Men's Health, Who Is Responsible? - Speech to the Australian Taxi Industry Conference By Dr John Gullotta

When I think about how we at the AMA rely on taxis,

I realise how big a stake we have in the health and vitality of this unique and special industry and the people involved in it.

That's what I want to talk to you about today - health and vitality, and who's got a stake in it.

Now if I say these two words to you - 'men's…health' - does that make anyone uncomfortable?

In my experience, using those words in the same sentence can produce reactions ranging from cringes, to squirms, to nervous laughter, embarrassment and out-and-out denial.

But we're all going to be hearing a lot more about these two words.

Until now, men's health has received an astounding lack of attention.

For years, the AMA has been calling for a national men's health policy.

The Federal Government has said that finally we are going to get a national men's health policy.

This is 20 years after the first national Women's Health Policy.

A national framework will be important to prioritise, coordinate and fund a range of policies and programs.

At the individual level, though, what does 'men's health' mean?

What does it mean for each person in this room?

I suspect that it is about untangling a whole host of complex issues, including:

• what we think it means 'to be a man',
• role and relationship issues within couples and families,
• how 'the system' provides health services, and how relevant the system is to men's needs and preferences,
• 'lifestyle' issues such as food and physical activity, and
• what being 'healthy' means, and
• why it does or doesn't matter.

Until now, references to 'men's health' usually meant something about prostates, testes and sexual health.

The view has been: "Well, those are men's issues - that's how men are different from women."

Obviously, those biological differences are important - and I'll say something more about that shortly.

But it's also the case that men and women share similar issues and concerns - but they have very different ways of looking at them.

Men tend to take a 'functional' view of their bodies.

We don't bother about a health problem until it starts to actually interfere with work, recreation, sport, or our social life or sex life.

Too often, physical symptoms go unrecognised or ignored. And, typically, a man won't even admit that it was his idea to turn up at the doctor's surgery when he finally does.

Male attributes like independence, assertiveness, risk-taking, a sense of invulnerability and withstanding pain may have helped to keep us alive in prehistoric times - but they are not necessarily doing that today.

We need to turn these qualities to our advantage or they will send us to an early grave.

Most importantly, we need to start realising that 'real men' DO look after themselves. This doesn't mean being obsessed - it just means being sensible.

In your working life, you are literally and figuratively 'in the driver's seat' - you are responsible and you are in charge when it comes to safety, hazard avoidance, and management of the myriad of issues that arise during working hours.

You need to be aware and in control.

It's a big responsibility.

Would you drive blindfolded? I hope you wouldn't.

But when it comes to our health, somehow we've closed our eyes. Somehow, being in control of what happens to our own bodies just doesn't seem like a 'guy thing'.

It's that macho, Aussie bravado attitude which we need to change and which has become a barrier to seeking medical advice and seeing a doctor.

But guess what? We are paying the price, with men dying earlier and suffering far more preventable disease and injury than we should be.

Unfortunately in Australia, the state of men's health is not good.

Men have less healthy lifestyles than women, we aren't as likely to respond to health promotion messages, and we don't tend to get medical attention when there's something wrong.

All too often, men only go along to the doctor when it's too late and earlier treatment could have made a big difference.

Men know a lot less than women about health in general and about specific diseases and risk factors.

About two-thirds of Australian men are overweight or obese.

Men die, on average, more than five years earlier than women.

The most common causes of disease in men are 'lifestyle factors'.

Things like smoking, alcohol, excess weight, lack of physical activity, not enough fruits and vegetables, high blood pressure, and high cholesterol - these are the things that are important in causing diseases such as type 2 diabetes, heart disease, stroke, lung cancer and emphysema.

The fact that men also tend to have smaller social networks than women is another factor.

Men are also less likely to talk about pain or discomfort, and are less likely than women to believe that they have control over their health.

That fatalistic attitude - "when your number's up, it's up" and "well, we've all got to die of something, so I might as well enjoy myself" is just male rationalisation and another way of making excuses - another way of saying, "I really can't be bothered".

"Here for a good time, not a long time."

How many of you have said that?

I've heard that from men in their twenties right up through their fifties and sixties.

"I'm here for a good time, not a long time". I don't think I've ever heard a woman say that.

Have you ever thought about it, though?

Why 'a good time' or 'a long time'? Who says you have to make that choice? Why not be here for a good time and for a long time?

Information that hit the news a few weeks ago suggests that, as a nation, that decision might have already been made for us.

If current Australian trends continue, the next generation's average life expectancy will be nearly two years shorter than ours. That's a tragic statistic.

Is this what we want to happen? Is there anything we can do to start making a difference?

And what will it take to not just kick-start some positive changes, but to continue to drive them along? That's why we need a national framework, a National Men's Health Policy.

Now let me ask you: how much time do you spend maintaining your car?

It's not just a myth - men do spend more time maintaining their cars than they spend looking after themselves.

The reason for looking after a car is to keep it running as well as possible for as long as possible.

If you treat your body as a highly-tuned machine that needs regular service checks, then you're on the right track.

There is still a predominant male view that acknowledging that you might have a health problem or, God forbid, actually going to the doctor - is a sign of weakness or vulnerability.

Being 10 feet tall and bullet-proof may be how we see ourselves - and that was probably a useful illusion when life was nasty, brutish and short.

But perpetuating that illusion today means that all those risk factors tend to do a fair bit of damage - damage that often goes unchecked until it's too late.

The good news is that if you're aged 45 to 49 - male or female - there's a special health check that you can ask for from your GP - and if your doctor doesn't bulk bill, you get a $100 rebate for it.

This '45 yr health check' is offered on a one-time basis for people in this age group who have at least one risk factor for chronic disease - and that's quite a significant proportion when you consider that the risk factors include smoking, physical inactivity, poor nutrition, high cholesterol, high blood pressure, overweight, and a family history of chronic disease.

So its fairly easy to qualify for this 45yr old checkup.

There are a couple of programs being run around the country that are aimed at helping men keep a check on their own health - sort of like a regular service for your car.

These programs -Tune-Up and PitStop - give men a chance to get a roadworthy certificate by going through a series of checks including: chassis check (height, weight and girth), torsion (flexibility), fuel additives (alcohol), transmission fluid (blood sugar), exhaust (smoking), oil pressure (blood pressure), and shock absorbers (mental health).

There's also advice to see your GP for spark plugs (testicles) and duco (skin cancer).

Just consider the results from the PitStop program that been run for the past three years in the Riverina region of New South Wales: about 60 per cent of the men who put themselves 'over the pits' need to be referred back to their own GP for a health issue that was found during the PitStop health checks.

Things like high cholesterol, high blood pressure and excess body weight are being found in large numbers of men.

They've also found increases in the numbers of men with mental health problems and risky levels of drinking.

Without a doubt, it would be great to see these kinds of men's health check programs rolled out more widely, such as at motor, bike and boat shows.

Now here's another question: How many of you men will go to the doctor without being asked to by a female?

It's also not a myth that many men only go to the doctor because their wife, girlfriend, mother or sister 'made them' go - it's the truth, It happens in real life.

There are some real issues that can just make it too difficult. For example, long and inconvenient working hours mean that you can't get to the doctor when the surgery or clinic is open - and so you just let the problem go, with a 'she'll be all right' attitude.

Lack of job security and sick leave can also make it easy to say, "If I ignore these symptoms, then there isn't a problem."

Or we don't take ownership of the problem - it's "the wife's fault" because "she does the cooking".

Or we find those 'fatalistic' and 'helpless' excuses - the "it doesn't matter what I do, they're always telling you it's the wrong thing" excuse.

Now as I mentioned earlier that there are some specific health issues particular to men, which I would like to outline for you.

Prostate disease is a common problem for Australian men. About half of Australian men will have some type of prostate problem at some stage in their life.

In nine out of 10 cases it's because the prostate has become enlarged and restricts the urethra where the urine flows out of.

Sometimes swelling of the prostate can be caused by an infection called prostatitis; this tends to affect younger men.

It is important to realise that most prostate problems are benign and not cancer, and most can be treated including cancer if detected early.

There are tests that the doctor can do to find out the cause of the problem. If you have an enlarged prostate, it doesn't mean that you are more likely to get cancer.

About 10,000 new cases of prostate cancer are diagnosed in Australia every year.

There are different views about whether all men should be screened for prostate cancer, so it is important for men between the ages of 50 and 70 to discuss the pros and cons with their GP.

Men with a family history of prostate cancer are at higher risk and should be tested from age 40.

Any symptoms such as frequent or urgent urination, difficulty passing urine, a weak stream, or blood in the urine or semen, should be investigated by a doctor.

The tests include a blood test or PSA test and of course the old fashioned but proved 'finger' test. Since the PSA test has come out, a lot more men are talking about these things.

Another of those 'special issues', impotence - what we now call erectile dysfunction - affects about four in 10 Australian men and, in most cases, has a physical cause but it also can have a psychological component.

Erectile dysfunction is often associated with other illnesses, such as heart disease, blood pressure or diabetes.

Because smoking affects the blood vessels, it is also associated with erectile dysfunction - and another great reason to quit, if you need that extra incentive.

Many men are embarrassed to talk to their doctor about sexual concerns, but your sexual health is a natural and normal part of a medical check-up.

Just bear in mind that a sensitive and embarrassing issue for you is a routine, professional issue for us.

Cultural sensitivities can play a part in how men communicate their concerns and how they relate to a GP.

I was reading a report the other day about Italian men in Australia and their awareness of prostate issues.

Several of the men had admitted that talking to their GP made them feel inferior and intimidated.

Some also said that there was a real communication barrier, so they just took their GP's advice without questioning.

That's why it is very important to find a GP that you feel comfortable with and can easily talk to.

The report also served as a good reminder that women do have a legitimate role in men's health, whether it be because of cultural issues or simply because the wife, mother, girlfriend or daughter is the 'keeper' or the 'organiser' of health information.

Often, if it weren't for the women, the men wouldn't get to the doctor at all.

In the case of the Italian men, many felt uncomfortable talking about prostate issues.

One man was asked if he had ever heard of prostate cancer. After a long pause, his wife said: 'His father had a prostate cancer. I keep telling him to go to the doctor to have it checked. He is scared. He is embarrassed about the procedure.'

Prevention is something I've mentioned a couple of times - it's a big issue in men's health and a key take-home message today. Detecting diseases early gives a greater chance of cure.

Most of the serious diseases and conditions that men get are not actually things that they just 'get', like a cold or the flu or a sore throat - they are things that relate directly to aspects of their lifestyle.

But if there is one thing that men have a high level of immunity to, it's health messages.

We do resist those, don't we?

But maybe it's not all our fault. How many health promotion messages have you seen that totally miss the mark because they just don't relate to the way that men think or deal with things?

It doesn't help, either, when the media constantly reinforce masculine stereotypes and link high-risk behaviours with health, invulnerability, and success.

It's also interesting to see how publications such as Men's Health magazine are trying to use the traditional 'male' perspective to encourage men to be more pro-active about their health.

These publications provide lots of useful information, beautifully and colourfully presented -- including useable information on diet and exercise - but they do it in ways that tap into traditional male attitudes about strength, fitness, weight, energy and wellbeing.

For example, there is a constant assumption that men want to be healthy, fit and look great in order to be attractive to women…

Well, there may be a lot of truth in that! But being healthy is also important aside from that.

As I've noted earlier, there are also those practical issues that always seem to get in the way.

If the priorities in your non-working hours are trying to get enough sleep and meeting the various demands of home and family, then going for a walk or a bicycle ride is not going to be very high on the list.

The health of workers is not just about individuals - managers have important roles as well.

A genuine commitment to health by management has been shown to translate into higher levels of job satisfaction for drivers.

I think we will see Australian employers becoming more proactive about employee health.

It's recently been announced that workplace health checks will be offered in Victoria to help reduce the incidence of chronic disease linked to overweight and obesity. I think we'll be seeing more of these kinds of programs.

I'd also like to say something about mental health and depression. I know that at a previous conference you had a presentation on this subject.

It's worth repeating that there is a tendency for men who are suffering depression to pretend that nothing is wrong. Depression is still a taboo subject for a lot of men.

It might be okay to be depressed if your wife has left you or if you've lost your job… but then you're supposed to bounce back after a week and 'get over it'.

Look around you. One in five people in this room will experience depression at some stage in their lives.

Whether you are suffering from depression or are concerned about someone who is, I would urge you to check out the beyondblue website and, of course, consult your doctor.

I have really just skimmed the surface of men's health issues and I may not have mentioned any of the issues that relate to you personally.

I haven't mentioned lower back pain, for example, which can be a real issue for professional drivers. And my friend Paul the cabbie says that your first 'health' issue is working out where all the urinals are so you don't end up with kidney problems

Prevention, awareness and treatment - as they say, it's not rocket science.

You've seen it in your industry newsletters, in the media and on internet websites: 'eat a balanced diet', 'get regular exercise', 'be smoke-free', 'drink in moderation' and 'maintain a healthy weight'.

But it's not always that easy, is it? It sounds easy but we need to put into practice!

The biggest hurdle is getting yourself into the right mind-set.

You CAN be healthier, now and in the future, and feel better and have more energy.

But it's like everything else - it might take a bit of organisation and commitment. So where do you start, and what is likely to make the most difference?

Obviously, it's important to not put off going to the doctor when something's not right.

And if you haven't had a check-up for a long time its probably a good idea to get one!

There's a big fear that men have when it comes to their health - a fear not only of doctors, but of deprivation, starvation, stagnation, humiliation and all those other -ations.

The only '-ation' that I want you to bear in mind is moderation.

Just take a look at what a well-tuned machine can be produced with the 'all things in moderation' approach.

Now, if you're ready for the doctor's prescription,

I'd like to suggest a few things that you can do to make difference.

First, if you smoke - stop. If you don't - don't start. Smoking is the most damaging thing you can do to your body. There is no 'safe' level of smoking.

Half of all smokers will die of smoking-related causes, taking years off their life. If cigarettes were a medicine they would be taken off the market because of the harm they cause.

There are a number of products available now that can help you quit - and don't get discouraged if it takes several attempts. Keep at it! Nicotine is one of the most addictive substances around.

Talk to your doctor about the right approach for you. Plan your 'quit' attempt and let your friends and family know because it will be easier with their support.

Second, commit to losing weight if you need to.

I've got quite a few things to say about weight loss, because it turns out to be very important.

If you want to know if you're in the healthy weight range, you can work out your body mass index or BMI with a BMI calculator on the internet (its your weight in kg divided by your height in meters squared). 19-25 is normal, 25-30 is overweight and over 30 is obese.

Waist measurement is also very important, as extra weight around the middle is a strong indicator of increased health risks.

For men, the overweight range is a waist measurement of more than 94 centimetres, and the obese range is 102 centimetres or more.

Staying within the normal range means that you'll feel better and be at less risk of diseases and conditions such as heart disease, arthritis, various cancers, and sleep disorders such as sleep apnoea.

Losing five to 10 per cent of your body weight can make a real difference to your health.

It's all about 'calories in vs calories out'.

Many men simply eat too much - we've all seen that steak or schnitzel that hangs over the sides of the plate. Believe it or not, the meat should be the size of your palm, or cover no more than a third of the plate, with vegetables, beans and rice or potato taking up the rest.

This is definitely one case where 'size matters': portion size is something that you can't ignore if you want to get your weight down.

Eating out can be a real challenge, with oversized steaks and generous portions of pasta, fried rice, or chips. Having your meal 'upsized' is another problem - try to resist that!

In coffee shops and fast food restaurants you have to choose very carefully to avoid piling on the calories and fat. But even fast food restaurants have introduced healthier options.

Try leaving the pie and chips alone and going for something like roast beef or chicken with salad on a wholemeal roll.

The key is to find food that gives you a sustained release of energy and keep you feeling full for longer.

Snack foods can be a real problem, too - and it isn't true that if no one sees you eat it, it doesn't count! One thing is often recommend is to keep a 'food diary' and write down everything you eat. You might find that you eat less, just by doing this.

When you're at home, don't sit next to a bag of snack food - you'll only do what they call 'mindless eating', and your hand will keep feeding your face before your brain tells your stomach that you're full!

At supermarkets, start to look at the labels and know what you're eating.

The best way to supermarket shop is to stick to the perimeters, where the fresh foods are.

It's a pretty good rule for food that, if it didn't walk or grow in the ground, steer clear!

If it went through a factory and comes in a cellophane bag or a cardboard box, it is likely to be very good at making money for food companies but is not likely to be very good for you.

There are a lot of things that we have started to rely on as 'always foods' - foods that really need to be shifted to the 'sometimes foods' pile.

So many of us really are creatures of habit.

It's amazing how many men have not outgrown their taste for what they were eating when they were seven: things like Rice Bubbles and Frosties are not particularly good for children, and they are definitely not good for you.

Look for whole-grain and high-fibre options, and have them with milk that's two per cent fat or less. If you read the label, you'll find that a lot of even 'healthy' cereals are loaded with sugar, so don't add any more!

I don't know what it is about guys and things like wholemeal bread and yoghurt, but they are not 'secret women's business'!

There are plenty of alternatives to high-calorie, nutrition-poor foods, so give them a chance. If you use full-cream milk and regular butter or margarine, try some of the lower-fat products, or try to use less. And read the labels, as many low-fat products are very high in sugar.

Many food habits are exactly that - habits.

Don't be afraid to experiment and try new things.

Men are notorious for convincing themselves that they won't like something if they think it's going to be 'healthier'. Give it a go.

According to people who've been researching men's health, blokes in their thirties and forties say that they've been eating exactly the same foods for 20 years - and then wonder why they're gaining weight!

Well, there are plenty of men, even in their fifties, whose diet hasn't really changed since they were a kid, except the portions are larger and they'd added a few beers.

What they're not accounting for is that we are no longer growing boys, and our energy requirements are dropping.

Remember the 'moderation' rule? If that piece of cheesecake is calling out to you, you don't have to deprive yourself - but split it with someone.

Another thing we hear a lot about is cholesterol.

If your cholesterol is high, the arteries can become narrower, decreasing blood flow and causing a condition called atherosclerosis. We're seeing that now even in children as young as 10 and 12.

When this affects the blood vessels that supply the heart muscles it puts you at risk for having a heart attack. When atherosclerosis affects the blood vessels that supply the brain, it puts you at risk of a stroke.

Atherosclerosis may also block blood flow to other organs, including the kidneys and intestines. This is why maintaining low cholesterol levels is so important.

Reducing saturated fat is the most important thing you can do to lower your cholesterol level.

The big culprits are fried foods and bakery foods, so look for alternatives to chips, pies and sausage rolls, and donuts.

You know the foods I mean - the ones where you can see the grease on the inside of the little white bag.

A piece of fruit or a zip-lock bag with a small handful of nuts and dried fruit makes a better snack than the high-fat, high-sugar alternatives.

Saturated fats are also found in animal products like whole milk, cream, butter, and cheese, and also in meats, such as beef, lamb and pork. Sausages tend to have high levels of fat.

A regular diet of processed meats, like sausages, ham and bacon, is not a healthy way to go anyway -- there is now strong evidence that eating processed meat like ham, bacon, pastrami, salami, hot dogs and processed sausages increases your risk of bowel cancer, so you're better off keeping these foods to a minimum.

Soluble fibre helps to lower cholesterol levels and also plays an important role in the prevention of other diseases.

Fibre is found in foods like wholegrain bread and cereals, brown rice, beans, apples, carrots, and many other fruits and vegetables.

Alcohol can also have a big impact on weight because beer, wine and spirits are all high in calories - and because when we drink, we usually eat fatty or high-calorie foods like chips, pizza and snack foods.

You'd need to do a 2.5km jog to burn off the calories in one 375ml stubbie of full strength beer - if you change it to a light beer, you'd still have to jog 1.5km.

Even a 100ml glass of wine would take a 1km jog to burn off, but the worst is a 375ml can of pre-mixed spirit, for which you'd have to jog 4 km to burn off.

But how do we know all this?

It would be helpful if we, the consumers, knew the kilojoule content and nutritional breakdown of what we eat.

Most packaged food is required to carry this information but it's hard to find, usually printed in the smallest print imaginable, and almost impossible to understand. The AMA has been working to get this system improved so that nutrition information is more prominent.

And we don't have easy access to the same information for foods that we buy from the bakery and the butcher, or from take-aways.

And, to be frank, men are more driven by habit, taste and convenience than they are by kilojoules and nutrition.

So that's why, if we're talking about 'responsibility' in men's health, there is tremendous scope for food and drink manufacturers to take the 'junk' out of 'junk food' - lower the levels of fat, sugar and salt.

Speaking of salt…

The third item on your prescription is: hold the salt. You'd be surprised at how many things have salt already in them -- so if you add salt to your food, you're getting a serious overdose.

Here's a challenge for you: try not adding salt to your food for four weeks. The first couple of weeks will not be fun.

But then, just like a smoker who has stopped sucking on smoke for a few weeks, something amazing happens: your real sense of taste returns. You become more aware of the actual flavours of foods, and you won't miss the salt any more. So give it a try.

One thing that works for a lot of people is to try using pepper and a squirt of lemon juice for most things instead of salt.

Fourth, go for moderation and balance. Most of the things our bodies need to function well - like iron, potassium, and omega-3 - can be found in a well-balanced diet.

That means eating a variety of foods and not going overboard on anything.

You control the type and amount of fuel that your system runs on. When it comes to food, you can choose what you eat, how often, and how much.

Fifth is exercise or physical activity. Being physically active helps reduce weight, cholesterol, blood pressure and stress levels, and it makes you feel better.

Aim for at least 30 minutes, five days a week. You need to get your heart rate up, so aim for at least the equivalent of a brisk walk.

Things like gardening and going out dancing definitely count as physical activity. Obviously, if you have not been exercising, check with your doctor before launching into an exercise program.

Try to work exercise into your work day by taking regular breaks, walking around and stretching.

Sixth, try to reduce stress, and if something is bothering you, don't keep it bottled up.

Stress can affect not only your mental health, but your physical health as well.

Find time to do things that you enjoy so you can relax and unwind.

But that doesn't mean sitting immobile in front of the telly with a couple of beers and a bag of chips. Exercise is actually a great stress-reducer.

And finally - doctors are not the enemy.

It's certainly true that the medical profession can do a lot more to make visiting the doctor more male-friendly, and we're working on that.

But it's important that you are satisfied with the information, advice and help that your doctor gives you.

If the information just isn't there or if it isn't communicated in a way that's helpful or you can understand well - let your doctor know.

Don't be afraid to ask questions!

If you aren't happy then change doctors! Find one that you are comfortable with.

And if we suggest a blood test or something to check how you're going, a few minutes of discomfort could prevent many years of future disability or disease and possibly even save your life.

So how can you tell how you're shaping up? Remember the man on the hoist?

• Blood pressure - get it checked every one to two years,
• Cholesterol - get it checked every two to five years (or more often if your doctor advises),
• Weight - 60 per cent of men are overweight. Losing even a few kilos can reduce your risk of serious problems,
• Smoking - if you are ready to quit, see your GP. And if you're not ready, start thinking about it: today - for the sake of your health and the health of those around you,
• Alcohol - is your drinking causing problems for you, or for someone else close to you? 'All things in moderation' definitely applies to alcohol, where you can easily find yourself into the high-risk zone for short-term and long-term health risks,
• Bowel cancer - annual tests are recommended for people starting at age 50,or over 40 if family history
• Blood sugar - regular testing for diabetes is advised if you are overweight, over 40 or have a family history of diabetes,
• Waterworks - if you are having water trouble, a prostate check is in order.

I hope that my comments to you today have not painted too gloomy a picture of men's health.

I have tried to lay the cards on the table and tell it like it is.

I know, and you know, that men can and do look after their health in particular ways - they just don't always think of it, or express it, in those terms.

If achieving good health were that easy, we would all have it and live forever , there would be no need for doctors and I wouldn't be talking to you today.

There are issues about 'individual responsibility'.

There are issues about the Government's role in helping to help make healthier choices the norm or default option and not the exception.

And there are issues about getting businesses to be more responsible about the products they produce and persuade us to consume including the advertising.

For men, there is a particular dilemma: the problem of not wanting to be seen as 'feminine' in terms of caring about their health and, at the same time, not wanting to be seen as too irresponsible in terms of not caring.

As a result, we are caught in the 'don't care vs should care' dilemma.

It's a jungle out there, but, as men, I think we're up to it.

We are and can be survivors, not victims.

Good health is a process, not an event.

It is a journey that you must begin, and continue, step by step.

It's about the pursuit of your own personal best - about being the best you can be.

The challenge is perfectly summed up in the theme of this year's conference, and it is the positive challenge that I would like to leave you with today:

"Be the Best" - and "Go for Gold"!

Thank you.