Australian males die, on average, five years earlier than women. Four experts discuss why this longevity gap is so difficult to bridge.

THE ADVOCATE: JOHN MACDONALD

Until recently, issues of men’s health were generally relegated to specialists in some physical pathology (for example, erectile dysfunction) or experts specialising in social pathologies of men, often described as “masculinity”. To answer the question posed, however, involves a cultural shift: to see if explanations for male health can be found in how supportive society and/or health services are for boys and men.

While 51.5 per cent of babies born are male, the mortality rate of male children is greater than that of female children and this pattern of higher mortality remains throughout childhood, adolescence and adulthood.

Doctors’ surgeries and community health centres have become places for women and children, or at least where women feel more at ease. This is understandable perhaps, given the big role women have played in child care, but it has resulted in a “health” culture that has excluded men. When, as a newly appointed professor of primary healthcare 15 years ago, I started to visit community health centres, the not infrequent reception was: ”Sexual health or drug and alcohol are in that other building.”

We have made it normal for women to have regular screenings. We need to make the same effort to make it normal for men to go for regular check-ups. Many states, led by NSW 12 years ago, have men’s health policies or plans. The Commonwealth’s Male Health Policy marks a true watershed, presenting a challenge to the health profession and society at large. Among other things, it emphasises “male-friendly” health services rather than just blaming men for non-attendance. So I am now empowered to ask doctors and community health services what they are doing to make attendance easier for men – for example, for those who commute for two hours in the morning and two in the evening.

The policy also talks of the importance of the context of men’s lives to their health – the social, economic and emotional circumstances which affect them. One example: men often do health-threatening (and even life-threatening) work to support their families.

We need to rethink accessibility to “male-friendly” health services. Also, as promised by the forthcoming national male health longitudinal study, we need to examine the environments which determine the health of males – and improve them.