Decolonising the health and well-being of Aboriginal men in Australia

Abstract

Aboriginal and/or Torres Strait Islander men have the worst health of any group in Australia. Despite this, relevant policies do not specifically explain how the issue will be improved. Existing research demonstrates the complexity of the problems facing Australian Indigenous men. The intersection of masculinity and Indigeneity, compounded by colonisation, historical policies, stigma, marginalisation, trauma, grief and loss of identity are key factors that shape these poor health outcomes. These outcomes are acknowledged in federal and some state government policies but not implemented. The article argues for a holistic and decolonised approach to Australian Aboriginal men’s health. Effective models of intervention to improve men’s health outcomes include men’s health clinics, men’s groups, Men’s Sheds, men’s health camps/bush adventure therapy, fathering groups and mentoring programs. Further research needs to be undertaken, with a greater emphasis on preventative health measures, adequate specific funding, culturally and gender appropriate responses to health, and government policy development and implementation covering Aboriginal male health.

Keywords

gender health health inequality Indigenous sociology medical sociology sociology

This article argues for a holistic and decolonised approach to Australian Aboriginal and Torres Strait Islander men’s health.¹ Holistic approaches to Indigenous health are important because they begin to address some of the problems caused by the Australian Aboriginal history of cultural and social dislocation and oppression (Fredericks et al., 2011: 81–3; Sherwood and Edwards 2006: 178). The importance of a holistic approach to Aboriginal men’s health is outlined in the National Aboriginal and Torres Strait Islander Male Health Framework: Revised Guiding Principles (Australian Department of Health and Ageing, 2010: 2–4). The National Aboriginal Health Strategy (1989) defines this holistic approach as:

Aboriginal health means not just the physical well-being of an individual but refers to the social, emotional and cultural well-being of the whole community in which each individual is able to achieve their full potential as a human being thereby bringing about the total well-being of their community. (National Aboriginal Health Strategy Working Party, 1989: 1)

This holistic approach recognises the interconnectedness of physical, mental, social, emotional and cultural well-being of individuals, families and communities (Dudgeon, Milroy et al., 2014: xviii). The diversity that exists in Aboriginal society spans across all facets of life, from culture, knowledge systems and spirituality to politics, economics, gender, sexuality and lifestyles, and Aboriginal people therefore cannot be reduced to a homogeneous group (Australian Department of Health and Ageing, 2010a: 2–4; Kariippanon and Senior, 2018: 33; McLennan and Khavarpour, 2004: 237–8). Without a holistic approach to Aboriginal men’s health, illness and poor health outcomes will persist.

Aboriginal and/or Torres Strait Islander males have the worst health outcomes of any group in Australia (Australian Department of Health and Ageing, 2013a: 36). There are approximately 322,200 Aboriginal and/or Torres Strait Islander males (Australian Bureau of Statistics, 2017a) and their average life expectancy is 10.6 years less than non-Indigenous males (Australian Institute of Health and Welfare, 2018: 1). Aboriginal men are four times more likely to die from accidental death and experience more frequent and intense mental health issues. Male suicide in Australia occurs at a rate three times greater than for women (Australian Bureau of Statistics, 2017b: 1). However, Aboriginal male suicide rates are twice those of non-Indigenous men, while the rates for particular age cohorts are up to five times higher (Australian Department of Health and Ageing, 2013b: 1). These grim health statistics highlight the health crises being experienced by Aboriginal men. There are other gender identities beyond the dichotomy of male and female which impact health, however their complexity is beyond the scope of this article (Connell, 2005a: 1804).

The mainstream Australian health system, reflecting a colonialist approach (Axelsson et al., 2016: 2, 5), lacks a culturally appropriate holistic understanding of Indigenous health. Aboriginal conceptualisations of health take a holistic approach, encompassing interconnected aspects of physical, mental, social, and emotional well-being (Australian Department of Health and Ageing, 2013a: 9–10). The health of Aboriginal men in contemporary Australia is integrally related to historical, cultural, political, economic, psychological, physical and environmental circumstances (Canuto et al., 2018: 4–7; McCalman et al., 2010: 2–3). Western approaches continue to dominate responses to poor Aboriginal male health, overlooking Aboriginal knowledges and perspectives (McCoy, 2008: 66–8; Ngaanyatjarra Pitjantjatjar Yankunytjatjara Women’s Council Aboriginal Corporation, 2013: 23–7). These responses have been largely ineffective. Effective responses require a decolonisation of the health system to empower Aboriginal men to take ownership over their health (McPhail-Bell et al., 2015: 195–8; Sherwood and Edwards, 2006: 178).

Aboriginal male identity

Colonisation has had a profound effect on Aboriginal male identity (Adams, 1998: 7; Innes and Anderson, 2015; McCoy, 2008: 46–50). The British had experience of colonising Indigenous peoples in other parts of the world before arriving on the Australian continent in 1788 (Dudgeon, Wright et al., 2014: 4; Taylor and Guerin, 2010; Tharoor, 2018). The British ‘believed that the introduction of Western education and Christianity would transform a morally decadent society’ (Tharoor, 2018: 201). Destroying Indigenous and gendered (Hardin, 2002; Sinha, 1995) identities and making their cultural practices illegal was an integral part of the colonising process. This process of colonisation is similar to that experienced by other Indigenous males such as Māori in New Zealand (Borrel, 2015; Hokowhitu, 2007), those in the Americas (Hardin, 2002; Innes and Anderson, 2015), Native Hawaiians (Tengan, 2002), South Africans (Morrell, 1998) and Bengalis (Sinha, 1995). An example in Australia was the incarceration of Aboriginal males in a prison on Rottnest Island that operated from 1838 to 1903.

Over 3,700 Aboriginal men were removed from throughout WA (Western Australia) and sent to Rottnest during this period. These men and boys were the Elders, the Custodians and the Lore men who were the keepers of order, culture, spiritual integrity and historical record for the Aboriginal community, as well as the protectors and providers for the women and children. This constituted the removal of ‘the leadership group’ across all Aboriginal nations in WA. (Rottnest Foundation, 2018: 1)

Since colonisation, major restrictions have been placed on Aboriginal male identity through removal, incarceration, legal restrictions, social dislocation, stigmatisation and the loss of traditional methods of passing on culture (Axelsson et al., 2016; McCoy, 2008: 46–50, 6–9). The colonisation of Australia by the British has severely undermined the traditional roles of Indigenous men (Adams, 1998: 7). The confusion and uncertainty associated with Aboriginal masculinity and its performance has resulted in men becoming lost and displaced within Aboriginal society (Hokowhitu, 2007: 63; McCoy, 2004: 19, 21). Premature death, excessive incarceration and poor health further contributes to the loss of male cultural identity. The demands of adjusting to non-Aboriginal society form an additional challenge, particularly when experiences of racism are common (Kowal and Paradies, 2005: 1347; Ladson-Billings, 1998). Historical injustices and the ongoing effects of colonisation have had a profoundly deleterious effect on the identities of Aboriginal men (Innes and Anderson, 2015; McCoy, 2008: 56–60, 92). The continued decolonisation of Australian society is crucial for Aboriginal men to grow strong and become empowered (Sherwood and Edwards, 2006: 178).

Aboriginal males are forced into a marginalised masculinity when trying to adjust to non-Aboriginal society. Masculinity is performed in different ways depending on geographical location and historical period (Connell, 1997: 8). Different masculinities can be marginalised and privileged, in relation to an idealised form of masculinity or hegemonic masculinity (Borrel, 2015: 829–32; Connell and Messerschmidt, 2005). Aboriginal men have difficulties adhering to mainstream Australian hegemonic masculinities because of historical and cultural factors. The intersectionality of being male and Aboriginal creates further levels of disadvantage. This complex intersectionality was discussed at the 1st World Conference on Men’s Health (McDermott et al., 2001: 80). The state of affairs for Aboriginal men is far more complex than for non-Indigenous men. Indigenous and non-Indigenous men are both affected by patriarchal powers and privilege within society. However, there is also racism and disadvantage experienced in the broader Australian society across the contexts of race, ethnicity, and cultural beliefs, negatively impacting on the health of Aboriginal men (Pease, 2013: 13–14). From a critical race theory perspective, the experience of marginalised masculinity may be a significant factor contributing to Aboriginal males’ poor health outcomes (Australian Department of Health and Ageing, 2013a: 36; Delgado and Stefancic, 2001: 7–8; Ladson-Billings, 1998: 7).

The dimensions of the problem

Aboriginal people experience the burden of disease at a rate 2.3 times greater than the non-Indigenous population (Australian Institute of Health and Welfare, 2011a: viii). Chronic diseases accounted for 64% of the total disease burden of Indigenous Australians. Chronic diseases accounted for 70% of the gap between Aboriginal people and non-Indigenous Australians. The five highest ranking diseases among Indigenous men were coronary heart disease, alcohol and substance use disorders, suicide and self-inflicted injuries, diabetes and anxiety disorders (Australian Institute of Health and Welfare, 2011a: 17). Approximately 37% of the burden of disease was preventable by reducing exposure to modifiable risk factors (Australian Institute of Health and Welfare, 2011a: 19).

The period 2007–8 saw the hospitalisation of 120,000 Aboriginal males from New South Wales, Victoria, Queensland, South Australia, Western Australia and the Northern Territory (Australian Institute of Health and Welfare, 2009a). The standardised adjusted rate was 876 of every 1000 Aboriginal men hospitalised compared to 358 of every 1000 non-Indigenous males. Hospitalisation rates for Aboriginal males are 2.4 times higher than those of non-Indigenous males (Australian Institute of Health and Welfare, 2009a). More recent data regarding the causes of these hospitalisation rates were not available. However, the data from the 1999–2000 period showed Indigenous males were six times more likely to be hospitalised for care involving dialysis (Australian Bureau of Statistics, 2002: 1). Other common causes of hospitalisation were injuries resulting from motor vehicle accidents and general accidents, mental and behavioural disorders and respiratory disease.

The Australian Bureau of Statistics found that 24% of Aboriginal and/or Torres Strait Islander males reported experiencing high or very high levels of psychological distress in the previous four weeks (Australian Bureau of Statistics, 2013: 1). This rate is more than double that of non-Indigenous males for most age cohorts. Life events are more likely to contribute to the higher levels of psychological distress among Aboriginal people (Australian Indigenous HealthInfoNet, 2012: 9). These negative life events include the death of a family member or a friend, serious illness or injury, unemployment, substance abuse issues, overcrowding or family or friends being involved with the criminal justice system. Supporting the social and emotional well-being of Aboriginal men is important to protect against negative life events (Department of the Prime Minister and Cabinet, 2017: 7).

The higher level of psychological distress experienced by Aboriginal males has led to increased mental health hospitalisation rates (Australian Institute of Health and Welfare, 2009a, 2009b). The hospitalisation rate for Aboriginal males regarding mental health-related issues including ‘schizophrenia, schizotypal and delusional disorders’ was 2.4 times that of non-Indigenous males (Australian Institute of Health and Welfare, 2009b: 56). The hospitalisation rate for Aboriginal males was 4.6 times that of non-Indigenous males for ‘mental and behavioural disorders due to psychoactive substance use’. Further, the number of deaths due to mental and behavioural disorders among Indigenous males living in several states was 5.8 times the expected rate for non-Indigenous males.

Past Australian federal, state and territory government policies compound stressful situations for Aboriginal people (Morseu-Diop, 2013). A history of colonisation, institutionalised racism, forced removal and alienation from culture and identity are some of the major contributing factors to the higher prevalence of mental illnesses (Axelsson et al., 2016: 1–7). These illnesses include transgenerational trauma, Post-Traumatic Stress Disorder (PTSD), grief and loss, depression, anxiety, adjustment disorders, lack of identity and others. Aboriginal people may resort to self-medicating as a response to the social and cultural circumstances that they are born into and have little control over. Despite significant amounts of money being spent on Indigenous health through schemes such as the Closing the Gap, ‘a December 2017 Australian Institute of Health and Welfare report found the mortality and life expectancy gaps are actually widening due to accelerating non-Indigenous population gains in these areas’ (Holland, 2018: 3).

Aboriginal people are significantly over-represented in the Australian criminal justice system. In 2016, Aboriginal men made up 26.7% of incarcerated men, despite being approximately 3% of the male population (Australian Bureau of Statistics, 2016: 1). The former Australian Prime Minister Kevin Rudd was quoted as saying ‘Australia is now facing an Indigenous incarceration epidemic’ (Bourke, 2015: 1). The number of Aboriginal people incarcerated has increased by 88% since 2004 (Korff, 2015: 1). In 1992, one in seven prisoners were Aboriginal, if the trend in incarceration numbers continues at this rate, 1 in 2 will be Aboriginal by 2020. Further, there is a lack of holistic supporting structures for Aboriginal men when transitioning from incarceration into the community (Willis and Moore, 2008: xi, 44, 6–50).

Cultural, historical and social factors are the main causes of the much higher rates of chronic disease (Australian Institute of Health and Welfare, 2011a), hospitalisation (Australian Institute of Health and Welfare, 2009a), psychological distress (Australian Institute of Health and Welfare, 2009b), and incarceration (Australian Bureau of Statistics, 2016: 1) among Indigenous people in Australia. However, the most common responses to these issues are informed by an individualised Western bio-medical model. This bio-medical individualised model is applied to the poor health outcomes experienced by Aboriginal people rather than acknowledging the collective structural experiences which are the key causes of much of the health inequalities (Newman et al., 2007: 571). The neoliberal discourse shifts blame from the state to individuals. This discourse has been applied by consecutive governments and become embedded in the realm of Aboriginal health policy since the 1990s (Walter, 2010: 121). This dominant health discourse requires an ongoing process of decolonisation to meet the needs of Aboriginal people (Sherwood and Edwards, 2006: 188). Innovation by health services to incorporate a holistic approach despite neoliberal confines is important if the health of Aboriginal men is to improve.

Policy

Policy responses at all levels of government to improve the health of Aboriginal and Torres Strait Islander males could benefit from a holistic and decolonised approach. The National Aboriginal and Torres Strait Islander Male Health Framework was developed by consulting leaders in the area (Australian Department of Health and Ageing, 2010a*). The framework has 11 guiding principles that were developed by the National Aboriginal and Torres Strait Islander Male Health Leadership Group. These principles are in place to help inform governments, service providers and other bodies and individuals to improve Aboriginal and Torres Strait Islander male health. These 11 principles are:

- reconstructing male empowerment and self-determination;

- a holistic approach;

- continuity of care;

- shared, integrated, collaborative and responsible processes;

- partnership approach;

- strategy and policy development;

- access and support;

- the health workforce;

- the evidence base;

- allocation of funding; and

- governance.

The 11 guiding principles present a strong foundation to consider when developing policies, strategies, programmes or other means of improving Aboriginal male health.

The National Aboriginal and Torres Strait Islander Health Plan 2013–2023 is a central document explaining how the Australian federal government plans to improve Indigenous health (Australian Department of Health and Ageing, 2013a). The health plan shares a vision to close the gap between Indigenous and non-Indigenous health by 2031, as part of the Closing the Gap initiative. Several priority areas are identified throughout the health plan, and yet Aboriginal males are not specifically addressed. The National Aboriginal and Torres Strait Islander Health Plan 2013–2023 discusses that Aboriginal men have the worst health outcomes of any group in Australia, yet does not mention it as a priority (Australian Department of Health and Ageing, 2013a). Further, neither the National Aboriginal and Torres Strait Islander Male Health Framework nor the National Male Health Policy are referenced. The National Aboriginal and Torres Strait Islander Health Plan 2013–2023 inadequately explains how the health of Aboriginal and Torres Strait Islander males will be improved.

Focusing on gender, The National Male Health Policy identifies Aboriginal men as being a priority group (Australian Department of Health and Ageing, 2010b). The policy importantly undertook eight specific consultation sessions with Aboriginal men and refers to the National Aboriginal and Torres Strait Islander Male Health Framework (Australian Department of Health and Ageing, 2010a). However, the only specific federal funding allocated in this policy is $6 million over three years. The allocated funding is to provide support and services to Aboriginal men to encourage them to take part in the lives of their children and families. While it is great that the importance of Aboriginal men being involved with their families is recognised, this is a surprisingly narrow and limited response for a group with the worst health outcomes in Australia.

At a state and territory level, there are no current specific Aboriginal and Torres Strait Islander male health policies or strategies. Instead, reference to Aboriginal male health occurs in sections on Indigenous health generally or on mainstream men’s health. The relevant state and territory policies do not specifically address Aboriginal men’s health. A notable example of Aboriginal men’s health being addressed at the local level is the Aboriginal and Torres Strait Islander Men’s Health Plan 2015–2020 developed by Northern Sydney Local Health District (Northern Sydney Local Health District, 2015). This plan was developed by consulting local Aboriginal men who identified areas of service delivery which needed improvement to meet their health needs. The plan aims to improve service delivery across seven areas with specific strategies for how this will be achieved. The Aboriginal and Torres Strait Islander Men’s Health Plan 2015–2020 could be used by Aboriginal Medical Services, Local Health Districts, National Aboriginal Community Controlled Health Organisation (NACCHO) and affiliates or even non-Indigenous health care providers as a guide to developing their own Aboriginal and/or Torres Strait Islander men’s health plan to meet their local needs (Northern Sydney Local Health District, 2015). Leadership at a federal level may help states and territories align their relevant policies and identify how Aboriginal men’s health can improve.

Appropriate models of Aboriginal male intervention

Aboriginal community controlled primary health care clinics provide a comprehensive, culturally appropriate and holistic service (Mohamed, 2014: 3). The Aboriginal community controlled health service sector focuses on ‘prevention, early intervention and comprehensive care’ and ‘has reduced barriers to access and unintentional racism, progressively improving individual health outcomes for Aboriginal people’ (Panaretto et al., 2014: 649). There is evidence to suggest that health clinics can marginalise the needs of Aboriginal men (Canuto et al., 2018; McCoy, 2008: 86). This is done through predominantly female staff being employed and clinics becoming primarily female spaces. Having male Aboriginal health workers and clinical staff encourages Aboriginal men to visit and feel comfortable discussing health issues (McCoy, 2008: 87).

These barriers may help to explain why Aboriginal men are accessing Aboriginal health services less than women (Australian Institute of Health and Welfare, 2011b: 28). In the period 2009–2010, an estimated 2.4 million episodes of health care were provided by Aboriginal primary health care services. Of these episodes of care, 59% were provided to female clients and approximately 41% to males (Australian Institute of Health and Welfare, 2011b: 28).

The concept of specific Aboriginal men’s health clinics has been used by medical services with success (Wenitong, 2002: 21, 59). Male-specific health clinics have a set time and location to meet the needs of Aboriginal men. Male Aboriginal health workers and Aboriginal health practitioners are key health professions to utilise for successful Aboriginal men’s health clinics (Tsey et al., 2014: 60). The current services model can fail to account for the needs of Aboriginal men. Indigenous males have reported feeling socially excluded from taking part in society and this includes accessing social services. Rather than labelling men as hard-to-reach clients, services need to consider their service delivery (Tsey et al., 2014: 58). This approach allows services to retain power over delivery and engagement rather than lay blame on external phenomena. Attributes identified that engage men in service delivery are:

- good policy and practice development prior to set up of service;

- building trust;

- developing culture;

- mentoring youth; and

- promoting the importance of being a good father. (Arney and Westby, 2012; McCalman et al., 2010; Tsey et al., 2014: 5)

A review of published and unpublished resources identified a variety of programs undertaken specifically by Aboriginal men to improve their health. These approaches include men’s health clinics (McCoy, 2008: 86–7; Wenitong, 2002: 21, 59); men’s camps (Mibbinbah Spirit Healing, 2019); sporting groups (Hallinan and Judd, 2007); fathering programs (Collard et al., 2016; Hammond, 2011); Men’s Sheds (Cavanagh et al., 2016; Sergeant, 2010); mentoring programs (Arney and Westby, 2012: 11) and others. These programs have varied across different Aboriginal communities throughout Australia. However, they have many common principles and aims: empowerment, social and emotional support, sharing culture, yarning and being a culturally safe space (Arney and Westby, 2012).

Aboriginal men’s health programs are under-funded and there is no specific funding source. The process of applying for funding and knowing where to begin can be difficult and off-putting (Arney and Westby, 2012: 37; McCalman et al., 2010). Aboriginal men’s programmes can have a lack of informed direction and research to assist those applying for funding, meaning there are difficulties knowing where to focus. Aboriginal men’s groups provide a crucial form of support for participants (McCalman et al., 2010: 2). In line with the Aboriginal conceptualisation of health, Aboriginal men’s groups take a holistic approach to activities with social and emotional well-being the primary dimension of health addressed, although mental and physical health can be improved too. There can be significant community pressure on Aboriginal men’s groups to provide an answer to the range and depth of issues faced by men. There is a variety of activities undertaken by Aboriginal men’s groups across Australia, these can be both proactive and reactive.

A crucial aspect of any Aboriginal or Torres Strait Islander men’s group is to emphasise the need for men to have culturally safe space for healing, reflection and re-establishment of their roles in the family and community. They often emphasise that the group should be owned and managed by the men themselves. Men’s group initiatives impact not only on men, but also on family and community members. (Arney and Westby, 2012: 5)

The Men’s Sheds movement has grown during recent times as an effective health intervention. Men’s Sheds are ‘a safe and conducive environment for men to yarn and learn new skills about educational, employment and economic matters and enhance their social learning and ability to reconnect with Aboriginal and Torres Strait Islander traditions and culture’ (Cavanagh et al., 2016: 55). They provide a useful and practical model for Aboriginal men’s health promotion, prevention programs, informal counselling, cultural connections, relationship building and teamwork (Sergeant, 2010: 3–4). Having an ongoing consultation with Aboriginal men to empower and allow them ownership over the Men’s Shed is crucial for success (Sergeant, 2010: 6). Men can opt to undertake the activities they believe are important for health and well-being. For example, making cultural items, such as waddies, clap-sticks and spears allows for a stronger identity, facilitates the transfer of cultural knowledge, and provides a platform for Aboriginal men to fulfil traditional roles of masculinity, improving health (Sergeant, 2010: 3–5).

Aboriginal men’s health camps have proven to be an effective method of improving health outcomes across different dimensions of health (Maller et al., 2006; Mibbinbah Spirit Healing, 2019). These health interventions provide a means for Aboriginal men to connect to Country and undertake cultural activities. Connecting to Country is an important component of Aboriginal identity and cultural practices. Having a stronger connection to Country is beneficial to improving human health (Bowen and Neill, 2013; Maller et al., 2006), although there is a lack of specific research regarding Aboriginal men. Individuals with access to natural settings such as parks have been found to be healthier overall. The biophilia hypothesis (Wilson, 1984) argues that humans are attracted to the natural world, an activity that Aboriginal people incorporate into their culture and is represented in the holistic conceptualisation of health (Dudgeon, Milroy et al., 2014: xxiv, 4).

The Quop Maaman: Aboriginal Fathering Project is an example of a fathering program developed primarily by Aboriginal men for other Aboriginal men (Collard et al., 2016). The program was designed for a Noongar context with a strong language and cultural component. Aboriginal fathering programs are proactive and holistic in their approach to health. The foundations of this program provide an important framework for Aboriginal men in other parts of Australia looking to develop a fathering program. The Quop Maaman: Aboriginal Fathering Project is built upon the key principles of culture, holistic approach, and empowerment. The Koori Fathering Program: Pilot Phase Evaluation Report found similar principles were crucial for success (Newell et al., 2006: 39). Mainstream fathering programs were found to not be culturally appropriate, too female-orientated and difficult to access (Stuart et al., 2015: 7–10). Aboriginal fathering programs improve fathering skills and the social and emotional well-being of participants, this can have a ripple effect on their family and community.

Mentoring programs are an important component to improve the holistic health outcomes of Aboriginal males. These programs are both proactive and reactive to those disengaged (Bainbridge et al., 2014). The uncle–nephew system is an important cultural way of teaching boys, teenagers and younger men, which is based on an Aboriginal cultural framework and has the potential to resolve many issues experienced by Aboriginal men (Spry and Territory Health Services: Male Health Policy Unit, 1999: 1). In Aboriginal culture, the uncle–nephew relationship can be more powerful and important than the father–son relationship. For an uncle–nephew program to be initiated in an Aboriginal community, Elders and senior men need to be consulted, give authority and take ownership. The uncle–nephew program provides a strong framework for other mentoring-type programs to be developed. Overall, mentoring programs can be an effective empowerment strategy in the area of health and well-being, although more research is needed (Bainbridge et al., 2014: 1).

Suggestions for improvement

The main reason for the life expectancy gap between Indigenous and non-Indigenous men is excessive rates of chronic disease. By the time an Aboriginal male has developed a chronic disease, there are limited options for treating and overcoming the illness. Well-planned prevention programs have made significant improvements to health outcomes (National Preventative Health Taskforce, 2009). Appropriate health interventions that empower Aboriginal men include, among others: men’s health clinics (McCoy, 2008: 86–7; Wenitong, 2002: 21, 59); men’s camps (Mibbinbah Spirit Healing, 2019); sporting groups (Hallinan and Judd, 2007); fathering programs (Collard et al., 2016; Hammond, 2011); Men’s Sheds (Cavanagh et al., 2016; Sergeant, 2010); and mentoring programs (Arney and Westby, 2012: 11). These preventative measures could also reduce the incarceration rate of Aboriginal males. With Indigenous men being more interconnected and supported to be healthy, they may have less involvement with activities which result in contact with the criminal justice system (Australian Medical Association, 2015: 3).

Implementing strategies to improve the lives and health of Aboriginal males will require specific funding. Funding is also required for further research into Aboriginal men’s health. This funding would be an investment, saving taxpayers’ money in years to come. These savings will occur across the areas of health, social welfare and criminal justice. Health services for Aboriginal men need to be culturally appropriate and tailored to meet the needs of local men (Northern Sydney Local Health District, 2015). Engaging Aboriginal men in this process will help to empower them and allow for self-determination of their health (Kinchin et al., 2015).

The group with the worst health outcomes in Australia would benefit from leadership at a federal level with a clear plan of policy implementation. The National Aboriginal and Torres Strait Islander Health Plan 2013–2023 acknowledges that Aboriginal males have the worst health outcomes of any group in Australia but fails to directly address them (Australian Department of Health and Ageing, 2013a: 36). A specific federal Aboriginal men’s health policy could be developed. Alternatively, a revised National Aboriginal and Torres Strait Islander Health Plan 2013–2023 could include a section on improving Aboriginal men’s health. The third option is to have a specific section for Aboriginal men in the National Men’s Health Strategy 2020–2030 (Commonwealth Department of Health, 2018), with a plan and stated means of implementation. The National Aboriginal and Torres Strait Islander Male Health Framework: Revised Principles (Australian Department of Health and Ageing, 2010a) is a strong foundational document to assist in this process. Engaging Aboriginal men in their respective regions, states and territories from the outset of development is crucial; empowerment is a fundamental component of healing (Tsey et al., 2007: 34).

Conclusion

To improve the health of Aboriginal men, a holistic and decolonised approach addressing the social determinants of health should be considered (Marmot, 2005, 2011). The social determinants of health approach postulates that population health is related to features of society and economic conditions. These features include socio-economic status, social support, ethnicity and gender (Carson et al., 2007). Neoliberalism focuses on health as an individual problem, failing to recognise the significance of the social determinants of health for Indigenous men. The neoliberal approach to Aboriginal men’s health appears to fall short. In contrast, holistic approaches which include the social determinants of health are important because they begin to address some of the problems created by the history of cultural and social dislocation and oppression.

The contexts of gender and ethnicity place Aboriginal men in a unique position in contemporary Australian society. Aboriginal men are oppressed with respect to their Indigeneity, but an intersectional matrix suggests they are privileged regarding their masculinity in a patriarchal society (Pease, 2013: 13–14). However, further analysis suggests that Aboriginal men cannot adhere to ‘mainstream’ Australian society’s hegemonic masculinity because of their Indigeneity (Connell, 2005b). The inability to attain ‘mainstream’ hegemonic expectations can cause Aboriginal men to undertake more risks to prove their masculinity. Risk-taking behaviour can impact on health outcomes and result in more interactions with the criminal justice system (Allard, 2010: 4; Kelly and Tubex, 2015: 7).

Existing research demonstrates the complexity of the problems facing Australian Indigenous men. The intersection of masculinity and Indigeneity, compounded by colonisation, historical policies, stigma, marginalisation, trauma, grief and loss of identity are key factors that shape these poor health outcomes. These poor health outcomes are acknowledged in federal government policies, but no clear plan of improvement has been discussed. Several models of male intervention to improve health outcomes have been identified, these include men’s groups, Men’s Sheds, men’s health camps, fathering groups and mentoring programs. These demonstrate that a holistic, decolonised and culturally appropriate approach to health care is effective. Further, applying these aspects to the bio-medical model will improve the health of Aboriginal males. Despite evidence of this success, there is a lack of specifically allocated funding for the group with the worst health outcomes in Australia. By providing specific funding to progress the issue, Aboriginal men will have the means to improve their health.

Footnotes

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Jacob Prehn

Notes

Author biographies

Jacob Prehn is a proud Worimi man living on Palawa Country, Tasmania. Jacob works for the Office of the Pro Vice-Chancellor Aboriginal Research and Leadership at the University of Tasmania. He is currently a PhD candidate exploring the health and wellbeing of Aboriginal men. His research includes quantitative and qualitative data and his publications topics comprise Aboriginal males, fathers and children. Jacob is a director of the National Aboriginal and Torres Strait Islander Health Worker Association (NATSHIWA). He is also a qualified Social Worker and Aboriginal Health Worker.

Douglas Ezzy, PhD is professor of Sociology at the University of Tasmania, Australia. His research focuses on the sociology of religion and health sociology and is driven by a fascination with how people make meaningful and dignified lives. He is lead investigator on the Australian Research Council Discovery project “Religious Diversity in Australia”. His books include LGBT Christians (2017, with Bronwyn Fielder), Reinventing Church (2016, with Helen and James Collins), Sex, Death and Witchcraft (2014), Teenage Witches (2007, with Helen Berger), and Qualitative Analysis (2002).

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