Men’s health:
what’s work and family got
to do with it?
Pru Goward
Federal Sex Discrimination Commissioner
and Commissioner Responsible for Age Discrimination.
6th National Men’s Health Conference incorporating the 4th National Aboriginal and
Torres Strait Islander Male Health Convention Oct 10-12
Wednesday 12 October 2005
Level 17, RACV Club
501 Bourke Street, Melbourne
9.30am – 10.15am (30 minute speech, followed by Q&A)
Contact: Greg Millan 0417 772 390
Thank you for that introduction Greg, and for inviting me to be
part of the 6th National Men’s Health Conference and the 4th
National Aboriginal and Torres Strait Islander Male Health
Convention. I am not often allowed out in mixed company and
it is nice to be talking to men as well as women today.
It’s not easy being sex discrimination commissioner – the title
often gets me off to a bad start. People get so flustered, perhaps
because it has sex in it. I am frequently called the sex
commissioner, the equal opportunity officer and sometimes – I
like this one – the sexual commissioner. I try to keep that quiet.
Whenever I sit next to some perfectly pleasant man in businessclass on the plane, and we’ve been getting along quite well, I
have come to dread the moment when he asks me what I am
doing in business class – in other words what do I do?
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Try as I might, the moment I say sex discrimination
commissioner, he draws back in fear, a look of terror on his
face, unsure as to whether I will castrate him on the spot or
simply charge him with the offence of being a man. He never
quite relaxes. The first question, almost invariably, is that he
hopes he hasn’t said anything wrong.
Perhaps this reaction is understandable given the history of the
women’s rights movement, but even in the world of women’s
rights, things are changing. These days everyone is talking to
men and women about their rights.
My current project Striking the Balance: Women, men, work and
family aims to involve women and men in the work and family
debate. The debate has traditionally been a woman’s discussion,
a kitchen table debate, with grandmothers, mothers, women
without children all having something to say. Only recently
have we recognised the importance of men being part of this and
perhaps this is why it is has moved from the kitchen to the
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barbecue, a man’s domestic domain, and came to be known as
the barbecue stopper by the Prime Minister!
The purpose of the project is to find out how Australians share
the care, the unpaid work of caring for kids, grandparents,
neighbours, houses and pets.
The Australian Bureau of Statistics tells us that women carry out
seventy per cent of all unpaid household work – that’s allowing
for tasks like lawn mowing, gutter cleaning and car
maintenance, which tend to be done by blokes. But we do not
know enough about what people think about this sharing of the
care, what impact it has on their lives and how it interacts with
our commitments to paid work.
Ultimately the project is about how sharing the care can be more
evenly divided between men and women and how good this is
for gender equality, in particular for enabling women to be
economically self-sufficient. There are a host of other
admirable national interest objectives such as increased
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workforce participation, improved competitiveness and
economic growth and more sustainable taxation burdens which
may also flow from this. What’s more, with the ageing of
Australia’s population coinciding with a move towards greater
economic self sufficiency, especially in old age, women will be
increasingly determined to change the share of unpaid caring
arrangements so that they can financially provide for
themselves. Their men will have to either work with them on
this or, one way or another, be forced to provide financial
compensation. Working with them sounds a lot easier.
While I could talk at length about these arguments, and reel off
statistics as I’ve been doing for most of this year, what I want to
focus on this morning are the links between balancing work and
family and men’s health outcomes.
I doubt there is anyone attending this conference who is not
already aware of the alarming figures on men’s health and
mortality, but although these will already be familiar to you,
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allow me to restate some of them to underscore their stark
reality.
Men die so much earlier than women, and so needlessly, almost
from the time they leave the womb. The picture is a universal
one, although third world countries and the former Soviet Union
countries suffer a greater disparity than Australia.
First, the gap in life expectancy in Australia between men and
women is 7 years and at last count, still growing. How can that
be when men are the scientists, the professors of oncology and
cardiology, the CEOs of aged care facilities and public
hospitals, the ones with the money and, in older generations, the
ones with the education?!
Next, more than three times more men than women die before
they are thirty five. Three times!!! This is after the birth defects
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and in vitro abnormalities are accounted for, which again, are
more prevalent in male neonatals.
For men in their prime years of work and fatherhood, there are
still more than twice as many men dying as women. How stupid
is that with modern medicine and all the advice in the world
available? It is not until people are over 70 that more women die
than men, clearly because there aren’t many men left. Even
amongst the fifty somethings, there are twice as many men
dying as women.
For Indigenous men, the story is worse. Life expectancy at birth
is just over 59, five years less than Indigenous women. This
compares with 77.6 years for all men and 82 years for all
women, a difference of 17 years for both.
But now let’s look at the causes. Are men more genetically pre
disposed to cancer or heart disease before they are 35? – I think
not. The numbers of young men and women dying of cancer,
for example, are about the same.
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Traffic accidents and suicide account for almost 80% of all
deaths for 15-24 year olds.
Each year in Australia, over 1600 young men aged 15 to 29
years die and more than 60,000 are admitted into hospital as a
result of injury (NHMRC, 1996).
Among young males aged 15 to 29, the risk of death is around
four times that of their female counterparts for accidental deaths,
six times as high for suicides and one and half times as high for
violence related death.
Many traffic accidents are caused through the influence of
alcohol or other drugs.
Mental illness also claims more deaths in young men than
young women.
For the over 35s, the greater number of deaths from heart
disease and cancers associated with life-style choices such as
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obesity, smoking, poor diet and alcohol, helps explain why
twice as many men die in the 35 to 44 age group. After that,
women start to catch up.
For Indigenous men we know that health outcomes are linked to
education, employment, and housing. And for all Indigenous
people in remote areas, access to the kinds of basic services that
urban dwellers take for granted.
But there is one explanation for the profound disparity in health
outcomes that eclipses all others: masculinity.
Masculinity, as it is commonly and traditionally defined, means
an identity based on risk taking. It means physically hard and
onerous work under unacceptable health and safety standards
(remembering that a lot of young male deaths occur as the result
of taking risks at work).
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It also means a great financial and emotional investment in paid
work.
Today this investment often means working long hours in paid
work, often at the expense of time with family. Or the flipside
for some groups of men, lack of opportunities for secure
employment and the resulting poverty and social exclusion.
Masculinity can also mean a deep and abiding belief in
immortality.
In other words those same qualities that ensured the survival of
the tribe when life was short, brutal and excessively physical,
are still ensuring men are more likely to die than women even in
peace-loving, quiet little Australia.
Is that smart? Shouldn’t we have worked out these risks were
no longer necessary?
And theoretically, of course we have. It is just that in practice
we continue to reward and encourage this type of male identity
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for its courage and daring and its achievements in invention,
science and politics.
Which is great if your life is about achievements.
But courage, daring and excessive self-belief in one’s mortality
also have an unnecessarily life-shortening downside for millions
of men who do not discover the cure for cancer, become prime
minister or get to run BHP. They live ordinary lives
unnecessarily cut short by their efforts to live up to expectations
that can have serious consequences for their health, their family
relationships and their connections to community.
So what, you may ask, has this to do with a project about
balancing work with family life?
Plenty.
The masculine ideal that says men fight wars, work huge hours
for forty years straight, are the family breadwinner and need to
spend years hunched over company accounts or microscopes
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eating terrible food and without exercising so their wives can be
the full time carers, also says that men don’t need to spend time
with their families, are hopeless at housework and can’t fold the
washing right, needn’t care for their parents, can’t get the baby
to sleep and have no particular need of the rich and deep ties
enjoyed by women and their children, women and their
communities, or women and their parents, for instance.
You have to suspect that if that’s your lot in life, no wonder men
regularly drink too much or go motor bike riding for relaxation.
In all these risk taking activities (like pub brawling, playing
contact sport or driving fast cars) you might also note an
element of irresponsibility, even of selfishness. But if we look a
little deeper, perhaps it is a sense of not counting?
Perhaps this risky behaviour reflects a belief that what a man
does and suffers will not matter to anyone else – his parents, his
partner, or his children. To quote one of the truck drivers that we
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spoke to in one of our focus groups – ‘you do what you gotta do
mate’ – this despite his awareness that his relationship was
suffering and that he misses his kids.
It cannot be simply lack of awareness given all the campaigns
about safety at work, road safety and smoking. Perhaps men
don’t really believe they matter?
Our society does a great job of supporting women’s deep ties to
their families – to parents as well as children – meaning that
women are always aware of how needed they are, and how
onerous their responsibilities.
This of course has its down sides – think of how little society
values unpaid caring work – but no one ever doubts whether
women in their roles as carers are needed.
The act of suicide has often been described as a selfish act, but
is it not more correctly the act of someone who does not believe
others need them to live?
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For those of us who have lived the merry-go round lives of
women, with time in and time out of the workforce, fitting
around the needs of children, husbands and parents, with a
(perhaps overstated) conviction that our families can’t live
without us, preserving our health is important to us because of
it.
Women, with exceptions of course, grow up knowing they will
be or are the centrepieces of their families. We know that the
ties between us take time, not quality time, but lots of time.
Watching children grow up over weeks and years, events small
and momentous, shared activities like peeling the potatoes or
planting the vegetable garden… Not always as exciting as
cutting a deal or a drink after work with the boys, but a
necessary part of family intimacy.
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It goes further than that – it is also true that living your life
closely with your children and your parents and network of
extended family and friends, also requires a flexibility, an ability
to fit in with their lives. And for anyone who needs to change
their life style- for example in order to improve their health,
flexibility is essential. You can’t change if you aren’t
changeable. Accordingly if you can manage the dietary
requirements of three children, then doing Jenny Craig should
be easy.
By contrast, a 1998 NSW State Government assessment of
Gutbusters, a successful Newcastle programme for male weight
loss, observed, quote, that any male weight control program
required non-disruptive changes to men’s lifestyles in order to
be successful.
What a challenge! Frankly it is hard to think of any weight
control programme that provides non-disruptive changes to
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lifestyle, since it is invariably lifestyle that produced the original
weight gain.
But to return to the purpose of this address: men, work and
family balance. How would men doing more with their kids
rather than for their kids, doing more housework, taking a bigger
share of caring for their parents, help them to live longer and
healthier?
It goes well beyond the physical exertion involved in all of those
activities.
First, feeling wanted and connected might make them conscious
of the need to be healthy, to watch what they eat and drink,
exercise more, and drive speeding cars less.
Second, building those connections with their children, their
partners, and their parents is likely to help their mental health, in
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particular depression, and again, make them less likely to
indulge in risk taking behaviours.
Not only is improved mental health good for adult men, it sets a
risk-averse example for their sons, who by age are more at risk
of dying or serious injury than their fathers.
Third, it ensures men are skilled up in the areas of life that we
traditionally allocate to women. This means bringing up both
our girl and our boy children to cook for themselves, keep their
living quarters clean and tidy, organise their social lives,
develop their own diet and exercise regimes without the need to
refer constantly to women as their caretakers.
It is in old age that the gendered division of unpaid care and
paid work shows itself most starkly.
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For women it means a much greater chance of living in poverty
because their onerous family responsibilities have prevented
them from working and providing for their own retirement.
For men, not only does the ‘work til you drop’ model reduce
their chances of living long, or instead increases their chance of
living with chronic illness such as heart disease, suicide is a
terrible outcome for older men who are unable to cope, either
emotionally or practically, without a woman.
As many of you will know, the highest suicide rate for any age
group, male or female, is in men over the age of 65- men who
have lost partners. Where older widows may go on to enjoy
another twenty years of life, men so often fade away, neglect
their health or, sadly, suicide, so lost are they without someone
to care for them and they for her. But you can see how it
happens- the family stops dropping in with kids to mind or a
family meal, because mum organised that and they really came
to see her. Friends don’t drop in because there’s never anything
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to eat in the fridge. The food you cook yourself leaves a bit to
be desired. The house gets a bit neglected and going out, unless
it’s to a local club, also becomes less frequent because mum
always did all that arranging and got on the phone to friends.
Why should this be the case in Australia in the 21st Century, at a
time when theoretically there are more ways of ‘being a man’
than ever before?
It may be tempting for some to conclude that the answer to the
problems of men’s health is to spend more time at the gym,
ensure there are more male community nurses, more support
services for men, or diet and exercise programmes at work sites.
More education, more awareness perhaps? Certainly these are
important elements. What doesn’t often get put on the list of
solutions is spending more time at home - but I beg to differ.
Nothing will work without motivation. A reason to live and to
live healthily. Time to look after ourselves. The healing power
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of being with people we love instead of people we are paid to be
with.
What we need to confront is the outdated belief that men are
impregnable, that risking life and limb is ok, that medical check
ups, diets and keep-fit regimes are to be avoided as unnecessary,
that a man’s job is never more than bringing home the bacon,
and that their families do not need them as much as mothers.
Instead, men should be as sure as women that they must live,
and live healthy lives, for all their sakes.
For Indigenous men the strategies for achieving this will
undoubtedly differ – their shockingly lower life expectancies
demand a targeted approach. Motivating Indigenous men to live
healthy lives may lie in strengthening family ties by
reconnecting with traditional parenting practices and promoting
Indigenous men as positive role models in their communities.
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And at a macro level, addressing social and economic
disadvantage through improving educational attainment,
employment participation and housing are crucial, and in these
areas there are already signs of progress.
And lest I be accused of trying to tell men what to do or of
social engineering, let’s remember many men are already
leading this change, already re-defining their roles, just as
women have been doing since the second wave of the women’s
movement. To the delight of many, society is beginning to
question the assumption that men’s role in families is confined
to being a credit card on legs.
The changing attitudes and practices of a few men have been
crucial to opening up greater choice for men and women in their
work and family lives. A more recent ideal of the ‘new man’ or
‘new father’ has emerged which does challenge older ideals of
masculinity by emphasising both men’s desire and capacity to
be active, involved and nurturing participants in family life.
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There is a very diverse collection of groups and individuals
concerned with men’s issues in Australia and it is an emerging
area of practice. The focuses vary, ranging across men’s health,
personal growth and support, men’s role in parenting and
programs for boys in schools.
We know men want change because they have told us what they
are missing out on with their current arrangements. Graeme
Russell’s survey of fathers showed that 68 per cent of
respondents felt they did not spend enough time with their
children.
In another survey 55 per cent of men working full time agreed
that the requirements of their jobs caused them to miss out of
family activities that they would prefer to participate in, with 60
per cent agreeing that working caused them to miss out on some
of the rewarding aspects of being a parent.
What our consultations are showing is that what men are not so
sure about is how to change, given the current constraints on
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their choices as well as the unspoken pressures of gender roles
that are adopted by default rather than intention. Not just by
them, either. While women are apparently quite comfortable
with changing roles for themselves, they are not quite so sure
how much time they really want their men to spend at home
with them and the children in their domain.
The Striking the Balance project aims to facilitate change by
looking at what helps and hinders the choices men and women
make about their work and family obligations. After all,
decisions about how to manage our competing responsibilities
are not made in a social vacuum – one man’s choice is another
man’s necessity. And within couples, men’s choices need to be
reconciled with women’s choices and the needs of their families.
The limits to choice have been starkly illustrated to me as I have
travelled around the country talking to men about their work and
family arrangements.
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Low skilled, low paid blue collar workers have spoken of the
need to work long hours to get the overtime they need to pay off
mortgages and support their partners, that majority of mothers
who are working in low paid part time jobs, or no work at allbecause there is none flexible enough to accommodate caring
for their kids.
Middle managers talk about the pressures of a 24/7 economy,
global link ups, 60-80 hour weeks in professions that
theoretically offer family-friendly work arrangements but which
amount to nothing in practice. Some speak of the continual
scheduling and negotiation required to get time off to attend
school events, or of their stoic resignation to being ‘weekend
dads’ to their kids. Many mention the pressures these
arrangements have on their relationships with partners and
children. The levels of stress are clear and profound.
Yet others speak of how they are doing things differently. Of
the difference that a CEO can make by discouraging a long
hours culture at work, or by members of senior management
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choosing to work part time so that they can spend more time
with their families, thereby giving permission other men to
follow suit.
Others proudly inform me that they are already sharing the load
at home on top of their manic working lives thank you very
much. To test one of these ‘new men’ I light-heartedly asked
him if he knew what kind of washing machine he had. He
replied yes, and gave me the make, model and litre capacity of
his Fischer and Paykel!
So there is evidence that the old stereotypes of masculinity are
breaking down, but not without concerted effort against
financial, workplace and cultural barriers. And for a lucky few,
the help of supports such as flexible and family-friendly
workplaces, formal childcare and child care provided by
grandparents.
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Striking the balance and better sharing the care can achieve a
number of great national objectives; if it can also help
men to live as long as women, then it will have achieved another
goal of gender equality. If it can accelerate the pace of change
for the benefit of men and women then this is an outcome that
should be welcomed by all.
‘Be a man’, as the new add says, and get your prostate checked
out.i But be a man in other ways too, don an apron and get into
the kitchen for a while, leave work early to pick up your kids or
get home in time to help with homework, nominate yourself for
tuckshop duty, get involved in sport or your local community, or
find other ways to share in the care for families and
communities. For in doing so, you will be caring for yourself
and those who need you.
Thank you.
i
Prostate Cancer Foundation of Australia's 'Be a Man' campaign, launched 1 September 2005. The
campaign promotes early detection by encouraging men to talk to their doctors and uses well known
sporting, media and community figures saying ‘Be a man’…
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