Good morning.

Could I begin by acknowledging the traditional owners of this country.

I'd also like to acknowledge Mr Bernie Singleton, Chair of the Apunipima Health Council and thank the Council for the privilege of being part of this forum today.

The AMA sees the health of men and boys as a priority for governments, decision makers and the medical profession. 

It is also a deep personal and professional concern of mine.

The statistics show men - particularly young men - are facing more and more complex mental health problems.

It grieves me to say I have lost more male friends to suicide than to road accidents.

There is so much to celebrate about the lives and achievements of men and boys in our time, but sadly, as John Macdonald said at last year's Men and Boys' Health Conference, society has developed a rather negative view of men.

This in itself may well be contributing to injury, death and ill health.

It's something we need to work on.

We have to work together as professionals, families and community members to make our society more nurturing and positive for our men - young and old.

Good health must be promoted.

Eminent researcher, Escobar, says a supportive culture generates resilience and better health.

It is easy to assume men will fix men's health issues.

But responsibility for improving the health of men and boys is an issue for all of us - parents, educators, employers, recreational providers and others.

Our problem is compounded because our health systems focus on disease systems. 

Approaches to preventing harm is fragmented, underdeveloped and under funded.

Health is complex. It involves not only care of the body but also care of the mind and the spirit.  It involves the offering of hope and opportunity.

Poverty, lack of education, poor nutrition, geographic isolation, lack of employment - all undermine health. We need to take them into account in an organised way.

Funding for public health strategies such as prevention and harm minimisation constitutes only 2% of health budgets.

Research has proven that investment of resources to build and maintain health and wellbeing saves health costs. These resources are urgently needed, now.

As I said earlier I am particularly concerned about the rise in mental health problems for men, especially the despair that leads to the high suicide rates for rural and indigenous men.

We have to deal with the root of the problem.   Research shows that suicide is motivated by relationship failure, alcohol and financial problems.

These issues relate in some way to the threat to identity that many men feel as they try to come to terms with their changing role in society.

Men's Role in Society

Changes in the job market and women's participation in the workforce have significantly altered the traditional concept of men as primary breadwinners.

Formerly men considered themselves the head of the household.  With newfound freedom women are rightly demanding and achieving more choice about the way they manage their lives.  

In many cases men are often joint breadwinners so they're expected to be more available as fathers and husbands.

I'm sure those of you who are fathers can relate to the sometimes complex nature of these shared responsibilities.

But you don't have to be a dad to experience this cultural shift.

It takes discipline and determination to sort these issues out. Communication is at heart of the issue, making sure everyone is heard and that everyone's needs are catered for.

This shared responsibility is enriching. It ensures, sometimes under difficult circumstances, that all family members have time together.

The old image of fathers as disciplinarians, or Santa Clause is fading. Establishing a new identity can be confusing and challenging.

The rules have changed but the employment and social contexts are not supportive enough yet to give men the flexibility they need to fulfil new roles.

How many men have access to paternity leave, for example? Individuals and families are increasingly choosing their own path - what works for them.

Issues have to be named, solutions sought. It's not easy and it doesn't always work.

Sadly almost 50 per cent of marriages end in divorce and women initiate the majority of divorces. Men are often left feeling bewildered and disempowered.

As I said earlier, relationship failure is a significant cause of depression and suicide among men.  This is not new, but the incidence is increasing.

Many men feel left on their own. 

To deal with these changes, which are largely beyond our control, we have to become more resilient.

Easily said.

One of the big challenges we have is to build the sense that we as men are as important as we always were, and there are new and exciting roles to be carved out that may not have been available to us before. 

In short we need to create a more hopeful, nurturing and forgiving society for everyone. The systems have to create new opportunities, especially as the population ages.

Financial issues and the Employment market

Financial concerns are the highest stated reason for suicide. 

It used to be reasonable to expect financial security. Get a good job, work hard, earn enough money to plan our lives, buy a house, have kids.

But a changing culture in the workforce is affecting men's health. Once, you got a job and you kept it for life, often staying with the same company, leaving after 40 years - the big gold pen experience.

But increasingly, people have casual or contract-based employment. We no longer have the luxury of job security enjoyed by our fathers.

The dollar drives a hard bargain. Not much room for loyalty or compassion.

Early retrenchment in middle age is a reality for many men.  Good jobs are hard to find for this ageing and often unhealthy group of people.

Many young men have never had a permanent job. They probably have no rights - no holiday pay, no sick pay, no job security. It's difficult to plan for the future, to plan families, housing and have the flexibility to achieve aspirations. 

Underemployment is another major issue, but rarely raised as a public health issue.  To be classified as 'employed' you need to work for one hour only - or work for the dole.

Many people have multiple jobs.  The stress experienced by men in this situation is enormous. 

These people are the working poor. 

Poverty brings more than just financial disadvantage. We know the clear connection of poverty to ill health - cancer, diabetes, cardiovascular disease, respiratory diseases. The list goes on.

When we discuss health, how often do we take into account the wellbeing created by work, the identity and self-respect it brings, and the ability to fulfil the expectations society has for us. 

The Australia Institute commends the notion of a  'health and well-being' indicator as a measure of a country's wealth.

The second most common cause or at least connection with suicide is alcohol.

Natural drive for adventure and the availability of drugs and alcohol are a potent mix.  Let me reflect on alcohol for a moment.

Australians love it.

It is seen - and portrayed in advertisements - as an integral part of Australian life.  Advertisements for alcohol connect its use with personal and career success, glamour, celebrations of births and commiseration at deaths.

But alcohol impacts more on males in our community, especially young males.  Fifteen per cent of males over 14 years old drink at risky levels at least monthly.  Binge drinking is a major concern among young males.

Males have consistently had higher rates of alcohol-related deaths and hospitalisations than have females. It is estimated, for example, that in Australia, males accounted for approximately 70% of:

the 3290 alcohol-related deaths in 1997;

the 72,302 alcohol-related hospitalisations in 1996/97; and

the 403,795 alcohol-related hospital bed-days in 1996/97.

74% of the 8,661 hospital admissions for alcohol related violence are male

of the 264 alcohol related suicide deaths in Australia in 1997, 86% were male.

I haven't even mentioned the catalogue of health conditions like cardiovascular disease and stroke, which are associated with excessive alcohol consumption.

Young men are a valuable part of our community. We can't afford this waste of young men - the lost opportunities for them, their families and for Australian society.

All societies have had recreational drug use throughout history but social mores limited the harm.

How can we minimise the harm now?

As communities we can take responsibility for safe drinking, we can influence the implementation of the codes of practice for advertising, the price of cask wine - the source of many peoples' problems - to establish new mores for use, to offer alternatives.

We can develop more attractive options for young males from the time they are at school, such as involvement in sport and other activities which build a sense of connection and self worth.

School rock eisteddfods and the croc festivals are examples of approaches, which build skills, develop friendships and belonging and a sense of achievement.

Involvement in local communities strengthens the resilience and maturity of groups.

As AMA President I'd like to comment briefly on how the medical profession can contribute to men's health.

In the clinical setting many cases make doctors feel helpless because of the broader societal forces at work.  But small changes can make a big difference.

As doctors we have an obligation to get to know and understand our patients within his or her cultural background and to appreciate what is both a supportive and useful intervention.

This means providing a context and environment which people find safe and responsive.

It means having an understanding of the epidemiology of disease or conditions in the area and the determinants of health for the person and the area.

For example, if there is a high level of chronic disease, doctors should consider what environmental factors may be contributing.

Doctors can put people in touch with networks and support groups.

A number of you may have attended talks by doctors and health professionals about men's health.  This has been enlightening to a number of men.

In Queensland in 2002 the AMA supported a Healthy Towns competition where communities developed their own strategies to improve health - and had fun doing it.

Men and Boys health is a priority policy area for the AMA.

The AMA's Men's Health Award acknowledges major contributions to men's health in Australia. Professor Handelson took out last year's award for his work on male reproductive and general health.

The AMA has supported men and boys' needs in submissions to government on a range of issues including drug and alcohol use, reproductive health and blood borne diseases.

The AMA calls for a federally funded, national Men and Boys' Health Program.

We have seen the positive results of affirmative action for girls. Strong strategic action is needed. Now.

The AMA looks forward to working towards improving the health of men and boys in our community.

Thank you.