Tackling inequities in men’s health: a reflective lens on the National Male Health Policy

The fourth Andrology Australia Forum on men’s health was held in Sydney on 4–6 June 2010, with about 70 researchers, policymakers and health professionals in attendance. The forum theme was “Tackling the inequities of men’s health”, and it provided the opportunity to consider one of the six priority areas of the National Male Health Policy — “Health equity between population groups of males”.1 The presentations and discussions highlighted areas for further consideration in policy implementation, while acknowledging the complexity of addressing health inequities through policy initiatives.

The Honourable Warren Snowdon, MP (former Minister for Indigenous Health, Rural and Regional Health and Regional Services Delivery), gave a keynote address on the first Australian National Male Health Policy.1 The Minister described the policy process, highlighting his involvement and drawing on his personal experience working with Indigenous communities, which ensured that a broad range of male health issues through the lifespan were included. Dr Noel Richardson (Director, Centre for Men’s Health, Institute of Technology Carlow, Ireland) followed, giving an account of the Irish experience in formulating a national men’s health policy.2 His account provided a direct contrast between the two policy processes. While both policies were underpinned by extensive community consultation, the Irish policy benefited from a strong evidence base commissioned by the government specifically for the policy, whereas the Australian policy was driven by grassroots men’s groups and guided by the limited available empirical research. This led to different guiding principles: Dr Richardson described the Irish policy as drawing on a “gender-mainstreaming” framework, in which gender is acknowledged as a key determinant of health. It also recognises the interaction of masculinities with social and economic factors in influencing men’s health, compared with the approach using broader social determinants in guiding the Australian policy.

The Minister acknowledged that coordinated action by the whole workforce was necessary to drive change. He also emphasised the need to embed the policy into government frameworks to withstand possible changes in government priorities. However, the broader structural change through which health inequities could be addressed was not clearly articulated. An important lesson from the Irish experience was the value of the policy itself in facilitating work across government sectors, not just health services, with men’s health now seen as a priority area. Importantly, both speakers acknowledged the impact of recent economic events on the policies, with the Minister highlighting that in such financial circumstances it was important to direct resources to areas that can further policy objectives in the long term.

Finally, forum delegates welcomed the Minister’s announcement that a male health policy reference group would be established. This would be to provide expert advice and assistance with the implementation of policy action areas, such as the proposed National Longitudinal Study on Male Health. This announcement partially reflected one of the fundamental lessons learned from the Irish experience: the need for good governance and accountability. However, it did not go as far as the requirement by the Irish government for annual progress reporting. While policy formulation reflected different mechanisms, both acknowledged the need for an evaluation and monitoring strategy to be established from the outset.

Several speakers highlighted the need for good data to underpin policy development and implementation. Lisa Thompson and Sally Bullock (data analysts, Australian Institute of Health and Welfare) reported data showing the poorer health status of men living in rural and remote areas. In particular, the data showed higher rates of chronic diseases that are partly due to lower socioeconomic status, but other factors remain to be elucidated.3 More focused data and policy analysis for groups with poor health and/or social isolation were called for, using cross-sectional health surveys, data linkage and longitudinal studies.

Professor Sally Redman (Chief Executive Officer, The Sax Institute) expanded on the value of longitudinal studies in providing high-quality evidence for policy questions. Using the 45 and Up Study as an example, Professor Redman highlighted how longitudinal studies can be used by researchers and policymakers. “Add-on” studies and data linkage can be used to answer questions arising over time, thus “future proofing” the significant investment necessary to conduct a longitudinal study. Acknowledging the time lag between evidence and policy, Professor Redman called for better ways to provide robust evidence to policymakers. James Smith (Discipline of Public Health, University of Adelaide) underscored this point by showing how evidence (in this case, qualitative evidence) can debunk myths promulgated by opinion rather than empirical research. Mr Smith argued for closing the biomedical–social and qualitative–quantitative research gaps to answer the important questions in men’s health. He coupled this with an emphasis on translating research into policy and practice.

Professor Gavin Turrell (Principal Research Fellow, School of Public Health, Queensland University of Technology) discussed the strong association between socioeconomic status and male health. He emphasised the need for a whole-of-government and whole-of-society approach to tackle socioeconomic inequities. In discussing policy implementation, Professor Turrell argued that interventions should be focused on environments as well as individuals, and occur across the lifespan, requiring an alignment of public policy and health policy. Improved monitoring and surveillance systems could address some of the gaps in Australian men’s health data, allowing proper evaluation of interventions designed to address socioeconomic inequities.

On a different theme, Associate Professor Doug Lording (Endocrinologist, Cabrini Medical Centre) highlighted emerging areas that require better policy, such as purchasing unsafe or ineffective medications from the internet or other unregulated markets. Improvements in health literacy and health promotion, as well as better regulation, are needed to meet the needs of those who are vulnerable to health practices that could be described as predatory.

Dr Mark Wenitong (Senior Medical Officer, Apunipima Cape York Health Council) spoke about increasing both the capacity and the quality of the Indigenous health workforce. He stressed the cultural importance of male health workers and pointed out that there is a current shortage of male nurses, and Aboriginal and allied health workers. Policy levers such as the Aboriginal and Torres Strait Islander Health Workforce Working Group,4 and programs such as the Indigenous health curriculum framework for medical schools5 and the Andrology Australia Aboriginal and Torres Strait Islander Male Health Module need further investment from government. Dr Wenitong argued for improved pathways and structural support to enable Aboriginal and Torres Strait Islander people to progress through health workforce education and training.

Peter Strange (Nurse Practitioner, Bendigo Community Health Services) highlighted the current lack of men’s health education in undergraduate and postgraduate nursing and allied health curricula, and Professor Rob McLachlan (Director, Andrology Australia) spoke about the lack of men’s health education in the medical undergraduate curriculum. These deficiencies flow through to a lack of men’s health specialist services and local programs. Audience discussion reflected on the critical need for more focused training across these domains, reinforcing that men’s health could be incorporated as a core education component and/or specific postgraduate training to build defined men’s health career pathways.

Descriptive accounts of programs designed to address male health disparities through better access and support (Box) prompted discussion of the need for program evaluation. Although the workplace is seen as a potentially successful forum for men’s health promotion, for example with high attendances recorded at WorkSafe Victoria’s workplace health checks, evaluations of the effectiveness of such programs can be limited due to privacy and other issues.