6 per cent);
• transport accidents (74.7 per cent);
• bladder cancers (72.2 per cent);
• cancer of the oesophagus (69.0 per cent);
• melanoma of skin (67.7 per cent).

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