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    Margo

    The SDHA Network may be setting itself up for failure by asking the wrong question. ‘What can the Tasmanian community do to make health our core business?’ carries with it certain assumptions. The truth of the matter is that there is nothing like a consensus — among Australians or other population groups — that ‘health’ should be ‘core business’ or even a central or guiding or paramount concern. It may come as a surprise to many public health advocates that ‘health’, in the biophysical sense, is not everyone’s over-riding concern. Not everyone actually believes that the pursuit of healthy individuals and communities is any more important than anything else — many people are actually of the view that it’s the ‘b!oody do-gooders’ who are making their lives miserable by trying to make them think about and worry about health all the time.
    Qualitative research on men’s health indicates that men rarely place health at the top of their priority list, and, when they do, it’s a very different concept of health. Many men are quite candid in acknowledging that they’d rather live a shorter and more indulgent life than a longer one full of restrictions, limitations, and ‘do withouts.’ It is important to realise that many people are quite prepared to risk having ‘worse health outcomes’ if it means they can keep living the way they want to live.
    It is also a mistake to continue to equate economic prosperity with better health: the factors, the causes, and ‘the causes of the causes’ which give risk to communicable diseases differ from those responsible for non-communicable diseases: social determinants of health work in different and more complex ways in relation to NCDs.
    Yes, by all means try to involve other disciplines and walks of life, but will they fall all over themselves getting excited about their role in promoting ‘health’? There are so many major, yet relatively simple, health-enhancing things that we have so far failed to do in settings such as schools and workplaces, and there are intense debates going on about what constitutes the most health-enhancing approaches to urban planning and residential development.
    There will always be tensions, too, between behavioural and SDH approaches: two approaches that bridge these are regulation (where unhealthy choices are reduced or eliminated) and ‘nudges’ (where there are still choices, but the default option is the healthy option). I remain unconvinced, however, that we will solve Australia’s, or even Tasmania’s, health problems by eliminating social and economic inequalities.

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    destroythejoint

    Well said Margo.

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    Gavin Mooney

    Margo writes: “The truth of the matter is that there is nothing like a consensus — among Australians or other population groups — that ‘health’ should be ‘core business’ or even a central or guiding or paramount concern. It may come as a surprise to many public health advocates that ‘health’, in the biophysical sense, is not everyone’s over-riding concern.”

    Thanks Margo as you have neatly summarised the key reasons why we have formed this network. We want to try to begin to build that consensus and we want to make health not an overriding concern but more of a concern. We also think that the fact that over 80 people came to the launch and we have 100 members within 13 days of the launch suggests maybe here in Tasmania there are many who want to try to make health more of a core concern. We think it is worth a try and we already have clear evidence that many fellow Tasmanians agree.

    We also agree when you conclude: “I remain unconvinced, however, that we will solve Australia’s, or even Tasmania’s, health problems by eliminating social and economic inequalities.” The Network is aiming (as our piece indicates) much more broadly than simply “social and economic inequalities” although we think these are important. We certainly don’t have plans to ‘eliminate’ them!

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    Margo

    I was asked, via a tweet, to explain whether my comments about men’s health apply only to a certain demographic, ie lower SES/disadvantaged men. The reason I don’t tweet is that I can’t face the challenge of condensing a response like this!:

    Male health attitudes, beliefs and behavior are not so much about demographics as they are about finding a comfortable ‘masculinity’ – i.e., it’s not education, occupation, or status that matters as much as beliefs about what it means to be a man. Much of men’s resistance to health promotion messages is grounded in beliefs about how masculinity should be enacted. Conformity to dominant masculine norms has been found to be one of the most significant factors in men’s likelihood of engaging in certain preventive health behaviours, in their attitudes and behaviours in relation to health risks, and in the way that men explain why they adopt certain ‘healthy’ practices. It is not just low SES men who avoid going to the doctor, who avoid ‘rabbit food’, and who ‘don’t want to be the sort of person who makes food decisions based on nutrition labels’ (actual quote). Men right across the socio-economic spectrum have been found to be resistant to health promotion messages (which are not usually pitched at them, anyway), as they don’t like being told what to do and they especially don’t like being told that they should prioritise something as feminine as ‘health’.

    Qualitative research has shown that, in many cases, the onset of a serious illness or disability can prompt a reassessment of what is ‘permissible’ within the parameters of masculinity. In the absence of overt symptoms of disease, however, expecting ‘health’ – consistently regarded by men as a female concern – to become a priority, represents an immediate obstacle for strategies which assume, or are designed to encourage, men to be proactive about, or to care about, their health. It’s not impossible to market ‘health’ to men — the success of gender-sensitive commercial marketing speaks volumes for the ability to target men through carefully-chosen language, presentation, content and imagery. I am sure it is not beyond our ability to promote a concept of masculinity in which looking after yourself and staying in control are key components. One of the clear messages from the ‘lay epidemiology’ of men’s health, however, is that men want to be healthy – they just don’t want to have to make a big deal out of it. (The benefit of ‘nudges’ and other similarly subtle appeals is exactly that.) So I’d just be sensitive to fact that, for a range of reasons, not everyone responds positively to the argument that ‘health’ must be treated as a priority.

    There is now steadily increasing evidence that improving health outcomes is not as simple as giving people access to opportunities for healthier options (such as fresh food) – there are numerous conditions that need to exist to make those opportunities both practical and socially acceptable. It may be a matter of finding the proverbial ‘win-win’ so that people (individuals, organisations and sectors) will ‘get it’ in terms of how better health can translate into meaningful benefits. A key issue will be how to proceed in relation to different aspects of ‘health’, including whether ‘motivation’ comes first or whether ‘change’ comes first.

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