Traditional land owners, Arrernte Country

Chairperson Aboriginal and Torres Strait Islander Commission, Mr Gatjil Djerrkura

Territory Parliamentary Colleague John Elferink

Distinguished guests

Ladies and gentlemen.

It gives me great pleasure to be here today for the third Men’s Health Conference and I thank you for the invitation to officially open proceedings.

In recent years, men’s health issues have been gaining increasing attention and recognition amongst workers in the health and community services fields and in the community at large. This has been based on an increasing awareness that gender is a significant determinant of health.

While programs to address women’s health issues have been established for many years, men’s health programs are only just beginning. This situation is surprising given the differences in health of men and women that have persisted over the years.

On average, men can expect to live significantly shorter lives and experience higher mortality rates at all ages than women. In the Northern Territory non-Indigenous males born in 1996/97 can expect to live 77.3 years compared to 85.5 years for non-Indigenous women. For Indigenous men the disadvantage in life expectancy and morbidity is far worse than for non-Indigenous men who can expect to live only 58.6 years.

There are no known genetic or biological reasons why women should live longer than men, or why non-Indigenous men live longer than Indigenous men, therefore the reasons for the health differential must be sought elsewhere.

It is now readily accepted that men and women experience health and illness on a number of levels including physical, social, mental, emotional, environmental, cultural, spiritual and sexual levels.

These experiences of health differ considerably between men and women, and between men of different ethnic and cultural backgrounds. Health should be viewed as a holistic concept.

Most health planners, policy makers and health professionals have been aware of the gender differences in health for some time, but it is only recently that they have begun to ask about;

• why men live shorter lives than women,
• why Indigenous men live much shorter lives than non-Indigenous men,
• why men use health and community service facilities at rates lower than women,
• why men are more likely to be victims of accidental death or injury, and victims or perpetrators of serious crime; and
• what can be done to improve the health of men, to close the gap in life expectancy between men and women and between Indigenous and non-Indigenous men.

Despite this shift in viewpoint, there is still a tendency to accept men’s health disadvantage simply because this is the way men are. It is this assumption that must be challenged and the road to manhood looked at from another more enlightened perspective that takes into account the many factors that structure and regulate men’s lives. Growing up male need not be accompanied by increased risks to health and wellbeing.

The health differences between men across the social strata and between Indigenous and non-Indigenous men ought to dispel once and for all any ideas that gender stereotypical behaviour alone is responsible for the health differential.

The temptation to lay responsibility for men’s health solely at the feet of the affected individual must therefore be rejected. Instead a more holistic appraisal is needed that considers the part social, economic and cultural factors play in determining health damaging male behaviour and the social and economic circumstances that create and perpetuate men’s poorer health outcomes throughout their lifespan.

In the context of the individual, the family and community, the health behaviours and health status of boys and young men need to be examined for their later impacts on the health of men.

Crucial to an understanding of this is an understanding of their socialisation as they make the transition from boys to men and the processes of growing up male. Many of the social factors that affect men’s health are first encountered by boys in childhood.

The central theme of this, the 1999 National Men’s Health Conference is precisely that; of growing up male in contemporary society and the various impacts this has on men’s health. The remaining three themes; medical and clinical issues; varieties of masculinity; and, working with others-relating and collaborating, cut across the process of growing up male.

Together these four themes will help conference delegates develop a better understanding of the scope and complexities of men’s health and the most appropriate ways of dealing with the variety of health problems they may encounter.

These problems emerge at various points in men’s lives, when there is a breakdown in their physical, mental and spiritual wellbeing. Men’s proper role and place in the family, community and society should be taken into account while exploring solutions and services to deal with the problems.

The Territory is unique among State jurisdictions in its cultural diversity and demography.

These two factors alone make the delivery of health services generally and men’s health programs in particular especially challenging.

More than 28 per cent of the Territory’s population is Indigenous. Furthermore, over 65 per cent of the NT’s Indigenous population live in remote communities.

In proportional terms, Indigenous men’s health problems probably equal or exceed that of the rest of the Territory’s male population combined. But there is of course a significant population of non-Indigenous males living and working in our remote regions on cattle stations and in the mining industry.

These men also have special health care needs unique to their role and occupation in remote areas.

In remote communities general health care services are provided by a complex mix of Northern Territory Government funded and managed health services, NT funded community controlled health services and some Commonwealth Government funded community controlled health services.

Together these provide a range of service delivery outlets numbering over 100 from which community based men’s health services designed specifically to meet the needs of the local male population may be provided.

Social and cultural problems in Aboriginal communities where the role of men in Aboriginal communities has been weakened over the years to the extent that men feel alienated and useless, has impacted negatively on their health.

While women have managed to translate their traditional nurturing role into an active involvement in modern health and welfare activities with relative ease, men have not been able to accomplish this transition as successfully.

The Territory’s Strong Women Strong Culture Strong Babies program is a good example of the receptivity of Indigenous women to combine modern health concepts with tradition. The conflict that exists between men’s traditional obligations and the need for them to be actively involved in various aspects of modern community living and maintenance of health must be resolved.

Remedying the health problem therefore necessitates a holistic community based approach which includes not just treatment services but also measures that target the underlying social and cultural causes.

The problem of integrating Indigenous communities into mainstream society is also a problem of re-instating the role of Indigenous males in their own community structures in a way that produces healthier lifestyles and relationships for men and their families.

Men’s health needs to be placed on the agenda of all government and non-government agencies that are involved in activities that may impact on men’s health.

The involvement and commitment of government agencies such as Education, Local Government, Sport and Recreation, Police and Correctional Services, Racing and Gaming, Licensing Commission, and non-Government organisations such as licensed venues, sporting clubs and other organisations is crucial to the success of attempts to address men’s health.

It is one the aims of Territory Health Services to focus people’s attention on these inter-relationships and help put men’s health on the agenda of other agencies and organisations.

We know that men tend to delay seeking assistance from health services longer than women and this must contribute to their health disadvantage. We also know that poor access to prevention and early treatment is a problem for many men. This is particularly a problem for Aboriginal men in remote communities, and for men from non-English speaking backgrounds due to a range of literacy, communication or cultural difficulties.

What needs to be improved are the ways in which current services are oriented; particularly in moving them towards prevention and earlier intervention, so that services are more accessible and more flexible in approach in meeting the diverse needs of the different groups of men in our community. Territory Health Services’ men’s health policy unit will play an important role in progressing this approach.

The Men’s Health Policy Unit was established in 1997, by Territory Health Services in response to rising concerns over men’s health in particular Indigenous men’s health. The main functions of the unit are:

• to provide strategic directions on men’s health for Territory Health Services and non-government health organisations and other organisations involved in men’s issues;
• to develop a men’s health policy and strategic action plan for the Northern Territory that reflects the diversity of men’s health problems; to facilitate the coordination of THS programs to ensure design and delivery of services include a male focus;
• to coordinate the involvement of other Territory and Commonwealth Government Departments and non-Government Organisations in achieving more effective inter-sectoral linkages for maximum men’s health gain.

The response to the establishment of the Men’s Health Policy Unit has been encouraging from both Indigenous and non-Indigenous men and men’s organisations.

Worthy of note is the open enthusiasm for men’s health programs from Indigenous women who feel that their men have been seriously disadvantaged for many years and that their communities have suffered as a result.

Within the Men’s Health Policy Unit there is a strong focus on Indigenous men’s health. We make no apology for this priority which is supported by the current state of Indigenous men’s health.

The aim of this sub-program is to improve the health and wellbeing of Indigenous people with an emphasis on the responsibility and leadership role of Indigenous men on health and health related social and cultural issues in communities.

Some of the objectives of Indigenous men’s health include:

• raising Indigenous men’s awareness of the relationship between their physical and mental health and social relations in communities;
• to inform Territory Health Services what men’s priority concerns are so that existing programs can be reorientated accordingly;
• to encourage Indigenous men to take a leading role and involvement in the design and implementation of special programs targeting the health of Indigenous people;
• to assist in the implementation of strategies to re-establish and reinforce the traditional roles and relationships between younger and older men and the proper role of men in community life;
• to inform service providers of socio-cultural dynamics underpinning health problems before attempting to develop solutions;
• assist in the development of men’s health/educational/social support services to address social and cultural problems that impact negatively on health and which stem from poor family and community relations and inability to adapt to social change;
• assist in the understanding and development to address the concerns of male Indigenous Health Workers and the need for appropriate supports and to ensure the correct gender balance of health workers in communities is maintained.

The enthusiasm from the Territory’s Aboriginal community for these developments has given rise to a range of community based men’s health meetings, workshops, seminars and health creation programs.

In 1997, more than one hundred Indigenous men including tribal elders, community councillors and health workers from Government and non-Government organisations from around the Territory attended workshops held in Darwin and Alice Springs to discuss social and cultural issues relating to health problems affecting Indigenous men, the shortage of appropriate services, and design and delivery of more suitable services.

These workshops were sponsored by Territory Health Services in response to calls from Indigenous men to develop health programs for men.

The workshops succeeded in meeting two principal aims; to raise Indigenous men's’ awareness of their health and the underlying social causes and inform Territory Health Services about the priority health concerns amongst Indigenous men.

These two meetings spawned a succession of further meetings, workshops and seminars in various communities throughout the Territory, as well as the 1st National Indigenous Male Health Convention ‘Growing up as an Indigenous Male’ held at the Ross River Homestead outside Alice Springs earlier this week.

What has emerged from the various workshops is the need to strengthen and tap into traditional social structures and linkages, and to take heed of the adage ‘old people know best’.

Older men’s knowledge and status in communities must be employed to influence younger men. The use of story telling by older men recounting personal achievements such as ‘beating the grog’ and restoring good social and family relations that benefits health should be encouraged.

It is important for the father-son, as well as uncle-nephew relationships (which is also one of the programs to be talked about today) be restored to their proper place.

Fathers need to teach their sons. Sons should accompany their fathers when attending talks on men’s health. It is important for sons to see their father as a role model.

Men’s health has come a long way in a short space of time nationally, in the other States and the Northern Territory, but this has been from a very low baseline. Much more needs to be done to address what is a complex health problem in a socially sensitive and innovative way.

This conference and the 1st National Indigenous Male Health Convention will help achieve that goal.

I wish you all well in your deliberations and thank you once again for the opportunity to officially declare this conference open.

Thank you.