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Addressing the Silence: Men’s Health in Australia

Addressing the Silence: Men’s Health in Australia aims to understand, and then dismantle, the stigma associated with male mental health, gender norms and the seeking of medical assistance. Bringing together some of Monash University’s leading men’s health experts, this collection examines how lifestyle, as well as personal and societal expectation can negatively impact upon male health, and how these concerns can be effectively addressed with strategic policy. An ongoing collection, Addressing the Silence: Men’s Health in Australia, provides policymakers, thought-leaders and decision makers with a variety of informed perspectives, an examination of the current state of men’s health in Australia, and projections of, and recommendations for, the future.

According to the Australian Men’s Health Forum (AMHF), Australia is one of the world’s healthiest societies. Yet, the gender health gap reveals concerning trends when it comes to the health of men. On average, Australian men die six years younger than their female counterparts. 4 out of 5 heart disease deaths in Australia are male. 3 out of 4 suicide deaths, 3 out of 4 road deaths and 2 out of 3 violent deaths in Australia are male. Men under 75 are twice as likely as women to die from preventable causes.

Men in rural or remote areas are particularly vulnerable. The lack of access to proper support and medical care means men in these areas are at a higher risk of mental health concerns, have a higher rate of suicide, and are more affected by otherwise preventable illnesses. Gender norms and societal expectation also contribute to the gender health gap. The stigma that still surrounds mental health issues mean men are traditionally less likely to seek help. Instead, they often remain undiagnosed, and tend toward self-medication through substance abuse. Higher rates of alcohol consumption, particularly within social situations, puts men at risk both in the short and long term. Men are more likely to engage in high-risk and dangerous behaviour, and the prolonged effects of excessive alcohol consumption negatively impact physical health. This all places unsustainable pressure on an already stretched healthcare system and contributes to increased rates of gender and family violence. These emotional and economic consequences are far-reaching, but they’re not inevitable. With good policy and governance, men's health issues can be addressed and attitudes and outcomes can be changed for the better.

Policy insights and responses

Policy implementation must occur in conjunction with open debate

Professor Alan Petersen -
School of Social Sciences, Monash University

Effective policies that accurately represent all areas of health and wellbeing across society need to be designed and implemented in conjunction with inclusive, community-based conversations that aim to dismantle gendered norms and assumptions.

What is a key policy challenge facing governments in relation to men's health?

The greatest policy challenge is shifting current constructions of gender, gendered behaviours, and gender-based divisions of labour in all areas of life. Currently, 'health' tends to be siloed, with an emphasis on biophysical and psychological dimensions, to the neglect of the broad range of other factors shaping citizens' conduct and wellbeing.

Are there currently any policies in place that respond to this challenge? If so, what are some of the positive impacts these policies have had?

There are policies that respond to aspects of the above, such as initiatives addressing men's violence and equal opportunities legislation, but no comprehensive approach of the kind I envisage. This would entail a fundamental restructuring of the economic, political, and social order.

If a government decision maker (e.g. a Cabinet Minister) asked you for advice on how to better address your described challenge what would you say? Why?

We need to develop policies that serve to dismantle existing gender based divisions of labour. To begin with, I suggest hosting a series of community-based programs to encourage debate and shift thinking about the kinds of policies needed to bring about change. This should involve all sectors of society. There is no 'blue-print' that could or should be imposed, but rather a need to begin questioning taken-for-granted assumptions about how men and women live, or should live, and their respective contributions to economic and family life. The next step is to begin to think about how to reorder societies to affect fundamental change, which is the more difficult challenge.

Additional resources:

Petersen, A. (2009) 'Future research agenda in men's health', in A. Broom & P. Tovey (eds) Men's Health: Body, Identity and Social Context. Wiley.

Connell, R.W. (2001) The Men and the Boys. University of California Press. California: US.

Policy plays a role in creating and maintaining gendered norms

Dr Fabrizzio Horta
Obstetrics and Gynaecology, Monash Health

Devising and implementing policies that support gender equality, particularly in the areas of reproduction, fertility, and child care, will encourage men to participate in, and take responsibility for, these traditionally ‘feminine’ areas.

What is a key policy challenge facing governments in relation to men's health?

The key challenge is that men are not often inclined to express their emotions and talk about personal issues. This leads to increased levels of mental illness in their adulthood and a decreased likelihood that they’ll seek help - even in the presence of severe health issues affecting their wellbeing.

Are there currently any policies in place that respond to this challenge? If so, what are some of the positive impacts these policies have had?

Recently, there has been an increasing awareness of the effects of mental illness on young and adult men. In response, there have been government and non-government led campaigns focused on encouraging men to speak up about personal issues affecting their wellbeing, and providing easily accessible information about common issues and pathways for seeking help.

If a government decision maker (e.g. a Cabinet Minister) asked you for advice on how to better address your described challenge what would you say? Why?

We face a cultural challenge that can only be solved by governments supporting and implementing gender equality policies. Human reproduction, fertility and raising children are topics commonly associated with women. This is because there is a lack of acceptance and support for men in these realms – as reflected in our laws. This inequality creates a lower sense of responsibility and discourages men’s participation, putting substantially more responsibility on women to deal with reproductive, fertility, and childcare matters. Encouraging and supporting men to participate equally in these areas could help the next generation obtain a different understanding of men’s and women’s roles and have a flow on effect, changing our approach to men’s emotions and men’s health.

Additional Links:

Vollenhoven, B., and Horta, F. (2020) Male fertility: The biological clock ticks for men, too, and affects IVF success. The Lens.

SCSenews. Study finds male ageing does affect outcomes for couples with idiopathic infertility who undergo IVF/ICSI cycles. Monash University.

We need services that are run by Aboriginal men, for Aboriginal men

Dr. Anton Isaacs

School of Rural Health, Monash University

Aboriginal Health Organisations need services that are run by Aboriginal men, for Aboriginal men. These services should be supported by other mainstream health organisations so they can offer the best care possible in an accessible and culturally appropriate manner.

What is a key policy challenge facing governments in relation to men's health?

Indigenous men experience poorer health outcomes than Indigenous women. Among the multiple factors that contribute to this disparity, perhaps the most crucial are the lack of knowledge about the various health issues affecting them and a reluctance to seek treatment. The key challenges for the government are to ensure that health knowledge is transferred to men from people they can trust, and regular health checks are available for men in a culturally safe environment.

Are there currently any policies in place that respond to this challenge? If so, what are some of the positive impacts these policies have had?

The National Aboriginal and Torres Strait Islander Male Health Framework is a good guiding document to the National Male Health Policy. While the policy is in place, implementation has been tardy.

If a government decision maker (e.g. a Cabinet Minister) asked you for advice on how to better address your described challenge what would you say? Why?

Every Aboriginal Health Organisation needs to have a men’s health service that is managed and run by Aboriginal men. This service must be technically supported by other mainstream health services to ensure that Aboriginal men receive the best possible healthcare in a culturally appropriate way.

Additional Links:

Isaacs, A.N.; Maybery, D.; Gruis, H. (2013) Help seeking by Aboriginal men who are mentally unwell: a pilot study. Early Intervention in Psychiatry 7: 407–413.

Canuto, K., Wittert, G., Harfield, S. et al. (2018) “I feel more comfortable speaking to a male”: Aboriginal and Torres Strait Islander men’s discourse on utilizing primary health care services. Int J Equity Health 17: 185.

Exposure to alcohol related harms is gendered - policy should reflect this

Associate Professor Steven Roberts.

School of Social Science, Monash University

Exposure to alcohol related harms is gendered and needs to be addressed through policies and support that explicitly target male perceptions of risk and cultural and community norms surrounding masculinity.

What is a key policy challenge facing governments in relation to men's health?

Men are more likely [than women] to drink alcohol at or beyond single occasion risk for alcohol consumption of five or more standard drinks in a single session. This figure is poorly understood, with research showing men estimate the risk threshold to be something between 10-30 drinks per session. Exposure to alcohol related harms is gendered but this remains largely undiscussed.

Are there currently any policies in place that respond to this challenge? If so, what are some of the positive impacts these policies have had?

The National Alcohol Strategy 2018–2026 identifies four priority areas of focus to prevent and minimise alcohol-related harm in Australia. A concern with risky drinking broadly reflects Priority area 1 (Improving community safety and amenity) and Priority area 4 (Promoting healthier communities). This is a productive document that takes seriously the need to change Australia's alcohol culture. It does, however, pay strikingly insufficient attention to gender across the groups it nominates as being most exposed to harm.

If a government decision maker (e.g. a Cabinet Minister) asked you for advice on how to better address your described challenge what would you say? Why?

Policy makers first need to think more overtly about men and masculinity. Any mention of gender is perplexingly near-absent in the National Alcohol Strategy 2018–2026, despite the fact that men outnumber women in virtually every drinking category used in research for comparison – prevalence consumption, frequency of drinking and intoxication, incidence of heavy and problem drinking.

Policy makers must promote the need for health education and health promotion practitioners to be more innovative in thinking about men’s perceptions of risk, their relationship to masculine norms, and how both these can be changed. For public health messaging about risky drinking to have greater relevance to men, it needs to engage with the realities and pleasures of men’s drinking and contextualised understandings of risk, and needs to be attuned to the mechanics of the norms – or the rules – around drinking that operate in a society and in subgroups in society. Risky drinking is much more than an individual issue.

A focus on risk to others in public health campaigns may be more fruitful than an exclusive focus on individual consumption levels.

Additional Links:

Roberts, S. (2019) Risky drinking among men: alcohol's role in social interaction.

Roberts, S., Ralph, B., Elliott, K., Robards, B., Lindsay, J., O’Brien, K., Savic, M., and Lubman, D. I. (2019) Exploring men’s risky drinking cultures (for Vic Health). Victorian Health Promotion Foundation, Melbourne, Australia.

Suicide prevention strategies should look to underlying causes

Dr Kylie King.

Turner Institute for Brain and Mental Health, Monash University

Researchers and policymakers need to work with men who have survived depression and trauma to develop a coordinated approach to men’s suicide prevention.

What is a key policy challenge facing governments in relation to men's health?

Men account for three-quarters of suicide deaths in Australia. A key policy challenge is the need for a coordinated approach to men’s suicide prevention that meets men where they are as workers, fathers, family members and friends and that supports men in higher risk groups and at vulnerable times of life.

Are there currently any policies in place that respond to this challenge? If so, what are some of the positive impacts these policies have had?

The Fifth National Mental Health and Suicide Prevention Plan seeks to establish a national approach to mental health and suicide prevention. However, this plan lacks a male specific focus. The National Suicide Prevention Adviser highlighted the impact of suicide on men. A plan for men’s suicide prevention in now needed.

If a government decision maker (e.g. a Cabinet Minister) asked you for advice on how to better address your described challenge what would you say? Why?

Little is known about what works for men’s suicide prevention. We know that some men are at higher risk than others and that social factors, such as masculine norms that value stoicism and self-reliance, also contribute. However, we know little about how all these factors interact. There is a pressing need to obtain this knowledge and then use it to support existing programs and develop and evaluate further targeted interventions. We should enable men with lived experience of suicide to work with researchers and policy makers to develop a coordinated approach to men’s suicide prevention.

Additional Links:

Beaton, S. and Forster, P. (2012) ‘Insights into men’s suicide.’ InPsych 34:4.

Department of Health (2019) The Prime Minister’s National Suicide Prevention Advisor. Commonwealth of Australia: Canberra.

We need to increase funding for research on male fertility

Professor Kate Loveland

Hudson Institute of Medical Research, Monash University

More funding is needed to support researchers examining the effect of environmental factors on male fertility.

What is a key policy challenge facing governments in relation to men's health?

The contribution of environmental factors to declining men’s reproductive health is unaddressed. Inter-generational and in utero exposures to medication, pollutants and infections are linked to increased rates of testicular cancer, undescended testes, hypospadias, and to declining sperm counts. One in 20 Australian couples face male-factor infertility and testicular cancer is rising 2% per annum, along with co-morbidities associated with infertility.

Are there currently any policies in place that respond to this challenge? If so, what are some of the positive impacts these policies have had?

Funding for public and clinician outreach via Healthy Male (formerly Andrology Australia) has facilitated key community dialogue about the importance of Men's Health.

If a government decision maker (e.g. a Cabinet Minister) asked you for advice on how to better address your described challenge what would you say? Why?

The first priority is a good evidence basis for understanding how environmental factors, particularly those relevant to Australians, influence adult male fertility. This requires high quality, peer-reviewed research. Australian scientists have traditionally excelled in this field (Andrology), but the longstanding decline in goverment-funded research is eroding the base of expertise, while restricting training and career prospects for younger scientists.

The second priority would be, perhaps through an MRFF, to link Men's Reproductive Health researchers, clinicians, and stakeholder groups with those working in Women's Reproductive Health, so that we can learn how pregnancy-related exposures contribute to lifelong reproductive health in Australian men.

Additional Links:

Loveland, K.L. and Itman, C.I. (2012) Rethinking the age boys reach puberty. The Conversation.

Reproductive Health Australia

Healthy Male, Andrology Australia