SUMMARY AND BACKGROUND INFORMATION FROM A FORUM HELD AT MASSEY UNIVERSITY, PALMERSTON NORTH, NEW ZEALAND, 8 MAY 1996, UNDER THE AUSPICES OF THE MANAWATU-WANGANUI BRANCH OF THE NEW ZEALAND PUBLIC HEALTH ASSOCIATION
In Australia, the Draft National Men's Health Policy was developed following the National Men's Health Conference, held in August 1995. Following the election, the policy is being reassessed, partly in the context of the budgetary process. nevertheless, there are certain perspectives described in the document which deserve attention. To quote (emphasis added):
"There is a dearth of research on men's health issues with a specific gender analysis." (p.9)
"... policy must extend beyond a focus on medical conditions and address the broader social and environmental issues that impact negatively on men's health." (p.12)
This includes socialisation - "The role of the media in shaping the popular image of what it is to be a man was also identified as a significant problem needing to be addressed." (p.12)
On the use of "gender analysis" - "... men are required to be independent, strong, intelligent, brave, mature and sexual initiators." (p.13)
The issue of masculinity, broader social dimensions, and gender-based analysis are also themes mentioned in the North Health Document entitled Men's Health Issues and Strategy (November 1995):
" ... it is now held that a major reason for the reluctance to address [male related health] issues comes from the whole social construction of masculinity in our culture, and how males are socialised from infancy to view themselves." (p.3 of introduction)
From points 11 and 12 of the executive summary:
11. " ... the male's innate propensity to aggression and competitiveness may be an important determinant of his health ... "
12. The psychosocial factor which emerges as the central "culprit" for the poor state of men's health is "the social construction of masculinity" - the way men are culturally expected and socialised to be in our society. This leads men to ignore symptoms, trying to "tough it out", and generally not wanting to look weak. It is easy to underestimate the power of this "masculinist" outlook, and we may have an especially strong version of it in New Zealand, although it is a n international phenomenon. Research shows that the higher the "masculinity", the poorer the health, whereas "androgyny" (a mixture of male and female characteristics) is beneficial to health, regardless of sex."
These are confidently specified definitions of masculinity, although many men may have some difficulty seeing themselves described in this manner. There is a particularly unflattering view of men from this perspective in Christine Forsey's The Making of Men: Guidelines for Working With Boys to Counter the Male Sex-role, West Footscray, Australia: West Education Centre, 1991:
The masculine ethos ... refers to a gender construct. A construct of attitudes, values and beliefs that are inculcated by males as a result of the expectations that are placed on them from the moment that they are born. These expectations are generated and reinforced by the family, education, religion, tradition, the media, peers and society at large.
The masculine ethos asserts that males, first and foremost, are powerful. It demands that they manifest their power through:
There is no mention of men using what power they have to protect or provide for those weaker than themselves.
There is no mention of self-sacrifice (women and children first, etc.).
There is the implicit assumption that power held by men is always abused and directed towards oppression of those who are weaker.
Forsey goes on to suggest that a feminisation of men would prevent this.
The forward to the publication states that Christine Forsey "has been working with teachers and boys in schools to develop strategies and curriculum support materials which counter the male sex-role".
This is an outline of the current policy environment. There are serious issues. Men may be concerned about the way they are addressed. It is important that men speak on and debate the issues as we see them. If men are to be defined, the definitions should be accurate ones that men are comfortable with. It is unfortunate that policies in these areas are becoming so gender-specific, but that is the current reality.
A number of issues were raised at the forum. They are listed here with links to further background information for some.
This appears to be the obligatory "men's health issue". Some background New Zealand data:
1992 deaths
Note that cancer is not the only prostate related health problem.
Note also that some prostate surgery in response to incontinence has been found to be inappropriate and a result of misdiagnosis (see here).
There are, among others, issues of:
Work related deaths and injuries
1989/90 ACC data show that in that year there were 114 male and 4 female work fatalities. 46,415 male work injuries were recorded, as compared with 12,583 female work injuries. The injury rate for men was highest in mining and quarrying, where it exceeded 1 in 10 workers. Injury rates were higher for men in every industry category.
There are some more data here.
It should be noted that OOS/RSI not just typist/keyboard related hazards, occurring also in several male dominated industries.
Household Labour Force Survey data for 1994 show much smaller differences between men and women when considering absences due to both illness and injury combined (see here). This would suggest a higher incidence of illness by women workers.
Dr E A Emmett, Chief Executive of Australia's National Occupational Health and Safety Commission, in his keynote presentation to the Australian National Men's Health Conference in August, 1995, addressed the question of "male culture" being a contributing factor to the higher work injury and death rates for men. He states that, "The role of Australian male culture in occupational health and safety is so well known that it has been very surprising for me to find there has been virtually no research on the topic at all!" (p. 85 of the proceedings). He goes on to give reasons why this "mythology" should not be unquestioningly accepted.
Sports related deaths and injuries
Some of these are gender-specific. There is currently attention being given to prevention of rugby scrum-related injuries.
It may be that causes and solutions are gender-specific, even if the problems are more general.
This is a very broad area. Several people have voiced a special interest in men's mental health issues, including both stress related and other dimensions.
Male suicides outnumber women's by approximately four to one. In 1990 in New Zealand there were 363 male and 92 female suicides recorded. This has been used by some to show that men are more violent than women, including violence against themselves. When it is suggested that suicide is a male problem, however, the point is often made that women attempt suicide at about the same rate, and men are merely more "successful" because they use more effective methods. Data on suicides and some attempted suicide data can be found here. These data would suggest that, while there are more identified suicide attempts by women in the substance ingestion category, there is little difference in the number of completed suicides from poisoning with solid or liquid substances (the most common female category), and if "other gases and vapours" are included, male deaths greatly outnumber female.
Suicide by men does not appear to get much attention when compared to deaths on the roads, although for virtually every five year cohort from 35-39 onwards, there are more male deaths through suicide than through motor vehicle accidents. A figure of $2million has been set as the value of a life for evaluation of road improvements. It is not clear how much is spent on reduction of suicide numbers.
Men are victims of violence also.
There is currently a focus on family violence. The media emphasis is on violence by men against women and children. This is not the whole picture, and overseas studies indicate high levels of domestic violence by women. There are numerous articles on this topic here. The evidence available in New Zealand is influenced by the nature of projects that receive funding. This can be seen in relation to the Hamilton Abuse Intervention Pilot Project (see here and here), and research projects such as those funded by the Health Research Council and outlined here.
One separated father, having spent a lot of time with his children since separation, but still being classified as an "absent parent", due to the children sleeping less than 146 nights a year with him, applied to the Family Court for custody. His ex-partner was unco-operative, and so the only option the judge chose to consider involved a halving of his time with the children.
Another father had custody of his child for 18 months since separation under a formal agreement, but his ex-partner changed her mind and applied for custody. The judge in this case thought the appropriate solution would be for the father just to see the child at weekends.
Yet another father was awarded access including over 130 nights a year (but again under the crucial 146 nights required for a change in the child support formula). His ex-partner was then allowed to relocate so far away that he had to change to part-time work and set up another home near the children so as to achieve this level of access and get the children to and from school when they were in his care.
Judge Green's paper to the New Zealand Law Society's Family Law Conference in October 1995 discussed issues of custody and access. It is discussed here. Despite gender-bias in custody decisions being explicitly ruled out by subsection 23.1.a of the Guardianship Act (see here), added 15 years earlier, it would appear that such bias is still acceptable, and hostile actions by a mother are tolerated. It even appears that a non-custodial parent might be required to have a "significant and positive" relationship with the custodial parent, if the latter is to be prevented from relocating the children.
The Duluth Wheel specifies a range of abusive behaviours. It comes from a programme on which the Hamilton Abuse Intervention Pilot Project is based. It is discussed here. The behaviours included are not unlike those considered in the New Zealand Justice Departments' Hitting Home study on male domestic violence towards women (for discussion of that study, see here and here). The following are among the behaviours considered:
* Using economic abuse
* Using gender privilege
* Using isolation
* Threatening to take children away
* Making light of the abuse and not taking other's concern about it seriously
There are very close parallels between these behaviours and some of the outcomes of the family law system in New Zealand.
On economic abuse, consider that up to virtually 40 per cent of a liable parent's take-home pay can be required for "child support", although there is no accountability whatsoever on how the money is used by the custodial parent.
On gender privilege, the award of custody appears to strongly favour women. Unfortunately data has not been collected since 1990, which is perhaps indicative of the lack of concern about this issue. Shared custody is virtually ruled out in all but the most amicable of separations, although the justification for this is questionable (see here).
On isolation, consider the acceptance of loss of contact between children and non-custodial parents. This is isolating both parties. The ability to do this with the court's acceptance makes threats to take children away all the more effective.
For an example of making light of the abuse, we can look at the interview with Australian Family Court Chief Justice Alistair Nicholson on Radio Australia's Law Report programme (discussed here, with a link to the full transcript). In brief, he believes that a man who is dissatisfied with losing his children is simply suffering from an old-fashioned belief that he has the right to control his family. He effectively suggests that he should, "shut up and take it like a man".
M McPherson, on page 41 of her book, Divorce in New Zealand (1996, Social Policy Research Centre, Massey University) describes control of access as, "one of the few sources of power women may hold in the divorce process". While this comes in a section which summarises the relevant literature, it is alarming for three reasons. First, it belittles and perhaps even excuses the use of the extremely powerful weapon of taking away someone's family for personal advantage. Second, it suggests, without giving reasons, that there is a major power imbalance in favour of men. Third, it shows that such behaviour is accepted in a family court system which is supposed to be based on the primary guiding principle of the "best interests of the children".
As to whether the outcomes of the family court system are harmful, this would be indicated by data on separation and suicide. An Australian study (Cantor C H and Slater P J, "Marital Breakdown, Parenthood, and Suicide", Journal of Family Studies Vol.1 No.2, October 1995) found that separated men had a suicide rate about 6.2 times that of married men, and about 12 times that of separated women. The study suggested that children "could well contribute to the observed different suicide rates, as females are more commonly the principal parents during separation". (p.99)
There may also be a link between separation and unemployment. McPherson mentions on page 43 that three out of four liable parents paid no more than the minimum $10 per week in child support. This would suggest that many of them are on very low incomes. This may be either a cause or an effect of separation. It may also be unrelated, but the figure seems very high for a coincidental outcome.
[There is additional information on the other family violence here.]
In a paper by Joanna Broad to the Public Health Association national conference in Palmerston North in 1994, data were presented giving the percentage of men and women in long term care. Rates for women 65+ were found to be almost twice as high as men for each 5 year cohort, with men peaking at about 40% for 95+, compared to about 80% for women in that age cohort.
When asked why this might be the case, two possible reasons were given:
The former reason could be linked to psychological factors, in association with society's attitude towards elderly men and their role in society. With the latter, it may be appropriate to consider quality of care issues. The comment was made that "perhaps men are more aware of a bad investment", and are concerned about providing financially for a spouse who may outlive them by many years.
Contact with health care professionals
Both the Australian and the North Health documents identified accessibility as a possible problem for men. This is because men are more likely to have to take time off from work to see doctors, and they are less likely to visit doctors regularly for other reasons, as mothers with children do. The recent series of radio programmes on men's health issues such as prostate problems, while commendable, may not have reached many of its target audience as it was broadcast at 3.45pm on weekdays.
There may also be issues of attitudes. North Health's reference to men tending to "tough it out" appears to put the focus on men as the ones needing to, and responsible for, change. This contrasts with the approach taken for women's health issues, where emphasis was placed on the attitudes of medical professionals and their need for sensitivity to women's perspectives. Media campaigns to encourage women to participate in screening programmes were also very sensitive to women's feelings.
Social workers and counsellors
There is perhaps a need to consider whether training includes appropriate coverage of men's issues and men's perspectives. The gender-mix of workers in these professions might also give some concern about awareness of and sensitivity to men's problems. An Australian study described in a paper presented to the Australian Family Law Conference in 1995 by Ruth Bradshaw concluded that female counsellors favoured the mothers and male counsellors favoured the fathers. Jack Kamer, in his book Good Will Toward Men, has a chapter describing the attitudes of many counsellors in the United States, suggesting reasons for concern about whether men are given a fair hearing.
The media is sometimes blamed for presenting an image of men as aggressive, dominant, and violent. There may well be problems arising from this. The media also gives other signals which may be inaccurate and harmful for men's behaviour and self-image. As an illustration, Marilyn Waring has been given a lot of publicity as a result of her book, Counting for Nothing: What Men Value and What Women are Worth, and the related documentary, Who's Counting? Marilyn Waring on Sex, Lies and Global Economics. This work is featured in a three page article in the first 1996 issue of Massey Focus, "a quarterly magazine which communicates the aims and activities of Massey University". Prominence is given to her assertion that, "no matter what the country or the culture, women work 16 to 18 hours a day every day of the week". The New Zealand Department of Statistics undertook a time diary study, presenting the results in 1991 in a publication called Testing Time. Figures on page 21 show that the sum of paid and unpaid work took up 34 per cent of an average 24-hour day for men and 28 per cent for women. An Australian Bureau of Statistics study described on page 148 of their 1993 publication, Women in Australia, found that "Overall, women and men spent about the same average amount of time (31% of the day) on paid and unpaid work combined in 1987". They also found that, among employed people with children, women spent on average 40 per cent of the day on paid and unpaid work, compared to 42 per cent for men. Nevertheless, we repeatedly hear of the "double burden" born by such women. Schmittroth L (ed), (1991) Statistical Record of Women Worldwide, London: Gale Research, includes time allocation data for several countries. Paid and unpaid work, plus commuting time, for a week are presented as follows: United States, 1981, women 56.4 hours, men 61.3 hours; Japan; 1985, women 56.8 hours, men 60.0 hours; USSR, 1985, women 69.7 hours, men 70.9 hours. If women worked at least 16 hours per day, the minimum suggested by Waring, and did nothing else but sleep, they would be sleeping for no more than 56 hours per week. Women's sleeping hours are given as: US 59.9; Japan 57.0; USSR 58.2. Despite these data, men are frequently told that women work far longer hours, men are advantaged, and men are not "pulling their weight". This also contributes to a misleading and harmful media image.
Various suggestions were made in discussion. The information presented was new to many of the forum participants. The areas are very broad, and much work needs to be done evaluating current research. This contrasts to much of the research work undertaken at present in that the latter is based more on new information, rather than reappraisals of existing information.
There was a feeling that definitions of masculinity are problematical and no single view is adequate. There was also criticism of gender analysis as a basis for policymaking in that many issues do not fit neatly into gender categories. The emphasis on gender could therefore detract from the issues themselves and result in inappropriate policies.
The broad social context and the highly political nature of many of the issues was identified. There was some brief discussion on the strategies required to ensure adequate debate of the issues, including problems of publication of results. The suggestion of a "Journal of Men's Health" was raised.
Given the possible harm arising from current policies and indicated future policy directions, it was suggested that attempts be made to obtain research funding to support an investigation of issues from contrasting perspectives.
The forum closed with an acknowledgement that there are important issues to address, but there may be problems obtaining the necessary support, funding and publicity.
Stuart Birks
24 May, 1996
(additional link added 12 June, 1996)