The health sector, strangely enough, has a long history of beating up on those it is meant to serve. Men, for example, have been widely castigated for being “poor patients”. What this means is that they haven’t always done what health services or health professionals think they should – ie turn up for appointments, seek help earlier rather than later and so on.
The Federal Government is due to release the country’s first national men’s health policy sometime soon. It’s likely that the policy will try to change some of the rhetoric around men’s health – instead of blaming men for not engaging, the policy may just turn the tables, and ask health services to take a hard look at themselves and what they could do to become more men-friendly.
At least that’s the guess I’m making after reading the information paper that was released earlier this year to support the policy’s development.
“It may be that it is the nature of services that determines willingness to seek help, suggesting the explanation of ‘masculinities’ for lower rates of men’s use of services may not be accurate,” says the paper. “Considerations of availability, access and suitability of services in line with men’s values and practices is likely to offer more fruitful explanations and ways to better engage men with appropriate health service use.”
Men’s health expert, Professor John Macdonald, believes the policy offers a “watershed” moment for men’s health. He writes:
“There will be an Australian National Men’s Health Policy this year, only the second in the world. Unnoticed by many, there has been a national discussion across the country about men’s health needs, initiated by the Department of Health and Ageing.
Instead of academics or medicos saying what men’s health needs are, men themselves were actually asked.
Among other things, the document used to promote this national debate speaks of a social determinants approach to men’s health as well as the need to think of male-friendly health services.
In the first instance, let’s look at the context of men’s lives: the impact of schooling on their health, of work- think of the high rate of industrial accidents in jobs men have to do, or the impact of job insecurity, of social isolation (the population most at risk of suicide in our country is older isolated men), the terrible effects of racism on Aboriginal and Torres Strait Islander men. The call to look at the social determinants of men’s health seems enlightened and compassionate.
The mention of “male-friendly” services marks a watershed.
Men themselves are often seen in our culture to be responsible for their poorer health and blamed for “not going to the doctor”. Whatever truth there may be in this, for once the spotlight can be turned on the doctors and community health services and we can (and I do) ask: “what are you doing to make yourselves “male-friendly”? Not very controversial, one might think. Alas, not so.
Leaving aside the issue of medicine (in this case urology) wanting the top place at the table (of men’s health, and indeed it should have a place), a recent issue of the Health Promotion Journal of Australia shows us that the knives are out to try to ensure the vision of the discussion document gets jettisoned.
Instead, two articles tell us, we should place male violence squarely at the centre of any men’s health policy, and focus on “hegemonic masculinity”.
Australia, Australia! Violence IS a Public health issue. The contradictions of men’s behaviour should not be avoided. Many countries are acknowledging it, both at its worst in sexual abuse but also the physical and psychological manifestations. of course, “No to violence against women!” (Also “No, to violence against children!” the main perpetrators of which are women, incidentally. Check it out!).
But I know of no other country in which academics would rise up in the year of a men’s health policy to demand that violence be central to that policy. S
ome would even say that gender equity as a social determinant is only about the imbalance of power between men and women in society and therefore nothing to do with the inaccessibility of many health services to men.
Gender as a social determinant would be only about this same imbalance and so we don’t have to look at the things already mentioned: health of boys in schools (unless we believe that the enormous amount of Ritalin dispensed to young boys (mainly) is because of their participation in hegemonic masculinity; likewise the many health-damaging male – another manifestation of hegemonic masculinity; socially isolated older men at risk of suicide – their masculinity is the problem, it seems. Aboriginal an Torres Strait Islander men, maybe they die 17 years younger than the rest of us because of the original sin of being “masculine”.
If we want a rational and compassionate men’s health policy, why would we start from the negative?
As a man, I will be castigated for challenging this “received wisdom” So be it.
Thank goodness there are many women who will also be sad if the government is cowed into changing tack and bringing out a men’s health policy focused on non-evidence based sociological constructs to please a certain lobby.
Let’s move away from gender wars and try to work with government to build a balanced, rational, not-afraid-to-look-at-all-contradictions–of-gendered-behaviour health policies for men and women, boys and girls.
• Professor John J Macdonald is Foundation Chair in Primary Health Care and Co-Director, Men’s Health Information and Resource Centre, University of Western Sydney