What will difference will the new national male health policy make on the ground? Margo Saunders, a health policy consultant in Canberra, suggests that it’s a question we will need to keep asking. She writes:
“Given that Kevin Rudd reckons that Australia’s first National Male Health Policy, launched yesterday, is about 110 years late, we certainly had the right to expect something good and something comprehensive. Whether the policy meets these expectations will have more to do with its implementation than to its welcome, but fairly predictable and well-chosen, words.
The policy certainly has been a long time coming, with aborted fits and starts in the early 1990s, the first national men’s health conference in 1995 and the release, 10 years later, of position statements on men’s health by the Australian Medical Association and the Royal Australian College of General Practitioners.
We have had a National Women’s Health Policy (currently being updated) since 1989, and the Australian Longitudinal Study on Women’s Health has been tracking the health of Australian women since 1996.
The National Male Health Policy’s priority areas are cover all the areas that you would expect: promoting optimal health outcomes for all Australian males; addressing health inequalities between male population groups; delivering initiatives and services that consider the health needs of Australian men in different age groups and at key transition points from youth to old age; focusing on preventive health; improving the evidence base to inform the development of policies, programs and initiatives, and improving access to health care for males by tailoring health care services and initiatives to facilitate access by men, particularly population groups at risk of poor health.
The policy certainly looks comprehensive and touches all the bases. It also attempts to avoid the ‘masculinity vs social determinants’ argument by not addressing the influence of masculinity head-on, but talking about its consequences.
The emphasis on men as individual agents, and phrases such as ‘raising male awareness’ and ‘males need to know’ feature prominently, but are balanced by a strong focus on the economic and social determinants of health. This approach differs from that of the Irish Men’s Health Policy, released in 2008, which explicitly acknowledges that men’s health-related behaviour must be constantly be negotiated against the backdrop of masculine behavioural norms – a view that finds strong support from within the men’s health literature.
The new policy comes with a commitment of $16.7 million, including the big-ticket items of $6.9 million for a national longitudinal men’s health study, $3 million for the Australian Men’s Sheds Association, and $6 million to promote the role of Indigenous men in their children’s and families’ lives. This clearly doesn’t leave a lot for everything else, such as addressing major needs in primary prevention.
Once the dust has settled and the policy itself, together with its associated documents — on social determinants, mental health, health practices, reproductive health, lifestyle behaviour, risk-taking, health in the workplace, and health services access — have been considered, there needs to be some serious thinking about priorities and funding, including the roles and responsibilities of government and non-government agencies at all levels.
There are also a range of unanswered questions, such as how this policy, and a new national women’s health policy, will relate to other national health policies, such as the National Drug Strategy and strategic approaches to obesity, and indeed whether there will be sufficient ‘oomph’ behind these policies to generate anything approaching the consistent and systematic application of a ‘gender lens’ to government policies and programs.
In releasing the policy yesterday, Minister for Indigenous Health and Rural and Regional Health, Warren Snowdon, made the important point that the policy is not just about life expectancy, but is about quality of life – in other words, it’s not about how men die but about how they live.
There are high hopes riding on this policy. Whether it makes a difference will depend on funding, commitment at all levels, and instigating changes not only in the health system but in the myriad factors which impact on men’s health.”
• Margo Saunders is an Affiliate Member of the Freemasons Foundation Centre for Men’s Health and has published articles and commentaries on men’s health and health literacy.
Leaving out any reference to the detrimental consequences of masculine ideals on men’s health was deliberate on the part of those people who devised the new men’s health policy. Many of those people belong or are sympathetic to the men’s rights movement in Australia. They are bitterly opposed to even considering that hegemonic masculinity creates cultural practices that are harmful to men, their significant others, and the wider community. By denying the central role that hegemonic masculinity plays in terms of men’s poor attachment behaviours, their restricted emotionality, and their propensity for violence to self and to others, the new men’s health policy will in fact lead to diminished health outcomes for men.
I think here of male suicide, where men in Australia outnumber women 4:1 in terms of completed acts. That is despite the fact that women attempt suicide more often than men do. I have worked therapeutically with many suicidal men. It is my considered opinion, and one which is reinforced by the accumulated empirical evidence, that the pressures brought to bear on men to uphold masculine ideals, including the prohibitions those ideals enforce against displaying any emotion that might be considered ‘feminine’ or ‘weak’, account for the massive gendered split in the suicide rate. The new men’s health policy completely ignores those stark realities, sidestepping the immense shame that compels more than 1,600 Australian men to kill themselves every year.
Pollack (1998) made the insightful observation that boys are born with just as much capacity for emotional expressivity as girls. However, by the time that boys have made it into kindergarten, they have already had that expressivity beaten out of them, emotionally if not physically as well. Big boys would rather die than cry. That ‘shame hardening process’, as Pollack (1998) refers to it, stays with boys and men across the lifespan. It explains, in large measure, the reluctance of men to seek help for their physical and mental health problems and, symbiotically, the reluctance of others to acknowledge those health problems. Any men’s health policy that ignores the impact of hegemonic masculinity is like a lung cancer reduction strategy that ignores the impact of smoking.
Thank you for making that crucial point — I obviously agree (see M Saunders and A Peerson, ‘Australia’s National Men’s Health Policy: Masculinity Matters’, Australian Journal of Health Promotion, August 2009). I wonder, though, whether the policy documents try to avoid the argument by talking about the impacts of hegemonic masculinity without referring to it by name. I agree, however, that the influence of hegemonic masculinity needs to be understood and addressed rather than treated as an unconscionable victim-blaming taboo. There is truth in the claim that, ‘It is men’s and boys’ practical relationships to collective images or models of masculinity, rather than simple reflections of them, that is central to understanding gendered consequences in violence, health, and education. The concept of hegemonic masculinity… is a means of grasping a certain dynamic within the social process’ (RW Connell and JW Messerschmidt, Hegemonic Masculinity – Rethinking the Concept Gender & Society, 2005, Vol. 19, No. 6, 829-859).
“What difference will the new national male health policy make on the ground”? Given that Rudd cooks-up men’s health policy within the federal election setting, this provides some context for the mounting criticism of prime ministerial spinelessness. Particularly that Rudd omitted prostate cancer elementary PSA testing from “the national male health policy”!
Failing also to inform the forsaken citizens whose working-life-taxes nurtured the system (in the zionist era of universal deceit), that since the mid 2009 major changes curtailed the bulk-billing for targeted pathology tests and ultrasound screening, we know nothing about. In contrast to the longstanding, previous widespread practice of the bulk-billing 87% outpatient services.
Perhaps justifiable in accordance with the Rudd govt set priorities in the taxpayers revenue distribution? Yet it’s just a commonsense notion: To be well informed by the govt in the authentic democracy!
At the risk of being shot down in flames, I think as a male patient, one of the issues that is not discussed is the gender imbalance that applies particularily in nursing staff. This is I believe this will be further compounded by the increasing role for nurses in GP clinics etc, the overwhelming majority of whom are female. It is just not true that men are not modest, many are, and this needs to be recognised by the “medical establishment”; in the same way that woment have been encouraged to study for doctors (a policy I support).
Look at the way that men are encouraged to get check ups as distinct from womens campaigns. For males lets treat it as a joke “be a man” or similar, rather that look at how those services are delivered and by who. Look at the culture of clinics, look at even such things as the reading material and you will see what I mean.