men's health diet 2013

hello. i'm norman swan. welcome tothis program called out of the shed: overcoming the barriers to men's health. each and every hour in australia,more than five men die from conditionsthat are potentially preventable. australian men experience higher ratesof morbidity and mortality than women across many health conditions. despite this,men tend to have fewer visits to doctors and often seek medical assistanceat a later stage in their illnesses. this program will look at preventativeapproaches in men's health,

and the need to make your surgeriesand services more attractive to them. we'll also give you tipson appropriate communication skills. the program's going outas both a satellite broadcast over the rural health educationfoundation's satellite network and as a live webcast. what we'd like to do is get an ideaof where you're located. so tell us where you're located - metropolitan, regional,rural or remote australia? i'll come back to the answersto that question in a moment.

as usual, there are a numberof useful resources available for you on the rural health educationfoundation's website - rhef.com.au. don't go there just yet,because you're going to meet our panel. david oberklaid has over 25 years'experience in general practice. he's a member of the medical advisorycommittee for foundation 49, a not-for-profit organisationdedicated to improving men's health. - welcome, david.- thank you, norman. you've also worked with gp divisions,

trying to get better men's healthin general practice? we had a program where we tried to take a more systematic approachto men's health, and also make practicesmuch more men-friendly. we had some success with that program, so there are possibilities,possible ways, to improve management of menin general practice. - and applicable elsewhere?- i think so. - we'll come back to some tips later.- yep.

kate temby has beenworking in health promotion and nursing for her entire career. kate coordinatesthe men's cancer program at the cancer council of victoria and sat on the education committee of the australian prostate cancercollaboration. and kate is now the executive officerat foundation 49, analysing, designing and applyingpractical health strategies to improve the health of men nationwide.

- welcome, kate.- thank you. so, just tell me a little bit moreabout foundation 49 and what you do. foundation 49 is really about trying tomake health more accessible to, i guess,the general population of men. we do that through trying to raise community awarenessabout men's health issues, encouraging mento have regular health checks. i guess we're a step outsidegeneral practice in really trying to work with mento engage them

more with a gp, and that sort of thing. we do that through a few different ways. one of the things that we dois we produce a health promotion magazine for men, which is this one right here. and it's just full of all sortsof information and stories that are particularly targeted for men. so, the visuals, the language,all of those sorts of things are all targeted at men.

and we have human interest storiesand all those sorts of things as well. ideal for waiting roomsin general practice. they're free,so they get sent out for free. - and...- and you have a toolkit as well. we have a toolkit as well.that's this little one here. and it's a little booklet that just contains informationabout all sorts of men's health issues, and preventive measures that they canchat with their doctor about, and... norman: so it's designed for menrather than clinicians.

that's right. it's for men, so theyhave something to take in and talk to their gp about. good. we've already got one question in, so you'd better get goingand send us in some questions on the live talk button under submit. those of you watchingin the regular way, don't lose out. you get your questions in too to1800 817 268, if you want to phone. or fax 1800 633 410. mark wenitong is from the kabi kabitribal group of south queensland.

he's a senior medical officerat apunipima cape york health council, where he's working on health reformacross cape york aboriginal communities. welcome, mark. mark has also worked as the medicaladviser of oatsih in canberra. and i suppose this is the... men and... men's healthin indigenous communities is where it really getsto the pointy end? yep. absolutely. it's just one of the critical areas,and we know,

you know, we're not going toclose any gap until we address the men's issues,and men's health issues specifically, 'cause they're probably the population with the worst health statsin australia as a subgroup, even of the indigenous population,so it's a big job. but there's certainly waysthat we can produce better results and be more effective in the area. michael woods trained in the ukas a registered nurse, and developed an interestin mental health,

and that led to his becominga psychologist. he's currently a senior lecturer inbiomedical and health sciences at university of western sydney, he's coordinator of the men's healthinformation and resource centre located at the university. what does that resource centre do,michael? we do a range of things, norm.we do a little bit of research, had a few projects over the years. we've got some live projectsthat we learn from and work with.

we coordinate the men's shedover at emerton in western sydney, which is designednot necessarily for aboriginal men. we do get a large aboriginal cohortgoing into that place. a lot of it's about giving whole-of-lifesupport to men, particularly at times whenthings are difficult for them - family breakdown, etc. speaking of whole-of-life support, before we get into the bodyof the program, let me ask you, michael,the first question.

it comes from psychologistpaul campbell. 'do you think programs aimed at children should be embeddedinto the education system to redefine what being a male isand promoting healthier attitudes? this, i feel,' says paul campbell,'should not be generic, but specifically aimed at boysto create a new sense of being a male. perhaps possibly more antenatal classesfor men on being fathers and health and social issuesthat brings.' what do you think? i agree totally about the ideaof antenatal classes for men.

we certainly need them.a lot of men would really like those. i don't know that i would beso enthusiastic about an educational program designed to generate a particularform of being a male in australia. i think that even if we... could have a few rugby leagueplayers give that. (some chuckling) can i interrupt, 'cause kate'sorganisation is looking at... - i might hand it... get kate to answer.kate: sure.

we're looking at trying to developa program into primary schools where... i think there is educationfor girls around health and development and that sort of thing, but there's very little for boys,just in, i guess, growing up with an awareness that it's important for themto care for themselves as well and just to fosterthat sort of a mentality. but the fact that that mighthave a lifetime effect is more of a hope thanany evidence behind it.

well, absolutely, at this stage, yes. michael: those kind of messages are moreimportant coming from the general media, from the culture that you live in,that you're embedded in. the idea somehowthat we can have a short, sharp snap somewhere in the early yearsin primary school and have an impact throughout lifei think is being very hopeful. let's go to our poll resultsfor finding out where our online audienceis actually located. (reads results)

that reflects, of course,that probably access to broadband, perhaps, is part of that story as well, but we always welcome our metropolitancolleagues to these rural broadcasts. we know that you can learn a lotfrom rural medicine in australia, and i'm glad you're recognising that. michael, are we talking about ...? some people would say it's an artifice -men's health. it's not really worth a separate topic. i'd have to disagree with that,of course.

- we could make a career out of this.(laughter) let me justify your career. yes. well, the 49% of the population... norman: which is why it's calledfoundation 49. that's right. and that missing 1%should certainly concern us because it's not justall about genetic abnormalities. a lot of this is men dying far younger. we do find that men die... overall, will have a lower life expectancythan women,

but at certain age groups,there's a much bigger discrepancy between the death rates for malesand females. and certainly with younger men,it's been increasing - the difference between the death ratesfor younger males and females. overall, the gap between men andwomen's life expectancy is narrowing. that's partly behind my question. it's now down to about five years. but there's a fair bit of evidencethat we can lower that gap even further. there's a lot of evidence that there'spreventable morbidity and mortality.

and a lot of people think men's healthis to do with men's bits, like prostates and testesand testosterone levels, but, in fact, if you lookat the major causes of mortality, they're things likecardiovascular disease, including stroke or respiratory disease,accidents, suicides. and a lot of those thingsare actually preventable. so, we knowthat if we get people to stop smoking, if we get them to exercise more, if we cut back on their alcohol,

then we're gonna reallyhave significant impact on morbidity and mortality in men. so i think it's greatthere's been a reduction in that gap between men and women, but we can reduce that gap even further. mark, do you think that it's a myth that men aren't interestedin their health? absolutely. i think, particularly for our mob,

the aboriginal-torres strait islanderpopulation, i think it's really importantto remember as well that there are aboriginal-specific and torres strait islander-specificgroups in australia. the aboriginal men and theirissues around men's business, et cetera, are quite differentto the torres strait issues. so for clinicians who arepractising with indigenous people, they need to be awareof some of those issues. so the sensitivities around genderare much more

implicit around the aboriginal males. and that can be urban as well as remote. so aboriginal men would be moresensitive to a female practitioner than torres strait islander men? and for us it's really, really importantthat there is a separation between the waythat we approach male health and the way we approach female health, partly because of the business stuff,but for a variety of reasons. the main one, though,is that gender and the impact of gender

on access and accessibility of servicesto aboriginal males particularly. what about rural issues? is it very different for menin rural areas, michael? i think that some of the informationthat david cited a moment ago - the actual disease rates do vary once we get into the rural areas and certainly injuries,which include suicide... i wish we could break those apartand have a closer look at those. injuries certainly...it's the second highest category

in the rural regionafter cardiovascular disease, where it comes about fifthin the metropolitan areas. so there's certainly a big shift there. and, kate, mental health issuesloom large. - sorry?- mental health issues loom large. they do. very much so. i mean, particularly for young men,the suicide rate, it's a huge problem in young menin their 20s. in their teens as well as their 20s.

then again as men age,the rate rises yet again. so mental healthis definitely something. i think it's a bit of a closet thingfor men. they don't tend to admit to having... ..feeling depressedor mental health issues. so i think it's something thatis a bit hidden in general practice, but certainly menneed to be supported very well. - you've done some online surveys.- we have. foundation 49 has beendoing some work in this area -

online surveys. it really reinforced the thought that men are interested in their health which, going back on what mark was saying, we sent out an email survey to 500 men and we had over 2,000 responses. so that really reinforces that idea and are contributing

to the health debate. and some of the interesting things that came out of that were that only 42% of men thought they had a family history of illness and disease, which begs the question of what the rest of the 100%, what those parents

had passed on to their children or not, which is a bit of a concern. encouragingly, 55% said that they'd been to the gp in the last 12 months. but it was 23% then that hadn't been in the last four years. i read a statistic recently that said... i think it might bejust a couple of years since this statistic was put together,

but it was 25% of men over 75 hadn't seen their gp in the last year. and i think that's a bitof a frightening statistic, that there are a lot of men over 75 who are probably on medication,all sorts of things. other things thatwe've been finding in the surveys are the reasons why mendon't get a health check is really quite interesting - that they don't get around to it,

that they think they're healthy, time is a really big issue,and cost is another big issue. they're two of the things that preventedmen from having a health check. reasons why they did have a healthcheck, though, were interesting too. and that's for family reasons often, for the partner or the children, to stay healthy for them, which is encouraging. turning up for flu vaccinations, travel,

those sorts of things as well. but another thing that came out of the survey was we asked men about how they deal with stress,what they do, and a lot of them said they would have some physical activity or they would talk to someone. but 20% of the responses were that men would turn to alcohol, which is a bit disturbing,

and 28% said thatthey became very angry. so i think there's a lot of work... there's a job of work to be done. there is an awful lot of workto be done. david, i noticed 37% said they feltpretty healthy and probably are. we don't want to make you all sick. but it just reminded meof the mental health survey that's just been recently reported which suggested that one reason whyonly a minority of people, men included,

are actually treated for,say, depression is that they feelthey're not going to be helped and they're ok,they can manage themselves. is that still a feature of menand their health, that they can manage themselves,the stoicism? i think there's a lot of evidence that men are very reluctant topresent with any depression or anxiety and they feel it's a sign of weakness. and i think it's very importantthat we let them know

that depression can be an illnessand certainly can be treated and it's much betterif you get professionals helping. in the same way if you fracture a leg, which is acceptedto come along and get treatment, the same is if you're depressedor anxious, you can be helpedby health professionals. that's an important message, and it'sok and it's not a sign of weakness. what about aboriginal-torres straitislander communities, mark? i think one of the ways...

..one of the issues is actuallygetting that kind of a message out. if you're a practising clinician, how do you get a message outto a diverse group of people that it's ok to be thinking aboutsome of those things and seeking help. so a lot of it is actuallycase-finding for us in that a relative or the partnerwill say, 'look, i think something's wrong.can you guys do a home visit?' or one of those kind of things. but the other ways that...we work a lot with men's groups,

so there's a lot of aboriginaland islander men's groups, in most communities, actually,in australia at the moment. and if you as a clinician havea way of actually engaging with them, or particularly they'll ask... often doctors and gpscome along and talk about men's issues. and in those kind of circumstances, it's a really safe environmentto talk to them about issues and they'll often then self-referafter that once they've got your trust and stufflike that and know a bit about you.

but it's really important to get a broadmessage out to those groups initially. dr rajendra pillay from victoria asks, 'what's the prevalence and priorityof men's health issues in rural and remote australiaand how do they differ between indigenous men and non-indigenous men?' there's a certainly a differencebetween... i don't want to talk about ruralat the moment, but remote certainly. there's a broad difference and... so, in general,regardless of aboriginality or not?

yeah. well, there's a differencein general, but there's a much biggerdiscrepancy in health outcomes for aboriginal people in remoteaustralia for indigenous people. and that continues through intothe urban, metropolitan areas as well, though the difference isn't as great. there's a question herefrom sharon trainor. 'what's the most effective wayto engage men in interactive groups and make them comfortableas a female facilitator?' well, you'd probably bequalified to tell us that, kate.

how do...? i think it's just really importantthat measures are taken to... well, i think, men on their turfis an important one. so, we do a lot of workplace healthchecks and that sort of thing, so engaging men and then referring themon to the gp practice from there. so that can be something,i think, that can be really useful. i think just the general practicesetting too that's important in terms of, you know, maybe some posters on the wallthat are about fellas.

- but i'm talking about...- oh, sorry? the question is asking about beinga woman working with men. oh, as a woman, i've foundthat i haven't had any problems at all. i often speak to men's groupsand we've asked those questions, 'would you prefer a man or a woman?' and it seems to be 50-50. some men like a man and peopleseem to be happy with a woman as well. there certainly are menthat are going to be better, perhaps, with a woman facilitator.

but i wonder about,not just with aboriginal men's business, but a lot of the other cult groupsin australia. there's a lot of culturesliving in australia where guys aren'tas comfortable working with a woman. and it's a great question,because it really is a challenge for a female facilitatorto try and get them onside. i think the points you've madeare the essentials - meeting them on their turf, trying to find some wayto blokify, perhaps, their environment.

and the old stand-by for any sort offacilitation - a little bit of humour. you know, it's a key. norman: and talk about their car. how you got there. it's actually important, i think,in the indigenous sense that in some placesthere will only be female practitioners whether it's allied healthor right through to general practice. it's really important justto be sensitive about whether this person in frontof you is comfortable with you or not

and asking questions and then thinking about who you couldrefer to or who you could get help from if they are not comfortable with you. some people will be,and in urban settings, quite often are. but in other settings, they're not and you have to think about ways oforganising the way you do your practice so that there are actuallyreferral points and other people that you can call in or maybe things can wait until themale doctor or the male psychologist

or the male person comes. question here from ken smith, david. 'what suggestions do you havein terms of activities to attract men whose work isphysically demanding and often dangerous who are too exhaustedto travel long distances at the end of the weekfor their healthcare?' um... i guess, there's general suggestions tomake practices much more male-friendly, like opening on weekends or after hours.

but this is specificallyabout too exhausted to travel. well, i guess, can you take some of the healthcare outcloser to these people's locations? you're doing that with men's groups,aren't you, mark? mark: yeah. absolutely. in some instances,we'll run a men's clinic, for instance, at a men's group, or with a men's group. it can be... we've done this in urbansettings, rural and remote settings. works actually really well in engagingour men in particular.

and from memory, actually,on a past rural health broadcast, we actually had a gpfrom the south coast nsw who goes out with men's groupsand works with them, talks to them and so on. i just wonder, how much is this...soft and fluffy and when you've actuallyjust gotta get down to tin tacks that if you're a higher smoking risk,you've actually gotta stop smoking. if you got high cholesterol...and get down to the real issues, particularly in indigenous communities,

to actually get down to the tin tacks about reducingthese enormous risk factors. but change is gradual, so... and there may bea number of elements to change. part of it may be having groupsand facilitating discussions, part of it may be prescribing nicotinepatch to help them quit smoking. so there's a whole range of things that may move someone that's not readyto make changes, to move them on. so, it's not just one strategy oftenthat is gonna work.

i think though, that as healthprofessionals, um... ..we're actually takenvery seriously by our patients, and... i mean, we have this discussion oftenwith the doctors that i work with. 'how do i keep my therapeuticrelationship and stuff, if i bring up negative issues aboutsmoking that people don't wanna hear?' in fact, most of our mob are gonnadie from smoking-related illnesses - we know that already. - it's up to us as clinicians...norman: 'a warm glow or death?' (chuckles) yeah, exactly.

we really want, you know...this is one of the key issues, i think, is that we attack these things face on. i haven't had a patient yetthat hasn't - that's been indigenous - that hasn't expected meto talk about smoking. and the way that we approach it is... often i'll say, 'look, i'm gonna talkto you about smoking - you know i am.' and they go 'yeah, yeah'and have a laugh. but then we'll get into it and talkand we can give them the information they need to make a decision about it.

norman: some will stop as a result. i think it's important,'cause there's still gps out there that are scared to raiseso-called sensitive issues 'cause they mightalienate their patients - whether it's smoking or alcoholor illicit drug use or unsafe sex. but the evidence for non-indigenousas well as indigenous, is it's very clear mendo want these issues raised. you've gotta raise them appropriately, so if they come inwith acute abdominal pain,

then you don't startto tell 'em to quit smoking, but if it's an appropriate consultation, men do think you're a better doctorif you do these things. well, let's get onto some consultations. bob's a 40-year-old man living in a rural area, working in his own business as a backhoe operator, and after being pestered by his wife,

he presents to you, david, his general practitioner, with persistent reflux. he's been smoking about 20 a day since he was a teenager, drinks on average, five to six standard drinks - so he says - a day, he's overweight, has a bit of a belly. david: this is a great opportunity in general practice to really makea huge impact on this person's life,

but the reality of general practice isif you see him on a busy monday morning, it may be all you're gonna dois prescribe a proton pump inhibitor. but the critical thing if you're busyand you haven't got the time, is you've gotta bring this patient back,and sometimes... norman: will he come back?- sometimes that means you actually make the appointment. and you might either - if you'vegot a manual system for appointments - you walk out to the front desk and say, 'i really want to see you next week,and we're gonna spend 30 minutes

to really discussall these issues in detail, 'cause there's important thingsi want to talk about.' or you do it on computer.but i think most... norman: he's only there'cause he's being pestered - why's he gonna come 'cause you say so? sometimes men use that as an excuse. sort of, 'i'm a real guy -i didn't really wanna come.' but they're actually... most men,when you really get down to it, are concerned about their health,

but they've got to, um...sort of make it seem acceptable, that they're really, you know...they're really sort of stoical, but they do wannahave their health looked after. and i think if you can show themyou're really interested and concerned, then i think you can reallyhave an impact. but, um... but this is a reallyimportant patient to bring back, and just make sure these reallyimportant issues are really addressed, 'cause you may well prevent this guyfrom having diabetes or a heart attack in 10 or 15 years time,so, it's really critical we intervene.

and lung cancer as well,or chronic bronchitis and emphysema. so, you can really do some great workin general practice on this patient. look, i just wanted to say there,if this kind of person turns up who's indigenous -40-year-old with those risk factors, it's cardiovascular diseaseuntil proven otherwise... norman: not reflux?- ..as far as we're concerned. you rule out the heart problems first. this is a really critical point...you know... because this is actuallya 60-year-old in non-indigenous terms.

absolutely. we're talking about... if it's a 60-year-old you'd be much moreinclined to rule out cardiac disease, but in patients we see at 40,it's almost certainly gonna be reflux. and i'd even go as far to sayyounger than 40. if an indigenous male turns up to youand they've got some kind of chest pain, you have to treat it as if it's gonna becardiac origin, and exclude that first. it's just a critical point... so, no proton pump inhibitor,'see you next week, chum'? well, no, you'd take a careful historyand do as much as you could then.

the other issueis that opportunistically, you may not see this personfor another six months or a year - or more than that - so it's really criticalthat you get in while you can, and do what you can when you can. i mean, time constraints consideredand all that as well. so... how do you lock them in then? how do you grab that moment,'cause it's true in non-indigenous mento some extent as well?

the critical thing from our perspectiveis to sell to the patient, 'look, this is whata lot of our people die from. you're at very high risk of havingsome kind of a heart problem with this. we need to make sure that it isn't that.it can be a number of other things, but the critical thing is wedon't want you to walk out of here and drop dead in a couple of weeks time, having been to the doctorand been prescribed something.' so, it's really getting them onside,selling them on what... ..interpreting the statsfor them basically,

and then working with a team. and often in aboriginal health service,if you're lucky enough to work in one, you do have a team approach,so you can get health workers and other educators involved. if you're a solo clinicianin a practice, it's a lot more difficult 'cause it means you've gotta spend timewith a person while you've got them, and that's a balancing act once again. so, what's your comment about, um,this guy? well, i'd take it from a slightlydifferent direction, i guess,

looking at the mental health questionsaround this too. what's a 40-year-old guydoing self-medicating with beer to that extent every night, and, um... damaging himself?it's a bit of a self-destructive path. i'd be just a little bitwanting to check out a bit about his emotional statesomewhere in there as well. as a small business operator,you just don't know what's going on behind all of that. the question you raised -you know, the readiness to change,

awareness that there's a problem,whether to address it - all that. sure, they're things to think about,but i would question his emotional side in this situation. i'd want to know about how he's feeling. norman: kate? my only question with this one would be how do we try and engage peoplelike bob before they get to this point? that, you know,if he's drinking this much beer and he's obviouslycarrying a bit of weight

and those sorts of things. in terms of community programsand engaging with health services, how can we bring that back a bit,and be engaging with him before then? norman: and? (kate chuckles) $64 question.- having raised the question. um... there area lot of fantastic programs that are being run throughthe community setting... norman: but they don't get to everybody.they're piecemeal. there's one or two here or there -it doesn't get to a whole population.

there's tens of thousandsof bobs around. yep, and unfortunately, i thinkone thing with men's health in australia is that it is fragmentedand it is under-resourced. it isn't the priorityit should be with government. and so, we need to be reallyadvocating for more funding for all sorts of programsthat are running. there are some very successful ones. i think the men's sheds movement hasreally been fantastic for a lot of men in terms of engaging,and maybe that opens...

norman: does that change their health?- sorry? does it change their health? i think it provides a safe placewhere they can talk about their health, and particularly emotional issues, i think, um...there's that opportunity... and if there are barriers, michael, then that will open up the doorto more healthy activity? i think the men's sheds -like the aboriginal men's groups - are one of the greatest untappedhealth resources in this country.

the men's sheds, they providea lot of emotional support to get rid of the isolation,but they're also an interface that health professionalscan use to try and connect with men who perhaps they wouldn'teasily connect with. gps, for example,can probably set up clinics, as mark has donewith aboriginal men's groups. you can do itwith men's sheds as well. let's go to another question online. jennifer allen,derby hospital, western australia.

'when i discuss lifestyle changeswith aboriginal men in remote areas, they find it very hardto make any changes. are there any strategies that help?'mark? mark: um... norman: well, that might be becauseshe's jennifer rather than john allen - a woman trying to deal with men. it may be, um... but it also... it is difficult in the contextthat men live in, for them to change their lifestyle

without changing someof the other things. so, that's engaging, you know,like, if the lady of the house is the one who's cooking all the food,and they've got high cholesterol, it's not much use talkingto the guy about changing... norman: the local shopsonly sell rubbish. yeah, exactly, so there's a lot of other issuesinvolved here, and, um... but still at some point, there's an individual choicearound this,

and there's a certain amountthat an individual can do, and we know that if we do our jobas health professionals well, we can actually make a differencein people's lives around best treatmentand evidence-based approaches, but there's certainlya lot of contextual things existing in aboriginal communities that make it difficultfor them to make those choices. so, some of it is,'is there a system in place?' i mean, i come back to systemsall the time because

all of us as individual practitionersdo practise within the health system, and it's the way that we use that systemfor the benefit of patients that's important, so... any tips on conveying conceptsof risk to... indigenous communities? yeah. look,i think it's really difficult in our sector to use things like, 'well, 5% of peoplein your group will...' you know? it's more about...for me personally, it's saying, 'look, you're a smoker -you're a heavy smoker -

you'll most likely dieof a smoking-related disease if you don't stop now, and there'sbig benefits to stopping smoking, so...' how would you motivate bob whenyou get him back for his full check-up? we can talk about the work-up, but most people watchingknow what the work-up's gonna be, but how can you motivate him to change? i think gps have got a great advantage because they oftenknow their patients really well, and if bob's a real family man,

maybe part of the motivationis not pointing out the statistics, but just saying, 'look, do youwanna see your kids grow up? you may not be around then.' so, i think it's trying to understand what is goingto get through to that individual, and gps are reallywell placed to do that. and you've gotta know... we oftenknow so much about our patients. let me ask you another question,our online viewers. how often do men come to your serviceor practice with symptoms of depression,

and yet don't discuss it? again, we'll come back with the resultsof that question in a moment. steven thompson,a social worker in queensland, asks, 'is there a possibility of alliedor other health professionals visiting patients at hometo support them between gp visits?' have you seen much of that happening,michael... michael: um... ..in multi-disciplinary practices,'cause there are an increasing number? well, not really. i think talkingabout those kind of issues would probably be moredavid's territory around...

but isn't that what enhancedpatient care items are all about? mark: well, look,in our sector, it's... norman: they'd page you laughing.(laughter) mark: it's a great model. i think there's the potentialfor it to occur, and certainly, um... ..there's been more involvementof nurses, and we've certainly had nurses becomingmore involved in health promotion with patients like this, and there'scertainly roles for pharmacists as well. it may be it's the pharmacistthat picks up

the blood pressure that's risenwith bob because he's drinking too much. so, certainly, epc item numbersaren't working terrifically, but there's the potential,and i think they make us realise that healthcare works much better if we've got a grouptalking to each other and working togetherto sort of look after people. let's go to our next case study while we're waiting on your answers coming in. bill's 60 years old,

lives in a regional town, has been your patient for some time, david, with coronary heart disease, hypertension, hypercholesterolemia, he's overweight, he's on a beta-blocker. he comes to you to talk about his lack of libido, and he's got some erectile dysfunction. he's also, you know, got poor stream,

he's going to the bathroom at night and so on. he's feeling pretty low. david: yeah, there's two components to this consultation, norman. i think firstly, we've got to addressthe issues that he's presenting with, and so we certainly need to lookat erectile dysfunction and low libido. but clearly, the concern hereis that this chap may be very depressed, and that may be relatingto some of these symptoms. we also need to cover organic sortof issues, and whether the metoprolol is

sort of relatedto some of these symptoms. so, um... so, this is a guy, again,that needs a fair bit of time and again, if we've got a busy scheduleon a particular day, he may be someone we've gotto bring back and say, 'look...' and he might be a bit easierto bring back than bob who seemsto be there under duress. yeah. so, what would you sayif he's an aboriginal bloke, um... mark? um... i think it's really, um...great that he's actually...

norman: ..got to 60.- ..come in. yeah, well...(norman laughs) norman: don't know why i'm laughing.- he's made it. - but as well as that, you know...norman: so, he's gonna be 40... - yeah. yeah.- ..in reality. if somebody comes inand their issue's erectile dysfunction, it's actually a huge thingfor them because it is often hard for mento come in and talk about those things, and bring it up themselves.

so, he's brought it up rather awkwardly,it says in the case, but he's there, so it's somethingthat you really have to deal with. and of course,for us once again in this sector, the risk factorsfor cardiovascular disease with erectile dysfunction as a marker are really important thatwe take care of both those issues, as well as the depression. norman: could be a motivator for change. absolutely.and absolutely quite often is.

although it's always hard to gauge -from my perspective anyway - how much, um...the motivation is around, you know, having better sexual function and stuff like that,is for the rest of a healthy lifestyle, and how that all sits together, because it's not always, um,what makes people change. the problem with this patient too,norman, is if someone sees him quickly,and just gives him some viagra and maybe does a serum testosterone,

they've really missedsome major sort of issues that can really make a huge impacton this chap. apart from interveningto help depression, which may be a really significant issue, we know erectile dysfunction is a majorrisk factor for coronary heart disease. as well, if he's depressed, he may not be managing his cardiovascular disease,he may not be taking his medication, so i think this is a good exampleof where a really good gp can have a huge impact on thisguy's life, and, uh... and vice versa -

if you're just gonna do the basics, you're really doingan awful disservice to this guy. how would you know if he's at risk...from his depression, michael? well, i guess, you reallywould wanna check that out, and to see, like...check out some of the basics - your physiological signs -how's he sleeping, is he eating? - some of those sort of things,to get more of an indication. but also what kind of, you know,thoughts he's been having. has there been any sort ofsuicide ideation or ideas about harm?

- those things.norman: he's entering... it's a bit off,but he's entering that age group with really quite high ratesof successful completed suicide. absolutely. look, i mean,it's an interesting case study 'cause you don't knowwhether the depression is accompanying these symptoms,or it could just be consequent to this. to have so many thingsgoing wrong with your body at one time at that age in life, in itself could probablybe generating depression,

so that depressionmay help be a motivator to address some of those other factors in some ways, but certainly it's gotto be taken very seriously at that age with, you know, like, a depressed mood. i'd be rather concernedabout someone like that, and want to look more carefully, certainly engage other members of theteam to work with someone like this - it's not a six-minuteconsultation job obviously. and the other trap would be it's easyfor a gp to write a script for an ssri,

and again,you'd be doing a real disservice, if you didn't explore these issuesand that sort of thing. with aboriginal-torres straitislander men, mark, digging out the depressive history - how hard is that, how careful haveyou got to be, how do you do it? um... i've never hadreally a lot of men present in general clinicswith depressive symptoms that have come in and talkedabout them... - ..or for those particular symptoms.- you have to ask?

often when i've been doing men's clinicswith men's groups, for instance, other men that work therewill bring people in who've had relationship break-upsand a whole lot of other issues happen. they'll help them to present, and once again, it's a little bitof case-finding there - it's not, you know,if you wait for these guys to suddenly decide they're depressed and turn up or there's something wrong -it's not gonna happen. in aboriginal men, it can outwork itselfin a lot of different ways

from anger and frustration and violence,through to self-medicating, as we know. and, uh, so getting them inat the right time - i mean, before things go off -would be great. but it's not always that easy to do unless you're engagedin some kind of a group that can help you do that. michael: one point i think'sreally important - a lot of men when they're depressedaren't necessarily gonna be acting out the standard, classical signsof being very flat emotionally.

sometimes their depressionwill be anger, frustration, you know... ..being very short of fusewith family members - those kinds of things, so sometimes when we're coming across situationslike that in a family, it's actually a depressionand it needs to be treated. it's a quite different profilefrom what we get with women. a lot of people aren't awarethat's something to be sensitive to. david: fatigue's also common.- sorry, david? fatigue, tiredness is anotherreally common presentation.

so, let's just talk practical stuff now. we've had two cases now - bob and...um... sorry, what's this one? bill... ..um... who are...and they're both challenges to engage. is there stuff that shouldbe happening in the surgery? how you organise your surgery,i mean, it's almost an impossible task. you've gotta make it child-friendly,woman-friendly, community-friendly, nice place to sitand now bloke-friendly. what do you do to makeyour practice immediately feel that men can come in and be engaged?

look, i think there's reallysimple things like putting magazines that are gonna hold the interest of men, and it doesn't obviously...norman: is this a sealed section? it doesn't have to be playboy, but, you know, whether it's a magazineon golf or sport or 4wd monthly, i think that's the first thing. i think if possible, to offer anoccasional evening or saturday morning, so it's easier for...your male patients to access that. and then i think the... there arethe things like reminder systems.

the government now offers reasonably... ..reasonable sort of remunerationunder medicare for a 45 to 49-year-old check, so we might... maybe that'san option for some practices. but what about systematic approaches? yeah, look, i think systematicis very important to try and get men to have a health check. now, that's gonna be very differentto a 60-year-old to a 20-year-old, but, uh... i think if we can, uh...

..encourage mento come back for a health check where we lookat their cardiac risk factors, their risk factors for cancers, i think we can havea significant impact, one of the things i find really helpfulis to have a questionnaire because menare reluctant to raise issues, and if they have to go througha questionnaire on men's healthand answer the questions, it makes it easier to raise them

and they're more likelyto raise them in a consultation. norman: mark? i think there's a couple of issues here. one's just a generic accessibility -for indigenous people - for your surgery or for your practice. and we know that there's models aroundthat like, you know, inala in brisbane, where they've increased by about 300% the indigenous peoplethat present there. then the secondary partis the men's stuff, and, you know,

it may not be that hardto actually ensure that there is a male doctor there once a week on a wednesday morning or something, or maybe a saturday morning,if that works better. it may be also cost-effectiveas well for the surgery. it may be worthwhile, if there isn't,that there is a gp in your area that maybe wants to take ona bit of men's health speciality that you can refer to,so that guys know they can go there. let me get to the results.i've got a question to ask as well.

let's get the resultsof the last question. so, in fact,the majority of men are, um... ..not fessing up to their symptoms. i'll ask you another questionwhich relates to what markwas just talking about. does your medical servicehave specific strategies to engage men in their health? do tell us and we'll come backto that later. a couple of quick questionsbefore we get onto the last case study.

this is from cathryn prendergast, who's from the country health servicein western australia. a lot of western australians online.welcome. 'how have clinicians approached men to deliver health servicesfor them at a men's shed when some men's shedsare a place of socialisation?' in other words,are you crossing the line turning men's sheds into a health venue? what do you think, kate?

i think, uh, things like men's shedscan be a great way to, um... ..introduce maybe health information. whether you actually do screeningor anything at a men's shed... you know, it might be more about talksand introducing a gp or sort of developing that relationship. we went to the grand prixand offered health checks there, and the link to a gp...- but that's not the shed which might have... might be quitea special place for men where they do... kate: they do a certain thing?- ..stuff which is not health stuff.

but she's raised a very good pointthat some sheds wouldn't want that, they wouldn't wanta health professional coming in, they wanna have their oily machinesand rags and things safely away from that other white-collar world out there. but by the same token,i mean, there are sheds... i think you approach them, you ask them, 'what about having...?if the gp comes... ' norman: it's white community control,isn't it, mark? you know all about community control.

we actually, um... even in cape york,the men's sheds guys get up there, and we've had a men's summit up there -an aboriginal and island men's summit - recently, where the men's sheds guys -the facilitators - brought groups of men down to cairns, and we did actually talk abouthealth-related issues. we had a couple of sessions on healthand it worked fantastically well. - so, there's lots of potentially...- but you need permission to do it. and yanna in townsville...this is a related topic. yanna in townsville says,

'when discussing the issuesof men's health, what are the goals for health promotion, where do the communityand health professionals meet?' what do you think, david? - i might handball that one.michael: and i will as well. - straight back to kate, that one.norman: that was a flick pass. well done.you've really stuffed them up here. kate: ok. the question one more time. 'when discussing issues of men's healthwhat are the goals for health promotion?

where do the communityand health professionals meet?' um... from foundation 49's perspectiveand the way we operate, the health promotion goalsare that we are trying to raise health awareness and tryand help men engage with gps. so, that's where those two things,to me, would meet. norman: you've had time to thinkabout it now, michael. michael: one of the pointsi'd like to make about this... the question's around healthprofessionals in the community - it's not just about gps - and that'sone thing we haven't talked a lot about.

the role of a lot of those otherhealth professionals out there that may be located in the community,that can play a part... norman: gps don't need to do it all.- exactly. you've got the pharmacists and ofcourse, standard allied health workers, but also some of those communityresources that you can tap into. aside from the men's groupswe've talked about, things like sporting clubs,rotary clubs - all of those people. health promotion goals, mark,you'd take a hardline position. they've gotta be hard-edged - you'vegot to actually save people's lives,

let them live longer, healthier. i guess the goal for us is that, um... ..for us in primary healthcare,that, i think, is the definition of primary healthcare, where health promotionand educational stuff comes together, where multi-disciplinary teamscome together, as you were saying, so that you do have nutritionists, you have healthy-lifestylecoordinators - a lot of people who cancome together under one roof

to help individual patientsto do better. and the goal for usis to keep them healthy, you know? we know that, you know,young aboriginal men can be relative... it's probably the healthiest timeof their life is their adolescent years and later up till they're about 20 and 30 -but how do we keep them there? so, the idea there is engaging earlyand doing maintenance, and that's, i guess, what things likethe adult health check are for aboriginal populations -

you go and do the screeningand you promote good health... interesting questionfrom paul campbell here, who says it's his first webcast,so welcome, paul. glad we're sharing in this importantmoment for you in your life. hope it'll be the first of many. 'have the panel heardof the pit stop program...' which is almost whatyou're alluding to, '..where men's healthis linked to health of a car, and men go into the pit stopto get checked out...

..and the workers are dressedas mechanics etc. etc.?' michael, you... we were chatting about that earlier,kate and i. certainly, the pit stop programhas its place in the realm of armaments that we need to work with. it's not for every male -not every male's gonna respond well to being allegorised to a motor car andhaving his exhaust checked and things - but certainly for some men,yes, they can relate to that - they can see in the same waythat there's components of the car,

and if one isn't working,it needs repairing, there's body components, they needchecking to make sure they're ok. it's certainly a line i use oftenon my 50-year-olds. i say, 'look, when your car's done100,000 kay, it needs a service whereas when it's 5,000 kay,it's probably gonna need it less.' and a lot men respond to it -some don't. let's do a case studyof a slightly newer model. ben's 20 years old. he presents to you, david,

on a monday morning, after a weekend of heavy drinking and ecstasy use. he's complaining of painwhen he passes water. he mostly drinks on the weekends, and also usually takes ecstasy or ice or an amphetamine-related drug. he smokes when out on weekends but not during the week. so, what are you gonna doabout young ben?

well, again, there's two components - there's the easy componentand the more complex. - the easy component...- what's easy about ben? i haven't seen that yet.just tell me that. well, the easy partis there's a fair chance he's gota sexually transmitted infection, and, uh... i think given the riskof chlamydia in the community, there's a fair chancehe's got chlamydia, and i'd probablyput him on some azithromycin,

but still test him - do a urine test -for chlamydia and gonorrhoea, and maybe talk about his risk factors... ..for other stis,and maybe do a screen for that. and then there's the other issueswith his sort of social activities, which are little bit harder thanmanaging an sti if it's chlamydia. we'll come back to that in a moment.let's go to the poll answer. the question,'does your medical service have specific strategiesto engage men in their health?' only a very small number -one in ten - said 'yes'.

'no' is the largest group,'partially' and 'don't know'. don't knows, we'll give themthe benefit of the doubt and say maybe half do and half don't. - not impressive in terms of doing this.david: pretty honest. not easy, these young men,whether they're aboriginal-torres strait islanderor non-indigenous, mark? um...certainly, in a patient like this... and we do get plentyof young people come in, and not necessarilythe more sophisticated illicits,

but at least alcoholand a lot of marijuana use, and now movinga little bit more sophisticated. and it's... the issue for us,around this particularly, that sti once again, we probablytake a fairly broad approach here because there's a lot of other stisstill very prevalent in our communities. so, almost certainlywe'd screen for syphilis. almost certainly we'd treatopportunistically, for gonorrhoea and chlamydia, so... the ceftriaxone,we're using at the moment. and then, um...

david: whereas we'd, i think,just treat for chlamydia... - ..if it wasn't a profuse discharge.- yeah. it's... the problem for us is thatthe opportunistic nature of this... this is probably gonna be... in a20-year-old, it's gonna be a one-off. if you can get 'em,you've gotta get 'em when you can. the other partis that we'd almost certainly treat for otherbloodborne viruses as well, and do everything...do the general stuff around that. what are you gonna do abouthis drug and alcohol binging?

um... that for us,is obviously one of the hardest issues, because some of this stuff is entrenchedin some of the communities already, and it's hard to change that,particularly in younger people. now, a couple of things have been triedwith reasonably good effect. one's been positiverisk-taking behaviour. so, in one community, they used... - positive risk-taking behaviour?- sorry? - positive risk-taking behaviour?- yep. - horse-breaking, aboriginal style.- bone-breaking, you mean?

yeah. (chuckles) so, yeah. so, they break bones, butthey don't break their minds, you know? they, uh...it's a way of encouraging them to do something that's risky and fun,as a young person, but is not gonna screw up their brainsand stuff like that. - the other stuff is how we use...- and you can't do it drunk. exactly. you'd fall off straightawayand break your arm. but, um... the other ways are around... using positive role models,

we've found actuallydoes have a bit of an influence. this is, you know, like, sports stars,and we have matty bowen... in some ways,although the problem's huge in aboriginal-torres strait islandercommunities, the solution's easier'cause of a ready-made community, if you're able to mobilise it...- yep. absolutely. ..than you'd have in the middleof melbourne or dubbo. i think it's a bit easier for usto drive some of the system's kind of approaches,so rather than just having

an individual cliniciantrying his best to do his best... norman: so, what would youdo about the binging? i'd certainly, um... let him know thatbinge drinking can be hazardous. i think there's a lot of young peopleout there - a lot of adult males - who don't realise binge drinkingcauses more harm than... so, a lot of people say,'look, i'm not an alcoholic, therefore i'm ok,' but the evidence...- i suppose raising, 'how do you feel on a monday?you feel pretty crap,' which is what they would be doing.

first two days of the week are almostgone 'cause they feel so terrible. if you're gonnaget a health message, you've got to relate it to his interest,so if he is playing sport, you might say, 'look, there's very few,um...' from victoria, we'd say, '..very few afl footballerswho are gonna binge drink.' now, the norm and their role modelsgenerally... norman: where are you gonna get help? if he says, 'ok, i want to do somethingabout it,' where do you get help? it's probably easier for mein a metropolitan area, i've gotta say,

because i know of drugand alcohol counsellors. michael: that's exactly the problemin rural areas - not having adequate supportsfor these kinds of issues. one of the few strategies - it's similarto what mark's talking about anyway - the old health promotion adage, you haveto make healthy choices easy choices. there have to be other optionson a weekend rather than just going out and binge drinking and trying to scorewith some new sexual partner or some ecstasy tabs or marijuana or whatever's the local flavourof the area.

but if there aren't opportunities...there are plenty of country towns where there are very limitedopportunities for kids this age. cold showers insteadof a sexual partner. sorry. i just wanted to say quickly,one of the really key issues for us is engaging younger peoplein their culture. and this has definitelybeen proven overseas in the canadian aboriginal population with reports to have an impacton everything from mental health, suicide reduction and other things -

in the natsiss reports in australia -on employment and ongoing education. so, people who are morelocked into their culture and have that cultural identity part,which is really important for us... now, how an average gp helpsto support that, you actually can... greek and italian communities... that research is pretty solidacross communities. the closer you are to the culture,the better off you are. absolutely. i think clinicians,whether metropolitan or remote, can actually support that in indigenouspeople by supporting their culture,

by recognising it and acknowledging itand talking about it to people when they do come and see them,and respecting it. sometimes as gps, there's a feelingyou've gotta be able to manage everything that presentsto you, and that's not realistic. so maybe in some instances, you dohave a gp, either in your practice who's got an interest in men's healthor you refer to a neighbouring practice, where someone's got that interest. and similarly in these areas, i thinkknowing the community resources, knowing the people to refer to,i think that's really important.

i think sometimes we burden ourselvesawfully, thinking, 'we should be solving everyone'sproblems', and that's not realistic. knowing where the resources are,i think, is often the hallmark of a good gp, as much as necessarily...you can't be an expert on everything, so i think that'sa really important issue. just before we get the resultsto that last poll question, yanna from townsville'scome back to us asking, 'when throwing a men's groupor a men's clinic,

what do you suggest to interest men,making them more comfortable?' - to make them more comfortable?- so, they don't feel like it's boring. well, i think you really need to gowhere men are, where they gather naturally anyway, and do it there - it's no goodcreating a whole new event out of nowhere for a bunch of men. that's where the idea of sheds,sporting clubs, you know, other service clubsthat attract a large number of men. use those. go to those places

where you've already got the menthere to engage with. - so, build on existing infrastructure?- absolutely. let's just ask the next one. let's hear what you have to say there. and let's go onto our next case study. sam's a 50-year-old aboriginal manin a remote community in the northern territory. he rarely comes forward for healthcare,and, mark, you've been looking after his long-term lung problemsdue to his smoking.

and now he's come inwith an increasing cough and there's the occasionalfleck of blood in his spit. you want to send him off for some testsand he says he doesn't want to go. yep. um... i think in this kind of instance,it's actually not uncommon that people you're willing to manage in remotecommunities don't wanna leave the country and go somewhere else. so, it's importantto actually understand the context of the person that you're dealing with.

as well as that, it's really usefulif you're a health professional working in one of these communities,to have cultural mentors, and if somebody doesn't give you one orallocate one to you when you go there, it's worthwhile asking around the senior health workers or whoeverelse - the council people, the elders - if someone will help youwith these kind of situations, so that you do understandthe context well. - and it's really important...- pretty scary going to the big city. yeah. absolutely.

the next thing was exploring the reasonswhy this guy might be scared about it. and often around patient travelfrom remote centres to urban centres, it's just thatthey haven't got any money. they won't be able to affordthe taxi from the airport to the accommodation,if there is accommodation supplied. and, i mean, we've heard horror storiesabout this kind of stuff happening where people have been leftat airstrips and sick and died. so, these kind of things, you know,really have big impacts, and they're just practical things thatprimary healthcare services remotely,

can actually, you know, organiseso that the patient travel and stuff, is well and truly coordinated using health workers,using somebody to go with them... - you've got an off-the-shelf thing, youjust know what you're gonna do? - yeah. what tips do you give non-indigenouspractitioners, clinicians, for actually engaging herewith a man like this, 'cause he's liable to say to you, 'look, i'm no fool, doc.i know this is gonna be bad news. why would i bother?it's probably cancer.'

- yep. um...- he's gonna know that. um... i think there's two levelsof what i call inertia anyway. you know, there's one in the patientwho's kind of feeling, well, 'do i really wanna know any more aboutthis? i can just die happily here, and not worry about going throughall this horrible stuff.' but the other side of that is thatyou've got to be able to, um... ..let them know that there's reasonablygood chances of good treatment and that they might havereally good outcomes and be able to spend a lot more timewith their grandchildren etc.,

and their extended family and family. the other part is the clinical inertiaon our part as health professionals in which i sometimes say, 'look...' an old aboriginal fellow... well,he's only 50 - not that old. but... norman: well, you've just beentelling us that is pretty old. mark: yeah, well, i'm 50, so i don'twant to talk too much about that, but, um... this therapeutic inertiathat we have as clinicians... i always thought our doctorslooked so young these days. (laughter)

the idea that, 'oh, he probably drinks,he probably smokes, you know, he's not gonna do much for himself, so what's the pointin actually pushing this too hard?' that's just not acceptable. if we want to make a differenceto aboriginal males' lives and close gaps, we've really gottapractise effective healthcare and do our jobs properly,and that just means treating everybody as you would if they werein the north shore and doing everything you possibly canto encourage and support a person

to take directionand to work towards good health. really interesting question herefrom stephanie kutek at the university of adelaide, who's doing her thesis on rural men,subjective wellbeing and the role of social support. and the summary of her questionis what's the balance between the positive thingsfrom a community and the negative? in other words, the positive stuffwhich is the support, and the negative stuffwhich is the male culture,

which is drinking, smoking,doing stuff that's not good for you. michael: i disagree with that,i think, norman. she's simply asking the questionrather than making an assertion here. - i've embellished it slightly.- ok. ok. the idea that'sthe standard male culture... i think there's a lot of variationsin male cultures, even in country towns. there's no sort of one versionof male culture that's just down the pub and that's it. there's a group that'll be there,and groups of guys doing other things.

there are negative aspectsto any community life. in small communities,your life's much more under the scrutiny of your neighbours,your friends, your community members, than it is in the city,but then by the same token, when something goes wrongyou've got that support, 'cause people know what'sgoing on with your life. it's a balance, it's a trade-off.but in a lot of cases, i think... south australia, particularly,i know of some situations there. men become quite isolatedwhen they have properties,

they're having a few problemsfinancially. they can't travel so much, they'renot gonna go in town for a drink - they lose that community support, then you've got real problemswith men in the rural areas. gets a bit more complicated where you've got kinship, where you'removing in family groups and so on, and you are a bit more locked in, if you happen to be in a family group,for example, which is hard to escape from,that's not got very healthy activity.

what's the advice there -is it a bit of leverage? look, there, once again, there's reallypositive aspects to community life and negative aspects...norman: ..which we spoke about. the positive ones are thatextended family and the relationships. so, if you do go to the city,there's almost always somebody you can stay with. and it's their obligationto actually take care of you - but you know thatyou'd take care of them as well, when they come to see you, and there'sa whole lot of things around that.

it's actually really good. it's good, you know...good social fabric for us to build on and to encourage peopleinto health behaviour as well, because we can utilise a lotof extended family stuff and a lot of the caring,sharing in relationships, so... the negative side,that it can be humbug, so that if you've got money,then somebody else wants to borrow it, and all those kind of things. but the opposite is also true,that when you've got nothing,

someone'll give you something as well,so there's good and bad in that, and the balance is -and i guess this is the nuts and bolts of some of the welfare-reform stuffat the moment - is how do we really harnessthe real cultural stuff and get away fromthe dysfunctional cultural stuff, and grow that so that it works for us? and that's the balance for us. here's the answer to our question,do you feel conf...? good news. in fact, most people would say thatat least partially - yes or partially -

they would - over 70% - so that's good, we've got a very culturally sensitiveaudience here, mark. on the word 'culturally appropriate', i'm going to expandthat word a little bit, and to say that maybe evenin the way you word, um... ..you speak to your patients, make sure you don't usetoo much medical terminology. when you speak to a patient,you probably... instead of using 'depressed',for example - 'are you depressed?'

maybe 'have you been feeling down?'just to... if you can make it sort of culturallyappropriate to that individual, so it means more thanjust whether they're indigenousor non-indigenous, i think. good point. and we've gota new national men's health policy coming round the corner,haven't we... michael? hopefully by the end of this year. the department of health and ageinghave been working on the policy. they've done a fairly extensive roundof consultations across all sectors

of the community. the indigenous community, in particular, they've held some very good meetings -some well-attended meetings there. it's been a really good process... they've got a set of principlesunder which they're operating? they have got a set of principles,norman, yes, that are going to drive the policy,but i... so, prevention across the life course,gender equity - that sort of thing? that's right, yes.

i think the primary principle -the underlying principle - of this, though, is the idea of, um...certainly a holistic concern with men - not just with their physical bodies,but with their mental, emotional, their social wellbeing.looking at boys too - not just men. it's called the men's health policy -it's actually a male health policy. we do need to be consideringour boys a lot more. that's part of it. some of the othersort of central features of this which...of the policy that are really important is we can see that this governmentis going to put

much greater emphasis on prevention and certainly more upstream focuson prevention, and i'm imaginingthat the men's health policy will certainly incorporatethat particular principle when it comes out, which'll be great. the aboriginal-torres strait islandermale health framework was developed by a national reference groupprobably about three or four years ago. that'll now hopefully get some legs and find its waystraight into this policy,

but the key areas thereare things like getting workforce equity and stuff like that, so that, um... it's a framework,so it's not telling people what to do, but it's suggesting that if you'redeveloping policy in your area - in your state - then tryand ensure if it's a workforce policy, that there's an equal amount of menthat are entering the health workforce, and those kind of things, that if you're developingyour health services, that you think about the waythat you're gonna deal with men

and how you're gonna approach thatin your health services, so it's kind of building thatinto the national policy. norman: how things have changed. thank... you know,sort of reverse discrimination now. gotta fix up the problems of all that... we won't get into that -that's another program. look, thank you all very much. what's your take-home messagesfor the audience? michael? um... i think it's great there's sucha growing interest around male health,

and find out as much as you can. work with the men in your community,use them as resources to tap into. a lot of the mens' groupsthat already exist are great resources - you don't have to doeverything by yourself. but it's great to see so much actionfrom a whole range of professionals. norman: mark wenitong?- indigenous culture is really varied, but you've gotta really be sensitiveto gender issues, gender-related issues when dealing with aboriginaland torres strait islander men, but particularly aboriginal men.

reflux is always heart diseaseuntil proven otherwise. absolutely. absolutely. if i could thumpthe desk, i would, but the sound guy... norman: feel free. the other things i think are around,you know, remembering that particular thingthat, you know... ..chronic disease is gonna happenprematurely in this group, and really be sensitive to that,and across it clinically. and think about more systems approachesto how your practice... you know, how you can changeas a clinician to be more responsive,

but also, how your practicecan also change to be more responsive to aboriginal men. very much echo those thoughts,but particularly thinking about how you can make your serviceas engaging as possible to men who maybe haven't felt comfortablein the past. that's really important. and just wanting to pick up on david'spoint about time pressures for gps, very busy, lots of appointments, that there are services -maybe online or telephone services - that can support men,say, in between visits,

such as there's an organisation,mensline, where men can ring if theyhave relationship problems and they need help right now,and maybe can't wait till they get to their gpin three days time. so, to utilise those services, i think, particularly in rural and regionalareas, can be really useful. i've given it a bit of thought, and wasgonna come up with a lot of points, but when i think of it, if there'sone issue i'd urge gps to do it's simply,start doing men's health checks...

- ..and full stop.norman: engaging? - well...norman: makes you engage? - yeah, but do the full health check...norman: be systematic? having said... well, do a full check - don't just manage the problemthey present with, but say, 'look, i haven'tseen you for a health check. i want to see you in a week's time.' and depending on their age,but, you know, if they're over 50, you do their cholesterol,you check their blood pressure,

do the blood glucose,do the validated testing. bowel cancer's one we haven't mentioned, but certainly the evidenceis very clear. but get men back not justfor the presenting problem, but say, 'look,i need to see you for a health check.' if they're younger,go through their lifestyle issues - they're gonna be much more relevant, and you certainly don't wanna bescreening for, in a low-risk person, for bowel or prostate cancer.

so, i think that'smy take-home message - start getting men back and saying,'look, i wanna see you, and we'll go systematicallythrough all the health issues.' and it's gonna be much less frequentin a 20-year-old than a 50-year-old, so a 20-year-old, you might onlydo that every five years, 50-year-old, you might startthinking of doing it annually. thank you. and thank you all.i hope you've enjoyed the program. sounds like it. out of the shed:overcoming the barriers to men's health. if you're interested in moreinformation about the issues raised,

there are a numberof resources available on the rural health educationfoundation's website, and that's at rhef.com.au. don't forget to completeand send in your evaluation forms 'cause that's what helps usimprove our service to you. and please register for cpd pointsby completing the attendance sheet. i'm norman swan. bye for now�