Convention Organising Committee: In no particular order, special thanks go to Patrick Torres, Frank Ansell, Ken Lechleitner, Neville Khan, Arthur Grogan, Jimmy Perry, Lloyd Bray, Douglas Abbott, Willy Satour and Graham Smith from Alice Springs; Alan (Oopy) Campbell and Martin Campbell from Jay Creek, via Alice Springs; Robin Granites and Harry Nelson from Yuendumu; Joe Rawson from Titjikala, via Alice Springs; Jasper Hains from Ti Tree; Anthony Petrick from Harts Range; Aaron Briscoe from OATSIH, Canberra; Shane Houston from the Health Department of WA; and Robert Cockatoo from Queensland Health.

A lot of people worked hard to make the Convention a success.
For a full list of names visit the Convention website at http://welcome.to/indigmalehealth

Committee Support: Frank Spry, Roy Price and Zane Hughes from the Male Health Policy Unit in Territory Health Services assisted the Convention Organising Committee by providing logistical support and advice.

Media Liaison: The Organising Committee would like to pass on thanks to Tangentyere Council. The Tangentyere Media Officer, Neville Khan, provided a media liaison service and arranged for coverage of the Convention in the print, radio and television media.

Alice Springs Street March: Thanks go to the Alice Springs Town Council for waiving the usual ‘permit to march’ procedures. The Organising Committee is grateful for the support from the Town Council.

Territory Health Services provided financial sponsorship and in-kind support through the Male Health Policy Unit. The Australian Department of Health & Aged Care and the Heart Foundation of Australia provided generous financial sponsorship. Dacou Aboriginal Art Gallery in Adelaide, South Australia provided valuable in-kind support. Visit the Web site at http://welcome.to/indigmalehealth for more information about the sponsors.

The 1st National Indigenous Male Health Convention, held at Ross River Homestead on the 4th & 5th October 1999, provided an opportunity for Indigenous males from around Australia to express their views and share their experiences of health. Delegates to the Convention explored strategies to improve the health and well-being of Indigenous males, their families and their communities. The Convention Organising Committee is proud of the success of the Convention.

• The establishment of men's centres equipped to deal with all aspects of men's health, such as diabetes, alcoholism, mental health and family wellbeing.

• The provision of more male oriented services to improve access.

• The establishment of a National Indigenous Male Health Reference Committee made up of reps from state and territory groups.

This section is an edited summary of the papers presented by keynote speakers. Full texts are available on the internet.

• Current estimates show that presently there are approximately 202,000 of us Indigenous males in Australia with about 120,000 aged 15 years and older.
• Indigenous males' life expectancy is only 56.9 years compared to 75.2 years for all Australian males. This is some 20 years difference.
• Infant mortality of Indigenous males remains stubbornly fixed at 2 to 3 times that for non-Indigenous males.
• The death rates for Indigenous males are higher than those for non-Indigenous males for every age-group, especially between the 15 – 54 year age range where death rates are 3 to 7 times that of non-Indigenous males.
• The main four conditions include, cardiovascular diseases, injury, respiratory diseases and endocrine, which is mainly diabetes. These four conditions together account for over two thirds of excess death.
• The medical issues for Indigenous men that we need to target are heart disease, injury, respiratory conditions, diabetes, and hypertension.
• A compounding factor for these high rates is that Indigenous males are reluctant to visit a clinic for treatment because of the lack of cultural sensitivity.
• The main behavioural risk factors are smoking, alcohol consumption and diet.
• Smoking is the "silent killer" of our people.
• At present the smoking prevalence in Indigenous Communities is anywhere from 50 to 80%.
• There have been recent reports linking low birth weight babies to heart disease in later life. Alcohol, smoking and nutrition are all important risk factors for low birth weight babies.

We need healthy strong babies to become healthy strong adults. One of the most important clinical issues for Indigenous males is the ability to access Primary Health Care Clinics. As an Aboriginal man as well as an Aboriginal doctor I known only too well how difficult it is for us to visit a doctor.

• Another access barrier includes inappropriate thought by mainstream health services to cultural differences. For example, Indigenous men have been forced to see female doctors for men's business.
• Indigenous men are more at ease with this concept of separate clinics and as a result are more likely to consult a male health worker or male doctor for a specific problem.
• There is also an access problem for Indigenous males in the prison system, they are reluctant to present to the prison medical centre when sick.
• How can we improve medication compliance for those who refuse? Can we use both traditional and western medicine to improve compliance?
• We need more men's groups around Australia to tackle this issue collectively.
• Prison health also needs to be on the agenda for change.
• For Indigenous male health to improve it will be up to Aboriginal male health professionals like all of those at our Convention to participate in bringing about change.
• I was very pleased to hear the Health Minister for the Northern Territory say that our three recommendations from our Convention would be easy to implement. I hope that Commonwealth Health will have a similar attitude towards these recommendations.

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Frank Spry
Miwatj Health Aboriginal Corporation
Nhulunbuy, NT

(Paper at http://welcome.to/indigmalehealth)

'The Uncle-Nephew Program'

Frank Spry (centre)

• The decline in men's authority and control, a process of disempowerment, has been accompanied by a deterioration in their health and spiritual wellbeing.
• In the context of the colonial 'takeover', men have been sidelined as leaders.
• The taking away of men's roles has also contributed in a significant way to the breakdown and collapse of community life.
• Existing health programs are in many ways incompatible.
• These programs are culturally inappropriate, inaccessible and do not work.
• The majority of health programs are delivered by female health workers in almost all of the Aboriginal communities in the Northern Territory.
• Specific programs like STD/AIDS, family planning, nutrition, primary and preventative health, in fact most of the program areas are not male focused and have a disempowering effect on Aboriginal men.
• The impact on Aboriginal men has been both negative and devastating, for example, chronic alcoholism, family violence, high imprisonment rates, deaths in custody, youth suicide and anti-social behaviour are just a few of the negative manifestations.
• At two recent conferences funded by the Territory Health Services, Aboriginal men testified to the loss of their own self-esteem, they emphasised the importance of returning to traditional, cultural and spiritual values that can provide strength.
• Men stood up and told their individual stories and the urgency that is needed to put into action a plan to improve their health and spiritual well being.
• Empowerment of Aboriginal men and their communities is crucial to the raising of men's self-esteem, quality of life, their health status and spiritual well being.
• Indigenous men must take a leading role in improving their own health status and that of their communities.
• Community involvement, consultation and providing the opportunity for men to define and take control of the issues that affect them is paramount to achieving positive and successful outcomes.
• Some of the links that hold Aboriginal society and culture together have been damaged, or broken. Men who have had a central role and responsibility in maintaining these links, have been cut off and alienated.
• This has resulted in 'spiritual imbalance', loss of identity and purpose, diminished roles and responsibilities, and a lack of respect and authority.
• The Uncle-Nephew relationship has a direct relationship to restoring the broken and severed links. It is an Aboriginal cultural model; Uncle/Nephew obligation and responsibility to family; respect for elders, family and community; teaching, leadership, guidance and discipline.
• 'Uncle-Nephew' approach can be used as a strategy to deal with Aboriginal men's issues.
• Uncle-Nephew is a cultural way of teaching and relating through family kinship and ceremonial responsibility. It supports and affirms values and beliefs that are fundamental to Aboriginal men's view of the world, and Aboriginal society. (The Strong Women, Strong Culture, Strong Babies is founded on similar fundamental concepts)

Indigenous youth, old men and supporters on the go in Alice Springs

• Empowering 'Elders' (uncles/men) to take control, leadership and responsibility is an important process in terms of dealing with their own health.
• 'Uncle-Nephew relationship' is a system based on the obligations of the Mothers-Brother (Uncle) to her son (Nephew). The relationship between the Uncle and Nephew is very strong, at times closer and more important than the Father - Son relationship.
• The 'Uncle-Nephew relationship' is based on an Aboriginal cultural framework. It has the potential to resolve very many issues including dealing with conflict situations.
• Men's Health Programs could be facilitated through the 'Uncle-Nephew' framework. Some of these programs might include; Nutrition, Family/Domestic Violence, Substance Abuse (petrol sniffing), Weight loss programs such as Gut Busters, Well Men's Checks, Diabetes, Tobacco, etc.
• Proposed Men's Centres are extremely important and central in terms of providing a 'place' where men can gather, maintain cultural activities and encourage younger men (Uncle/Nephew) in men's matters.
• Finally an Uncle/Nephew approach is about engaging Aboriginal men, Grandmothers, families and the community through a system that is already in existence and understood.
• The empowerment of Aboriginal men and their communities is crucial to the raising of men's health status.
• Community involvement, consultation and providing the opportunity for men to define and take control of the issues that affect them is paramount to achieving positive outcomes.

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The scenario in another community: Mr X has been named as a contact for an STD (his wife had a positive Tampon Test as part of her antenatal check up). He is picked up by a Health Worker (his aunt) and now sits in a crowded waiting room where he is the only adult male. Next to him sits his mother-in-law. The clinic staff are all female except the doctor who calls him into the consulting room. Mr X has to produce a urine specimen and carries the readily recognisable yellow-topped urine bottle through the waiting room to the only toilet. After this, the female Health Worker labels the specimen at the desk in front of the rest of the waiting room. By now everyone has worked out what is going on. Mr X later confides to his close friends how humiliated he felt. They all vow never to go back to the clinic.

• Gapuwiyak has a demountable "donga" (transportable building) about 25 metres from the main clinic.
• It was the vision of Terrance Guyula, Senior Male Health Worker, who felt frustrated by numerous current problems in Men's Health and difficulty accessing male patients.
• It was set up with assistance from Miwatj. Ongoing costs are mainly covered by Territory Health Services and the Gapuwiyak Community Council.
• It has a main office and waiting area, a bathroom/toilet and a private consulting room.
• The vast majority of men presenting to the Health Service are seen at this clinic.
• After opening, the number of adult males attending service increased by 600%.
• Miwatj staff and local nursing staff worked together with the Men's clinic to get appropriate systems in place, like a men's day sheet for clinic attendance.
• Also, the clinic became a discrete point for condom supply.
• This has been a significant achievement as it is preferred by the men.
• The Men's clinic is used as a platform for Health Promotion on Men's Health Issues.

• In 1996 Noongar men of the Southwest held their first gathering since the 1940's.

• Both the Wandering and Mogumber missions were established between the 1915 and 1918 periods. This was the Government's idea to re-educate the Aboriginal people of the southwest. To take children often forcibly from their families and placed in these missions. Adult Aboriginal people were also forcibly removed for almost any reason at all.

• The Government did all of this without consideration to Indigenous people's lives and what the effects would have on Indigenous people later on in their lives.

• Catholic and Baptists tried to look after Indigenous people, but had no idea about our lifestyles and culture.

• The missions were handed over to the WA Aboriginal Lands Trust (1976 onwards). Then in the 1980's the ALT handed the missions over to the peak Aboriginal Resource Agencies, the Southern Aboriginal Corporation (Wandering farm) and the Wheatbelt Aboriginal Corporation (Mogumber).

• Then came other gatherings such as the Father and Son Learning Together camp at Albany (1997), and the Indigenous Men's Conference held in Fremantle WA in November 1997. The Indigenous Men's Conference saw Indigenous men attend from all over Australia.

• Since attending these gatherings myself as an organiser and facilitator, I have found that there is a lot of concern regarding the well being of Indigenous men in a way that they put their health last. A report states that men look after their cars better than their own health.

• Out of the Wandering and Mogumber men's gatherings came two reports that were put into a 'Noongar Men's Health Manual' for Noongar men to read and present as facilitators at men's meetings in their own towns and areas.

• The other concerns from the men's gatherings were; Alcohol & Drugs; Mental Health; Unsafe Sex; Diet & Nutrition; Land claims; Language & Culture; Child Abuse; Domestic violence; and Father and Son relationships.

• Male statistics feature more significantly amongst many of the major causes of mortality and morbidity than they should.

• While it is important that gender does not determine the level of health care provided, there are issues that need to be addressed in a gender specific context.

• These problems are particularly obvious when looking at specific sub-groups. Eg., there is a marked disparity between the Indigenous population and non-Indigenous population.

• One of the main problems in trying to determine the exact difference between the two populations is the lack of data.

• There is anecdotal evidence that suggests Indigenous males do not seek treatment because of an unwillingness to attend health services.

• At a population level, increased access to primary health care services has improved many aspects of Indigenous health in the past twenty years or so. However, anecdotal evidence suggests there are still many barriers to accessing health services for Indigenous males.

• There is still much work to be done to identify the more detailed issues, both at a national and regional level.

• Develop a framework to focus primarily on supporting those Indigenous males who wish to use Aboriginal primary health care services. The secondary focus will be on providing guidance to mainstream primary health services.

• All State/Territory Governments have entered into framework agreements on Aboriginal and Torres Strait Islander Health that provide the basis for equitable outcomes.

• An agreed national strategy will help to ensure consistent approaches across the country. It is recognised that Indigenous men and their needs differ greatly throughout Australia.

• Allow men to take an active role in dealing with their own health care needs.

• For example, with the support of the Miwatj Health Service and the Gapuwiyak Council, the Gapuwiyak men's health program was established in 1997.

• This example demonstrates three things. Firstly, men's health must be addressed through specific strategies; secondly, when services are specific to male health issues, the men will attend; and thirdly, the service was developed within the terms set down by local men.

• To make existing programs more responsive and reduce the possible duplication of programs and resources, one possible option is to ensure that the health of Indigenous males is a major theme running through all programs.

• There are limited resources available to address broad population health issues within the Indigenous community. Therefore, it is important that services are effectively targeted without any unnecessary duplication.

• Workforce strategies - One of the key issues in improving men's health access will be an increase in the number of men who work in the health sector. For example, the role of male health workers is an important factor in drawing Indigenous males to primary health care facilities.

• The Service Activity Reporting (SAR) process will: contribute data and information to the policy and program development process; identify workforce issues; and total episodes of care by services – including a breakdown by gender.

Convention members were asked to split up into State/Territory groupings and elect their members of the Committee.

Mick Adams and Dr Noel Hayman were elected by nominated members. There was unanimous endorsement (show of hands) of these appointments. Convention delegates made the following suggestions with respect to what the reference Committee could undertake in its first year;

• Gain support and endorsement for the NIMHRC
• Ensure each State/Territory stages its own Indigenous male health Convention annually, and that the National Indigenous Male Health Convention is held bi-annually with the National Men's Health Conference.
• Work with local groups to examine the issues, and develop strategies for submission to Government.
• Develop formal links with the National Aboriginal and Torres Strait Islander Health Council that advises the Commonwealth Minister for Health.
• Advocate for resources, additional to current resources available within programs, specifically to address a range of male health problems, notably (i) alcohol, (ii) other drugs, (iii) domestic violence, (iv) suicide, (v) sexual abuse, and (vi) anger management.
• Advocate to ensure youth alcohol prevention and harm minimisation programs are adequately resourced.
• Advocate to ensure an equal amount of funds is allocated to health promotion and preventive programs for children and youth. Work at all stages of the health continuum, from health promotion to acute health care.
• Examine education programs for children and youth.
• Ensure all Indigenous male health strategies and support programs acknowledge and address issues of sexuality.
• Government and non-government organisations provide financial assistance in staging further State/Territory and National Indigenous Male Health Conventions.

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These were variously referred to by delegates as men's centres, men's refuges, men's shelters etc. During the Convention a consensus developed around the name Men's Place. Delegates working on the role of Men's Places generated the following ideas

• All Convention delegates joined in the debate on the need for, organisation and role of Men's Places. The following list contains the comments of Convention delegates on the proposed Men's Places. (In no particular order)
• Need to develop strategies for each region to ensure that all health workers are working on the same issues
• Work towards 5 year funding commitment
• Men's places important as a place where men can gather to talk about their problems
• A place which takes a practical approach to male health problems
• Will be a focal point of efforts to deal with male suicide, men released from gaol, & other mental health issues
• Men's place will be a "safe place for men coming out of prison, to stop them going back" and returning them safely to their country
• Be a place where men are encouraged to become health workers and for existing male health workers to "get more training".
• Will deal with domestic violence problems, "women have their refuges, men need theirs"
• "Develop an environment where men can share." Men have difficulty talking with women. The men's place can address these sorts of problems; a place where men can take care of each others physical, mental and emotional wellbeing.
• Young men are drifting away from their traditional lifestyle. Men's places may provide an area where these problems can be addressed.
• The male prison population is an issue; staff of men's places can provide visiting services to assist the rehabilitation process
• Indigenous men are not outsiders. We can research ourselves. "The Convention is a form of research". Men's places can play an active role in research.
• A place where older men teach the young about Indigenous life and traditions. Father to Son; Uncle to Nephew.
• Where men's health service is made culturally appropriate.
• What men's places do will vary from place to place, eg Alice Springs and small community will be different.
• Old men’s business needs very specialised services; definitely no women, exclusively male places to deal with all manner of male health problems and flexible to accommodate cultural variation.
• Recommendation made for the recruitment and training of men to work in men's places.
• Need to reinstate traditional ways of communication; eg stories, message stick
• Men's place a multipurpose centre to deal with all manner of problems, social, legal, health and other problems relating to family wellbeing, family breakdown etc.
• Question: How much funding is allocated to men's health?
• Answer: No specific funding is directed at male health within the Indigenous health sector.
• Research: Concern that communities are sick of research without follow-up services.
• Response: More Indigenous male involvement in research is needed.
• Katherine West Health Board: The advantages of the Katherine West Coordinated Care Trial were discussed.
• Funding: We can identify the problems. Just give us the tools (money and resources) and we can do the job.
• MBS/PBS: Commonwealth "unspent" MBS/PBS can be ‘tapped’ into.
• Much of Aboriginal health funding is swallowed up in government administrative costs---funding never reaches the ground. More funds must reach the ground. ‘Cashing out’ MBS/PBS is one way that is already being used.

Ken Lechleitner presented the following statement to the 3rd National Men's Health Conference in Alice Springs on the 6th of October 1999. The NT Minister for Health, Family and Children's Services, the Honourable Stephen Dunham MLA accepted the resolutions in principle on behalf of the Northern Territory Government.

Outcomes of the Convention

1. Establishment of a National Male Health Reference Committee;

2. Endorsement for the development of Men's/Male Places – to promote Indigenous male well-being;

3. To promote and fund a National Indigenous Male Health Conference every 2 years;

4. Each state and territory conducts an annual Indigenous Male Health Conference.

That the newly established National Indigenous Male Health Reference Committee be appointed as a Sub-committee to the National Aboriginal and Torres Strait Islander Health Council as advisers to the Council and the Commonwealth Health Minister on health and social issues regarding Indigenous male health matters.

That the Office of Aboriginal and Torres Strait Islander Health in the Australian Department of Health and Aged Care allocate appropriate funding to enable the newly established National Indigenous Male Health Reference Committee to operate sufficiently in order to promote and attend to the issues affecting Indigenous men's health.

That male health programs be established in the Territory Health Services and the Office for Aboriginal and Torres Strait Islander Health under the services such as the Community Development and Social Health branch to assist in providing an avenue to attend to Indigenous male health matters.

That State and Territory health services fully fund the concept of annual Indigenous Male Health Conferences in their states and territories.

We would like your support by endorsing the outcomes and recommendations submitted to you in this 3rd National Men's Health Conference. In addition we call on Mr Michael Martin, Deputy Secretary of the Territory Health Services, to advocate on behalf of the Indigenous men of Australia to have these outcomes and recommendations endorsed and implemented by the Federal Minister of Health.

Marched through Alice Springs and presented a Statement on Male Indigenous Health at the opening of the 3rd National Men's Health Conference.

Formed the National Indigenous Male Health Reference Committee. Work is in progress to establish links with peak health agencies and organisations.

General agreement to work towards the establishment of male centres or places as defined above.

Agreement was reached to run the 2nd National Indigenous Male Health Convention in the year 2001, prior to the 4th National Men's Health Conference. (Update: there has been a proposal to bring the 2nd National Indigenous Male Health Convention forward to the year 2000).

Territory Health Services agreed to provide an interim secretariat service to the National Indigenous Male Health Reference Committee.

• Convention has been successful because people in Central Australia wanted to be involved in the organising of the Convention. Therefore, men must build on the impetus and desire to take control. But don't expect fast results.

• Suicide is very much a health priority. Talking about it is a good thing. Must talk about problems before things can happen.

• There have been some success stories; not enough but they are there. Aboriginal Health Worker training and career structures/pathways program have been announced.

• Must identify the most appropriate contacts within Territory Health Services to obtain definitive information on the issues of concern.

• Looked forward to working in partnership with the National Indigenous Male Health Reference Committee and the regional male health groups in the NT.

"The clear message from the Convention was that Indigenous men should take greater responsibility themselves to improve the status of men's health and play their rightful role as leaders, fathers, uncles, husbands and grandfathers".

Diversity and Commonality:  The exchanges at Ross River highlighted the diversity in masculinity and being an Indigenous male in Australia. Yet, the exchanges also confirmed the common attributes shared by Indigenous males from all over Australia.

Statistics:  Unfortunately, some of the common attributes are related to poor health and an absence of well-being. For example, the Australian Bureau of Statistics reports that the average life expectancy for Indigenous males is about 57 years across Australia. When compared to the 75 year life expectancy for all Australian males, there is an 18 year difference. These figures did not come as a revelation to the Convention. As one Aboriginal man from Central Australia commented:

Australia Compared:  While the tools (funds and resources) are available in Australia, the life expectancy of Indigenous males is on a par with males living in countries with few resources. For example, the rate is about the same in Papua New Guinea, Mongolia, Ghana, Swaziland, Yemen, Bangladesh, Lesotho, Western Sahara, Bolivia and Nepal. Also, the life expectancy of Indigenous males in Australia does not compare very well to the life expectancy of Indigenous males in other colonised countries, such as the USA, Canada and New Zealand.

NT Case Study:  From 1982 to 1996, the life expectancy for non-Aboriginal males, non-Aboriginal females and Aboriginal females in the Northern Territory increased.  On the other hand, there was no increase in the life expectancy for Aboriginal males. This phenomenon indicates that there are serious flaws in the delivery of health services to Aboriginal males in the NT. Similar situations exist in the other states and territories.

These situations need an urgent response. Indigenous males are working to "fix the problems". All sectors of the community and government are invited to work with us.

Photos by Robert Assan, Roy Price, Patrick Torres, and Vladimir Williams.

For the purposes of promoting male health, the information contained herein may be copied and distributed freely as long as its use is acknowledged and is for non-commercial purposes.

Whilst every effort has been made to ensure the accuracy and reliability of the information contained in this report at the time of production, Territory Health Services cannot warrant that the information is completely accurate. The views expressed in this report are not necessarily supported by THS. Neither the Northern Territory of Australia nor its employees, servants or agents will be responsible or liable for any loss or damages occasioned by the publication of this report.

We apologise if there are any misspelled names, misquotes and other unintended inaccuracies. Please contact Joe Martin-Jard on 08 89992424 or Roy Price on 08 898516911 for comments and corrections. Alternatively, send an email message to mens.health@nt.gov.au.