The National Male Health Policy

The Healthy Male
NEWSLETTER OF ANDROLOGY AUSTRALIA
Winter 2013
National Male Health Policy
Australian Centre of Excellence in Male Reproductive Health
issue 47
BUILDING ON THE STRENGTHS OF
AUSTRALIAN MALES
CONTENTS
1 Male Health Policy
Three years on
2 From the Director
2 Letters
Andrology Australia’s
outgoing Chairman reflects
2 Health Spot
The Foreskin
3 Focus On
The National Male
Health Policy
5 Community Development
Men’s Sheds: Here, there
and everywhere
5 Research Round-up
Ten To Men: The
Australian Longitudinal
Study on Male Health
6 Latest News
Learning about screening
6 News in brief
National Male Health Policy:
Three years on
We have just celebrated another
International Men’s Health Week
(IMHW). Community groups around
Australia continue to lend their
support to men’s health advocacy
efforts through IMHW events. What
we may not remember is that IMHW
was first recognised in Australia in
2002, which prompts us to stop and
think what has changed in the men’s
health landscape in that decade.
Certainly, the phenomenon that
is Movember has gone a long
way towards ‘changing the face
of men’s health’ in Australia and
overseas. Men’s Sheds is also a great
example of a grass-roots movement
that has expanded nationally and
internationally over the years. Such
initiatives suggest that men’s health is
indeed receiving greater recognition
in the broader community.
Arguably the most significant
change in the last ten years was the
development of the first National
Male Health Policy, launched in May
2010 by the Australian Government
in response to extended calls from
men’s health advocacy groups and a
2007 pre-election commitment by the
Labor Government.
The release of the Policy, together
with nine supporting documents,
provided a comprehensive analysis of
male health issues and a framework
for action to improve male health
outcomes for all males across
Australia. In addition, a total of
$16.7 million over four years was
committed to male health programs
that supported the Policy.
Despite the release of the Policy,
advocacy efforts still need to
continue so that changes in health
outcomes are seen for all males across
Australia. Three years on since the
Policy was introduced, it’s a good time
to reflect on what’s been achieved
and to look ahead to what remains to
be done over the next decade.
From the Director
Letters
In my time as Chairman of Andrology
Australia, I have seen significant
increase in both community awareness
of men’s health and desire for reliable
information from authoritative,
independent sources.
Highlights of my time with Andrology
Australia include the Men in
Australia Telephone Survey (MATeS),
development of the online information
resources and the extent to which
they are now utilised, and the progress
achieved in health awareness and
action for Aboriginal and Torres Strait
Islander men.
I hope that we will see further
development of Andrology Australia’s
information base and distribution
systems for the community at large,
expansion and greater penetration
of professional education, driven by
the early general adoption of the
proposed medical curriculum module,
and significantly increased funding,
both government and private sector,
particularly to help drive expanded
research and education efforts.
Finally, I urge all Australian men to
talk openly to your doctor about
health issues, sooner rather than later
and as often as they arise!
Mark Rayner
Andrology Australia Chairman 2001–2013
The National Male Health Policy’s aim
to ‘improve the health of all males
and achieve equal health outcomes
for population groups of males at
risk of poor health’ is a bold longterm vision, and we won’t know how
effective it has been for years or
perhaps even decades.
But three years on we can still reflect
on achievements to date and ask
if the foundations for longer-term
change have been established.
My thanks go to all contributors to
this issue of The Healthy Male who
provided insights into key Policy
activities and opportunities that still
exist to ensure that the Policy makes
a lasting difference to the health
outcomes of all Australian males.
I also take this opportunity to reflect
on the significant contribution
that our recently retired Chairman,
Mr Mark Rayner, has made to the
Andrology Australia program during
his twelve-year appointment.
Mark has been an integral part
of Andrology Australia since the
start. We have always valued his
commitment and business acumen,
and his unwavering support of the
program over many years.
We are fortunate to have an equally
talented and experienced new
Chairman in Mr David Crawford, and
we welcome him to the program.
Professor Rob McLachlan
Health spot - The foreskin
It is now uncommon, except for
religious or cultural reasons, for boys
to be circumcised as babies. It is
important therefore that boys and
men take care of their foreskin to
avoid certain penis problems.
At birth, the foreskin and the glans
penis (head of the penis) are joined.
As boys start growing, an increase
in hormones helps the foreskin and
glans to separate and the foreskin
can then be pulled back. In most boys,
this happens at around three years
of age. The foreskin of an
uncircumcised boy should not
be forcibly pulled back as this
can cause bleeding and injury.
If force is used to pull back the
foreskin, scarring can happen.
This scarring can cause problems
in the future with retracting
(pulling back) the foreskin, a
condition called phimosis. If the
foreskin cannot be pulled back, it
is hard to keep the inside of the
foreskin clean and this can lead
to inflammation of the glans
penis, sometimes due to infection,
a condition called balanitis.
All uncircumcised adult men
should have a periodic genital
examination by their doctor and
have their foreskin retracted to
check for signs of infection or
penis cancer. If there is an infection,
the doctor may prescribe antibiotics
or antifungal medication. In severe
cases of balanitis, circumcision may be
recommended. To avoid balanitis, do
not use strong soaps and chemicals,
and pull back the foreskin and clean
it daily.
For more information, see fact sheet “Penis
Problems” at www.andrologyaustralia.org
or call 1300 303 878.
Focus on: The National Male Health Policy
Where are we at with the
National Male Health Policy? The
following overview highlights key
activities targeting male health
and identifies opportunities
that still exist to ensure that
the Policy makes a lasting
difference to the health outcomes
of all Australian males.
Statistical bulletins
on male health
Governance
Minister’s Male Health
Reference Group
An important initiative instigated by the Minister
responsible for male health, the Hon Warren Snowdon
MP, was the establishment of an expert advisory group,
comprising leading academics, health professionals and
key stakeholders in male health. The Reference Group
meets about three times a year to provide advice on male
health issues and oversee the implementation of key
Policy initiatives.
The Reference group has also provided advice on specific
program activity made available through the Policy, and is
developing a strategic framework to ensure that identified
Policy action areas can be effectively implemented.
The work of the reference group is complemented
by meetings between representatives of Australian
Government Departments that manage programs
which impact on men’s health. These meetings aim to
enable a more co-ordinated approach to male health
across Departments; identify opportunities for potential
collaboration; and share learnings about effective programs
relating to male health.
Supporting national
infrastructure
Building the male health
evidence-base
Importantly, for any policy to be effective and to
appropriately align resources to identified need, strategies
need to be informed by robust evidence. An important
Policy area is the attention to building the male health
evidence-base and providing the infrastructure that will
allow researchers, health professionals and policy-makers
to better understand the impact of sex, age and gender on
attitudes, behaviours and outcomes and understand the
behavioural, economic and social determinants that put
some groups of males at greater risk of poor health.
The Australian Longitudinal Study on Male Health—known
as Ten To Men—was commissioned in 2011 by the Australian
Government Department of Health and Ageing as a key
element of the Policy to build the evidence base on male
health and ensure that evidence will be a key factor in
shaping male health policy over time.
The longitudinal nature of the study is crucial to this
task—not only does it allow the identification of the
lifestyle and environmental factors that play a role in
determining health outcomes (both good and poor
outcomes) in the future for males, it will also generate
knowledge of risk and protective factors associated with
health outcomes over time, and thus identify potential
targets for policy intervention.
Moreover, the longitudinal approach, particularly one
that follows participants from a young age, allows an
examination of the key transition points in men’s lives
and the impact of these on lifestyles and health, for
example, entering the workforce, establishing relationships
and becoming a father. This life-course approach will
present policy opportunities for supporting the health and
wellbeing of Australian males at such key life stages.
The Ten to Men study is an important national resource
with data collected being made available, upon application,
to the broader male health research community.
More on the Ten to Men study is included in the Research
Round-up column in this newsletter.
Commonwealth support was also provided to the
Australian Institute of Health and Welfare (AIHW),
the government agency that collects and analyses
health and welfare data for all Australians, to
develop regular statistical bulletins on male
health. Drawing on a wide range of national data
sources, the AIHW publish up-to-date ‘snapshots’
of the health and wellbeing of Australian males
for health professionals, academics, policy-makers
and the broader community to discuss and debate
current issues and future trends in male health.
Launched in June 2011, the first in the series
of four male health bulletins, The Health of
Australia’s Males, provides a summary of the
health and wellbeing of the Australian male
population. The first bulletin ‘sets the scene’ by
outlining the lifestyle factors influencing male
health, the health status of Australian males and
their access to health services.
The Health of Australia’s Males: A focus on five population
groups was the second in the series of male health bulletins,
released in June 2012. This bulletin starts to break down
the data into distinct health profiles of five population
groups, namely Aboriginal and Torres Strait Islander males,
males living in regional and remote areas, males living
in socioeconomically disadvantaged areas, males born
overseas and older males.
Bulletins can be accessed directly from the AIHW website,
www.aihw.gov.au
Supporting
population groups
Programs to alleviate
social isolation
A key determinant of health is social isolation. People
who are more isolated tend to demonstrate poorer health
outcomes across a range of measures. Recognising the
impact of social isolation, the Australian Men’s Shed
Association (AMSA) was funded to develop national
infrastructure aimed at ensuring the future sustainability
of men’s sheds. At the time of the Policy launch, there were
approximately 300 men’s sheds nationally in various stages
of operation: today there are over 940 with an estimated
200 sheds in many other countries such as Ireland, New
Zealand, Canada, United States and the United Kingdom.
Through the Policy initiative, the AMSA also administers the
Australian Government Shed Development Program that
provides direct financial assistance to Men’s Sheds, by way
of small grants.
Another organisation, Mensheds Australia, has been funded
to undertake and support health initiatives targeting Men’s
Sheds with Aboriginal and Torres Strait Islander participants.
More on the Men’s Sheds program is included in the
Community Development column of this newsletter.
Programs to support Aboriginal
and Torres Strait Islander Fathers
It is well-recognised that Indigenous males are the most
disadvantaged population group in Australia in terms
of physical health and wellbeing. A key element of the
Policy is the National Aboriginal Islander Male Health
Framework Revised Guiding Principles, which recognises
the interconnectedness between individuals, families and
communities and the need for a holistic approach when
addressing the health needs of Indigenous males.
As part of the Policy, funding was made available for The
Strong Fathers, Strong Families Program which aims to
build on and complement other Department of Health and
Ageing initiatives addressing Indigenous child and maternal
health. The program is designed to specifically promote
the role of Aboriginal and Torres Strait Islander fathers,
partners, grandfathers and uncles, and encourage them to
actively participate in their children’s and families’ lives,
particularly in the antenatal period and early childhood
development years.
Where to next?
As a result of the Policy, male health initiatives have
been established that start to lay the foundation on
which to build future policy and programs specifically for
Australian males.
It is hoped that as we move into a final year of a four-year
commitment, resources are directed to develop key, relevant
and measurable male health indicators and an independent
evaluation of Policy actions is undertaken. Such initiatives
will help ensure that limited resources are aligned to
evidence-based and integrated programs and services and
the effectiveness of the Policy actions can be appropriately
measured. The Policy spoke of much promise: building on
the foundations that have been established will help ensure
‘optimal health outcomes of all Australian males’ is an
achievable goal.
Andrology Australia would like to thank Dr Dianne Currier (Ten to
Men), David Helmers (Australian Men’s Shed Association) and Professor
Rob Moodie (Chair, Ministers Male Health Reference Group) for their
contributions to this Focus On article.
Community Development
Men’s Sheds: Here, there and everywhere
suicidal men. Nor are they a referral
agency that provides comprehensive
counselling that will make everything
better. And they are definitely not a
place that society should look upon
with pity for suffering occupants.
Men’s Sheds are vibrant places full
of good, well men participating in
meaningful projects for the benefit of
themselves and their communities.
I
T IS easier to state what a
Men’s Shed is not rather than
to describe what it is. Men’s
Sheds are not places full of lonely,
clinically depressed, social outcasts or
The Australian Men’s Shed Association
(AMSA) views Men’s Shed facilities
as providing a comfortable place of
belonging for men, where they can
work together and be an inclusive
part of the community, where they
can talk comfortably on issues to do
with their lives and also their health,
and in this sense can be seen as
another health preventative measure.
They also provide an ideal platform
from which to launch future men’s
health initiatives.
But over the years they have become
so much more than this, Men’s Sheds
have become key social hubs within
their community, the men of the sheds
have developed a strong sense of
belonging to and ownership of their
sheds, their community and to their
Association, AMSA. Sheds have become
community service organisations
contributing valued support to many
other community groups and facilities.
They have achieved so many objectives
it is now harder than ever to clearly
define or summarise exactly what is a
“Men’s Shed” and what does it do.
Although Sheds existed before the
National Male Health Policy, it is
clear that with the support of the
Policy and the energy of the shedders,
Men’s Sheds have made a significant
difference for the betterment of men
and the wider community.
Our thanks to AMSA for providing this article. For
more information please visit www.mensshed.org.
Research round-up
Ten To Men: The Australian
Longitudinal Study on Male Health
T
HE MELBOURNE School of
Population and Global Health at
the University of Melbourne is
overseeing the establishment of the
Ten to Men study and coordinating
the first wave of data collection.
The chief investigators are Professor
Jane Pirkis (Director of the Centre
for Health Policy, Programs and
Economics) and Professor Dallas
English (Director of the Centre for
Molecular, Environmental, Genetic and
Analytic Epidemiology) supported by
four advisory groups of more than 30
researchers from across Australia.
The aims of Ten to Men are to:
• Examine male health and its key
determinants including social,
economic, environmental and
behavioural factors that affect
the length and quality of life of
Australian males,
• Address a range of key research
questions about the health of
Australian males, including their
health behaviours and risk factors
(including risky behaviours), key life
transition points, social and economic
environments in which they work and
live together with their use of health
and other services, and
• Identify policy opportunities for
improving the health and wellbeing
of males and providing support for
males at key life stages, particularly
those at risk of poor health.
The study will recruit three cohorts of
males between 10 and 55 years from
across Australia (boys aged 10-14
years; adolescent males 15-18 years;
and adult males 19-55 years). It is
anticipated that follow-up surveys
will be conducted every three years
to gather data on health and lifestyle
changes and outcomes over time.
Wave 1 data collection will occur in
the second half of 2013.
The first of its kind, the Ten to Men
study is providing an important
resource for improving the health and
wellbeing of Australian men and boys.
Our thanks to Ten To Men for providing this
article. For more information please visit
www.tentomen.org.au.
In brief
Latest News
Expressions of Interest:
PhD Scholarship in Aboriginal and
Torres Strait Islander male health
Learning about screening
As part of Andrology Australia’s
program to build research capacity in
men’s health, expressions of interest
(EOI) are being called for a scholarship
for an Aboriginal and Torres Strait
Islander student to undertake full time
research towards a PhD degree.
It is proposed that the project will focus
on health service access and primary
health care for Aboriginal and Torres
Strait Islander males. Applicants will
need to negotiate their candidature
with an Australian University.
Details about the PhD scholarship and
EOI application process are available at
www.andrologyaustralia.org/phd/.
We need your help
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approaches, we invite you to contribute
to our annual gift-giving program.
Andrology Australia rarely appeals for
donations but with broader restrictions
on Government funding and the
growing need for our work, your
tax-deductible donation will help us
continue our community, professional
and research programs in men’s health.
You may choose to support a specific
project, such as helping to sponsor a
PhD student and sustain our research
program in male reproductive health.
To donate online please visit
www.andrologyaustralia.org/donate/.
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A
SCREENING TEST is one
carried out on a population
of apparently healthy people
intended to find out who is likely
to have a specified disease and who
probably does not. It is not meant
to be a diagnostic test and usually
further testing is needed. Factors that
make a good screening test include:
• the nature of the disease itself (e.g.
its severity and how often it occurs),
• the effectiveness and risk of sideeffects of available treatments, and
• the cost, safety, convenience, and the
sensitivity and specificity of the test.
The sensitivity of a test shows how
reliable it is based on the proportion
of people with the disease who get a
positive result to the test: the higher
the sensitivity, the better the test is at
detecting people who have the disease.
On the other hand, specificity shows
how well a test excludes people who
do not have a particular disease: the
higher the specificity, the fewer false
positives (a false positive is where
a positive screening test indicates
a person may have the disease but
further testing shows they do not have
the condition).
In general, a good screening test has
high sensitivity and high specificity
but most tests work in such a way
that increasing sensitivity reduces
specificity, and vice versa.
Clinical adviser to the National
Prescribing Service (NPS) Dr Andrew
Boyden says there is complexity for GPs
in deciding which tests are appropriate.
“There is a great opportunity to
identify people who are at increased
risk of developing chronic conditions
and give them the opportunity to
make lifestyle changes that will
benefit them into the future,” he says.
“However tests are just one part of
the story and are not infallible. Taking
a good clinical history and physical
examination and considering family
history and lifestyle issues will best
determine which patients are most
likely to benefit from which tests.”
NPS is providing a new educational
program that encourages GPs to
prioritise the use of evidence-based
risk assessments and tests and avoid
inappropriate testing.
“Harm can be caused through
overdiagnosis—for example a test
may identify a condition that if left
alone would not impact on a person’s
health, but once identified could
lead to further investigations and
treatments with harmful side effects,”
says Dr Boyden.
“Helping patients understand the risks
and benefits of tests in relation to
their individual health needs will help
them to make informed decisions in
partnership with their doctor.”
NPS has launched an information hub
(www.nps.org.au/preventive-health)
that provides a more detailed appraisal
of the latest evidence on a range of
tests used during preventive activities,
such as prostate-specific antigen
(PSA), faecal occult blood test for
colorectal cancer (FOBT), vitamin D,
thyroid, diabetes risk assessment
and the absolute cardiovascular
disease risk assessment. Look for the
article ‘Testing Times’, for a detailed
comparison of the PSA and the FOBT.
NEWSLETTER OF ANDROLOGY AUSTRALIA
Australian Centre of Excellence in Male Reproductive Health
The Andrology Australia project is supported by funding from the Australian Government under
the Health System Capacity Development fund, and is administered by Monash University.
Postal Address:
Andrology Australia, c/o Monash Institute of
Medical Research PO Box 5418, Clayton,
Victoria, Australia, 3168
Web:
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Street Address:
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DISCLAIMER: This newsletter is provided as an information service. Information contained in this newsletter is based on current medical evidence but should not take the place of proper
medical advice from a qualified health professional. The services of a qualified medical practitioner should be sought before applying the information to particular circumstances.