Get up! Stand up! Show up! For Aboriginal and Torres Strait Islander men’s health

COVID-19 showed us how to ‘close the gap’ between health outcomes of non-Indigenous Australians and Aboriginal and Torres Strait Islander peoples. We need to continue learning from Aboriginal and Torres Strait Islander people about what works when it comes to healthcare.

The success of self-determination

There was an understandable sense of dread about the threat to Aboriginal and Torres Strait Islander peoples, posed by COVID-19 when the disease began to spread across Australia in 2020. The H1N1 outbreak a decade earlier caused a disproportionate number of infections, hospitalisations and deaths in Aboriginal and Torres Strait Islander people – we could not afford a repeat of previous public health failures^[1].

By any measure, the immediate response to COVID-19 from Aboriginal Community-Controlled Health Organisations, health professionals and community leaders are exemplary. Undoubtedly, hundreds (if not thousands) of Aboriginal and Torres Strait Islander peoples’ lives were saved; an outcome among the best of any Indigenous group globally^[2].

The reason for this outstanding success^1,2 is “because behind every major decision, strategy, approach and public health deployment we have seen culturally-centred leadership from Aboriginal and Torres Strait Islander people.”^[3] This approach stands in stark contrast to the failure of the Northern Territory intervention response to the ‘Little Children are Sacred’ report. The intervention was developed without input from Aboriginal and Torres Strait Islander people², ostensibly to prevent child abuse. It required suspension of the racial discrimination act, to legislate controls that included quarantining of welfare payments; changes to education, housing and health services; compulsory land acquisition; increased policing; and mandating health checks for children. Child abuse has steadily increased since the intervention².

The self-determination of health policy and implementation that has been so successful during the COVID-19 pandemic is the same as that which is called for by Aboriginal and Torres Strait Islander men when it comes to improving their health^[4].

There is an urgent and long overdue need to understand what Aboriginal and Torres Strait Islander men require from health services and programs. The only valid perspective from which this understanding should come, is that of Aboriginal and Torres Strait Islander men governed by Aboriginal and Torres Strait Islander men.

Harnessing strength

Contemporary healthcare can be seen as disempowering, fostering dependence on health care services in response to disease, rather than promoting health and wellbeing^[5]. Thus, healthcare utilisation reflects deficiency, not strength. This creates a barrier to using healthcare services because it requires behaviour that clashes with notions of masculinity, which are common among all men but may be particularly strong for those from Aboriginal and Torres Strait Islander Communities^4,[6].

Framing healthcare in the context of deficiency is contrary to the strength-based approach promoted by those who are most expert^4,5. Recent key stakeholder feedback from the Aboriginal and Torres Strait Islander Male Health Research Strategy in Northern Australia project in 2021 identified that health service partners serving Aboriginal and Torres Strait Islander men require direction on how best to provide coordinated and codesigned solutions^[7].

Aboriginal and Torres Strait Islander men (and women) know how to improve their own health, based on cultural practices established over thousands of years^2,4. Rather than considering health simply as the absence of disease, “Aboriginal health means not just the physical wellbeing 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. It is a whole of life view and includes the cyclical concept of life-death-life.”^[8]

Programs undertaken by Aboriginal and Torres Strait Islander men to improve their health include dedicated men’s clinics and camps, sporting groups and Men’s sheds, fathering and mentoring programs, and spending time on Country⁴. They provide social and emotional support, empowerment, the opportunity to share culture and yarn in a culturally safe environment. Such programs designed by Aboriginal and Torres Strait Islander men are effective in improving their health⁴. However, current structural and practical barriers, identified by Aboriginal and Torres Strait Islander men, continue to hinder access to such programs. These barriers include a lack of cultural competence of staff and access to male practitioners; a lack of gender-specific spaces to discuss sensitive issues like those relating to sexual health, mental illness, fatherhood and preventative health maintenance; and limited knowledge and availability of more appropriate options⁷.

The inclusion of social, emotional and cultural wellbeing as critical aspects of health is consistent with the flourishing wellness industry that caters to people’s sense that conventional medicine does not provide all they need to feel healthy⁸. Aboriginal and Torres Strait Islander people have known for generations the things that are required for their health and wellbeing. Those same things are probably critical for the health of everyone.

The success of the Aboriginal and Torres Strait Islander response to COVID-19 has established that self-determination of healthcare can be profoundly successful. Giving the power and control to consumers, so they can be active participants in developing health services appropriate to their needs, is imperative. As such, Aboriginal and Torres Strait Islander men must be empowered to use their strength and knowledge, accumulated over thousands of years, to improve their health and wellbeing.

This article was written in collaboration with Dr Kootsy Canuto.