Footnotes

Chapter 1 - Men's health in Australia

[1] WHO. Preamble to the Constitution of the World Health Organization, adopted New York, June 1946.

[2] Australian Institute of Health & Welfare (AIHW), Australia's Health 2008, (2008), p.51, table 2.15. This chapter draws heavily on the AIHW report. The AIHW notes that most of the statistics used in the 2008 Report refer to the years 2006 or earlier. This is a result of the timing of collection patterns and the need to process and verify the quality of data.

[3] Royal Australasian College of Surgeons, Submission 14, p.4.

[4] See, for example, BMJ 1997;314:1409 The world health organisation needs to reconsider its definition of health, Rodolfo Saracci, Director of Research in Epidemiology, National Research Council, Pisa, Italy BMJ 2008;337:a2900, Editorial, How should health be defined?

[5] Bulletin of the WHO, Bulletin Board, Niyi Awofeso: Associate Professor, School of Public Health and Community Medicine, University of New South Wales, Sydney (accessed 6 May 2009)    http://www.who.int/bulletin/bulletin_board/83/ustun11051/en/

[6] Prof. R. Gruen, Royal Australasian College of Surgeons, Committee transcript, 8 April 2009, p. 11.

[7] Foundation 49, submission 10, p.3

[8] AIHW, Australia's Health 2008, p.28, source, WHO 2007. Life expectancy at birth, 2005. Note that, in the same study women are ranked fifth.

[9] ibid., p.48, source OECD. The OECD consists of thirty leading developed democracies.

[10] ibid., p.27. Figures for 2003-2005.

[11] ibid., p.84, table 3.6

[12] ibid., p.23

[13] ibid., p.24, table 2.2

[14] ibid., p.24, table 2.2. Note that the ratio of male:female at birth is 105.5:100 (ABS 3201.0 – Population by age and sex, Australian States & Territories, June 2008)

[15] ibid., p.43, table 2.12

[16] ibid., p.43, table 2.12.  The six conditions that appear in the male cause of death list but not the female are prostate cancer, suicide, land transport accidents, liver disease, melanoma and oesophageal cancer. Note that breast, uterine and ovarian cancers appear in the female list but obviously not in the male list.

[17] ibid., p.50

[18] ibid., p.50

[19] ibid., p.51, table 2.15. In terms of the 'breast cancer v prostate cancer' debate that has been mentioned in some submissions to the committee it is worth noting that breast cancer exceeds prostate cancer in terms of PYLL and also in terms of disability adjusted life years – a measure that seeks to estimate the combined impact of loss of 'quality of life' as a result of illness, and early death. The conclusion might be expressed as: Men are just as likely to die of prostate cancer as women are to die of breast cancer however on average male sufferers are likely to be affected at a later age, experience less loss of quality of  life while still alive and live to a greater age than women with breast cancer.

[20] ibid., p.51. Pages 51-52 provide a detailed discussion of what constitutes an 'avoidable' death.

[21] Foundation 49, submission 10, p.1

[22] AIHW, op cit, p.52. Figures are for 1997-2001

[23] ibid., p.52. The method of calculating DALYs is explained in detail in Australia's Health 2008.

[24] AIHW, Cancer in Australia: an overview, 2008, p.4-5. "Based on 2005 data, the risk for a male of being diagnosed with cancer before age 75 was 1 in 3, and before age 85 was 1 in 2." "Almost all cancers occur at higher rates in males than females, with an overall male-to female ratio of 1.4, that is, the male rate is 1.4 times the female rate."

[25] AIHW, Australia's Health, op cit, p.57, table 2.18

[26] ibid., p.29

[27] ibid., p.57

[28] ibid., p.83

[29] ibid., p.85, table 3.7

[30] ibid., p.69

[31] ibid., p.75. Note that these figures are derived from data for Queensland, South Australia, Western Australia and the Northern Territory which are considered to have the most reliable statistics.

[32] ibid., p.78

[33] Prof R. Gruen, Royal Australasian College of Surgeons, committee transcript, 8 April 2009, p.12

[34] Central Australian Aboriginal Congress, submission 129, p.1; quoting Anderson & Wild, Report of the Northern Territory Board of Inquiry into the Protection of Aboriginal Children from Sexual Abuse, 2007:57

[35] National Aboriginal Community Controlled Health Organisation, submission 134, p.1

[36] Aboriginal and Torres Strait Islander Social Justice Commissioner and Race Discrimination Commissioner, submission 135, p.1

Chapter 2 - Men's Health Issues

[1] For example, men are disproportionately affected by HIV/AIDS, cancers of the bladder and the oesophagus, melanoma and trauma related to road accidents and self-harm.

[2] Lung cancer remains a significant cause of death and ill-health among both men and women as do conditions such as stroke and heart disease, to which smoking is a contributory factor. However the incidence of smoking has been declining steadily in response to legal restrictions on use, cost increases and public health and education campaigns. Thus mortality and morbidity from this source is also declining.

[3] Andrology Australia, submission 18, p.5

[4] Mr G. Gregory, Executive Director, National Rural Health Alliance, Committee transcript, 26 March 2009, p.27

[5] Andrology Australia, op cit., p.5. For a full discussion of the proposal for a longitudinal study of men's health, see Andrology Australia, Men's Health Longitudinal Study-a Missing Chapter in Australia's Health Narrative, May 2008.

[6] Prof. G. Risbridger, Head Researcher, Victorian Prostate Cancer Research Consortium, committee transcript, 9 April 2009, p.52

[7] Prof. V. Marshall AC, Centre Director, Freemason's Foundation Centre for Men’s Health, University of Adelaide, committee transcript, 30 April 2009, p.46

[8] Mr A. Phillips, Policy Adviser, National Rural Health Alliance, committee transcript, 26 March 2009, p.38

[9] ibid.

[10] Ms Jennifer Bryant, First Assistant Secretary & Mr David Learmonth, Deputy Secretary, Department of Health and Ageing, committee transcript, 26 March 2009, p.14

[11] Andrology Australia, Men's Health Longitudinal Study-a Missing Chapter in Australia's Health Narrative, May 2008, p.5

[12] AIHW, General Practice Activity in Australia 2007–08- the BEACH Program, p.36, figure 6.1

[13] ibid., p.1. Based on BEACH data for 2001-02, Australians on average spent 83 minutes with a GP compared with 56 minutes in New Zealand and 30 minutes in the USA. There may be differences in methods of service provision which affect the validity of this comparison. 

[14] Holden et al, Men in Australia Telephone Survey  (MATeS), The Lancet, vol 366, July 2005, p.220

[15] AIHW, BEACH data, op cit, p.35

[16] Foundation 49, submission 10, p. 8

[17] beyondblue, submission 84, p.4 & the Hon. Jeff Kennett, committee  transcript p.2.

[18] Prof. R. McLachlan, Andrology Australia, committee transcript, 8 April 2009, p.13

[19] Royal Australian College of General Practitioners, Men's Health Policy Statement, 2006, p.3

[20] AIHW, BEACH data, op cit, p.91

[21] Such a 'free' consultation item could be made available to men and women once per year only.

[22] AIHW, BEACH data, op cit, p.28

[23] ibid., p.25

[24] ibid., p.89

[25]  Ms K. Riley, Bendigo Community Health Service, committee transcript, 8 April 2009, p.94

[26] Mr P. Strange, Bendigo Community Health Service, committee transcript, 8 April 2009, p.96

[27] The terms 'nurse practitioner' and 'practice nurse' are used at various places in this report. Note that a nurse practitioner is a trained nurse with post-graduate qualifications, in this case in men's health, and a practice nurse is a nurse employed to carry out simple procedures in a medical practice.

[28] Mr P. Strange, op cit, 8 April 2009, p.97

[29] Ms J. Bryant, op cit, 26 March 2009, p.13

[30] Foundation 49, submission 10, p.11

[31] Prof. R. McLachlan, committee transcript, p.15

[32] See chapter 3, paragraph 3.38

[33] See for example Andrology Australia, committee transcript, 8 April 2009, pp16-17; Australian General Practice Network, submission 77, p.1

[34] Mr D. Learmonth, op cit,  26 March 2009, p.13

[35] Mr J. Giles AM, COTA, committee transcript, 30 April 2009, p.14

[36] http://www.healthinsite.gov.au/index.cfm

[37] Mr G. Gregory, op cit, 26 March 2009, p.40 

[38] beyondblue, submission 84, p.5

[39] beyondblue, ibid., p.6,  describes the cooperative work being done with the Professional Golfers Association, the AFL and the Australian Cricketer's Association.

[40] Dr E. Celi, committee transcript, 8 April 2009, p.62

[41] Mr C. Tatz, Mental Health Council of Australia, committee transcript, 26 March 2009,  p.86-87

[42] Mr D. Learmonth, op cit, p.13

[43] beyondblue, Depression & Exercise, http://www.beyondblue.org.au/index.aspx?link_id=9.697 (accessed 25 May 2009)

[44] Mr J. Liddel, Male Health Officer, Central Australian Aboriginal Congress. committee transcript, 30 April 2009, p.51

[45] Prof. R. Gruen, op cit, 8 April 2009, p.11.

[46] Ms L. Wett, Deputy Chief Executive Officer, Australian General Practice Network, committee transcript, 26 March 2009, p.66

[47] RACS, submission 13, p.6

[48] Mr A. McLorinan, Manager, Fellowships, RACS, committee transcript, 8 April 2009, p.2

[49] ibid., p.2

[50] RACS, submission 13, p.8

[51] Mr R. Welsh, Aboriginal Men's Health Project Officer, Men's Health Information and Resource Centre, committee transcript, 7 April 2009, p.85

[52] Mr G. Robertson, Coordinator, Wamba Nilgee Burru Ngardu Aboriginal Corporation, committee transcript, 30 April 2009, p.26

[53] Mr J. Liddle, committee transcript, 30 April 2009. p.59

[54] Dr J. Boffa, committee transcript, 30 April 2009, p.60

[55] It was put to the committee that carers generally have "...the lowest health and wellbeing in the community". Ms Joan Hughes, CEO, Carers Australia, committee transcript, 26 March 2009, p.16

[56] Osteoporosis Australia, submission 125. This issue is discussed generally in the submission and page 4 considers the question of who should be tested for the condition.

[57] ACON, submission 75, p.5-8

[58] ibid., p.5-7

[59] Gay Men's Health, submission 54, p.1

Chapter 3 - Depression and other mental illness

[1] AIHW, Australia's Health 2008, p.55, table 2.17. The respective proportions are 19%, 18% and 13.3% of total DALYs.

[2] ibid., p.57, table 2.18. Coronary heart disease and anxiety and depression contribute 10% and 7.3% respectively of the total burden of disease.

[3] ibid., p.55, table 2.17

[4] Crisis Support Services, submission 35, p.3. Men account for 47% of the mental illness burden in Australia but only 39% of all mental health‐related general practice visits. In 2006‐07, only 29% of men that had experienced a mental disorder in the past 12 months sought support services, compared to 46% of females.

[5] beyondblue, submission 84, p.2.

[6] ibid., p.4, citing Australian Bureau of Statistics (2008), 2007 National Survey of Mental Health and Wellbeing: Summary of Results (4326.0). Canberra: ABS.

[7] ibid., p.4

[8] Freemason's Foundation for Men's Health, submission 38, p.6

[9] Republic of Ireland, Department of Health & Children, National Men's Health Policy 2008-2012, (Dublin 2008), p. 72, paragraph 83

[10] beyondblue, submission 84, p.8

[11] ibid., p.8. The committee reports these as perceptions which may influence patient behaviour, not as fact. The limitations of, and pressures upon, general practice are discussed in chapter 2.

[12] Private Mental Health Consumer Carer Network, submission 33, p.1

[13] Royal Australian & New Zealand College of Psychiatrists, submission 14, p.7

[14] ibid., p.9

[15] ibid., p.9

[16] ibid., p.7

[17] AIHW, Australia's Health 2008, p.4111, table 8.9

[18] E.g. Mental Health Council of Australia, submission 5, p. 3; beyondblue, submission 84, p.3

[19] ibid., p.413, table 8.10

[20] RANZCP, submission 14, p.4

[21] ibid., p.7

[22] The Hon J. Kennett, beyondblue, committee transcript, 9 April 2009, p.3

[23] RANZCP, submission 14, p.7

[24] Crisis Support Services, submission 35, p.3. For example, among Korean War veterans studied in 2004, anxiety was present in 31% and depression in 24%, while 59% drank hazardous amounts of alcohol. In 2005, there were 9.5 suicides per 100,000 people in capital cities compared with 12.5 suicides per 100,000 people in rural areas. Indigenous Australians experience rates of self‐harm and suicide that are higher; and substance abuse, domestic violence and disadvantage contributed additional risk factors.

[25] Mr C. Tatz, committee transcript, 26 March 2009, p.90

[26] The Hon J. Kennett, committee transcript, 9 April 2009, p. 5

[27] Dr J. Lemon, National Drug & Alcohol Research Centre, UNSW, committee transcript, 7 April 2009, p.78

[28] ibid., p.77. It should be noted that, while there have been small variations in patterns of drinking, alcohol consumption in Australia is actually declining overall.

[29] ibid., p.76

[30] RANZCP, submission 14, p.4

[31] Submission 7

[32] Approximately 16% of mothers experience problems related to perinatal depression. See beyondblue Media Release, 26 November 2008

[33] Department of Health and Ageing;  http://www.health.gov.au/internet/mentalhealth/publishing.nsf/Content/perinatal-depression-3 (accessed 25 May 2009)

[34] beyondblue, submission 84, p.8

[35] ibid., p.8

[36] Freemasons Foundation, submission 38, p.7

[37] beyondblue, op cit, p.3

[38] ibid., p.5

[39] Ms L. Young, CEO, beyondblue, committee transcript, p.7

[40] ibid.,p.7

[41] RANZCP, submission 14, p.9

[42] ibid., p.8

[43] Crisis Support Services, submission 35, p.4

[44] AIHW, Australia's Health 2008, p. 43, table 2.12. The comparable rates are: men 16.6 per 100 000; women 4.4 per 100 000

[45] beyondblue, submission, p.3

[46] ibid.

Chapter 4 - The Prostate

[1] The Victorian Prostate Cancer Research Consortium (VPCRC) estimates that diagnoses of prostate cancer will double by 2020. VPCRC submission, p.1. With the decline in smoking, the mortality from lung cancer in men is declining.

[2] AIHW, Cancer in Australia: an overview, 2008, p.4. "The five most common cancers were prostate cancer (16,349 cases), colorectal cancer (13,076), breast cancer (12,265), melanoma of the skin (10,684) and lung cancer (9,182). These five cancers accounted for over 61% of all diagnoses."

[3] ibid., p.16

[4] AIHW, Cancer in Australia, op cit,  p.vii

[5] Prof. J. Best, Chair, Victorian Prostate Cancer Research Consortium, committee transcript, 9 April 2009, p.41

[6] AIHW, Australia's Health, op cit, pp. 45-46

[7] NHMRC funded research into cancer and other malignant neoplasms 2000 – 2008, the Cancer Dataset,  http://www.nhmrc.gov.au/grants/dataset/disease/cancer.php (accessed 14 May 2009). In making this comparison the committee does not wish to engage in any 'men v women' debate. The similarity of death rates from the two diseases and a range of other matters makes this a valid comparison.

[8] AIHW, Cancer in Australia, op cit, p.16

[9] Associate Prof. D. Horsfall, National Project Manager, Australian Prostate Cancer BioResource, committee transcript, 30 April 2009, p.4

[10] ibid., Prof. D. Horsfall. p.8

[11] Australian Prostate Cancer BioResource, submission 22, p.1

[12] Queensland University of Technology, Institute of Health and Biomedical Innovation (IHBI), submission 52, p.1

[13] Prof.J. Best VPCRC, op cit, p.41-42

[14] Australian Prostate Cancer BioResource, submission 22, p.1

[15] Prof. D. Horsfall, op cit, 30 April 2009, p.2

[16] Prof. G. Risbridger, Monash Institute for Medical Research, committee transcript, 8 April 2009, p.28

[17] ibid., p.4

[18] Other collections are held by researchers in Victoria and Western Australia.

[19] Prof. D. Horsfall, op cit, p.7

[20] ibid., p.3

[21] Australian Prostate Cancer BioResource, submission 22, p.3

[22] ibid., p.3

[23] Prof. D. Horsfall, op cit, p.7

[24] ibid., p.7

[25] ibid., p.11

[26] This issue is considered in  more detail in the committee transcript, 8 April 2009, pp.32-34

[27] The committee has used the term screening to refer to the surveying of populations who have no symptoms but are selected on the basis of some general factor such as sex or age group, for example taking a pap smear or carrying out mammography, and testing to refer to a test administered to a patient showing symptoms.

[28] AIHW, Cancer in Australia, op cit, p.viii

[29] Dr C. Hovens, VPCRC, committee transcript, 9 April 2009, p.43-44

[30] Medical Journal of Australia, 2007; 187(9):501-502

[31] ibid.

[32] See discussion of these studies at, Doubts raised over US study on prostate cancer screening test, Urological Society of Australia and New Zealand, 24 March 2009; Prostate Cancer Screening, ABC Health Report,  23 March 2009 http://www.abc.net.au/rn/healthreport/stories/2009/2520425.htm (accessed 14 May 2009)

[33] Jury still out on PSA testing, Andrology Australia, 3 April 2009,  http://www.andrologyaustralia.org/pageContent.asp?pageCode=WHATSNEW1742 (accessed 14 May 2009)

[34] Prof. V. Marshall AC, Centre Director, Freemasons Foundation Centre for Men’s Health, University of Adelaide, committee transcript, 30 April 2009, p.46

[35] Mr A. Giles, Prostate Cancer Foundation of Australia, committee transcript, 8 April 2009, p.84

[36] Prof. G. Risbridger, committee transcript, 8 April 2009, p.35

[37] Dr. A. Wootten, Department of Urology, Royal Melbourne Hospital, committee transcript, 8 April 2009,  p.41

[38] ibid., p.37

[39] ibid.

[40] The Hon. J. Kennett, op cit, 9 April 2009, p.3

[41] Dr. A. Wootten, op cit, p.38. These findings come from a NSW Cancer Council study.

[42] Prostate Cancer Foundation of Australia, National Prostate Cancer Information Pack, Pilot, Final Report (April 2009), p.7. The introduction to this report provides a useful summary of recent research into the psychological impact of prostate cancer.

[43] Dr. A. Wootten , op cit, p.41

[44] National Prostate Cancer Information Pack, op cit, p.4

[45] This figure is based on the number of prostate cancer diagnoses per year.

[46] Prostate Cancer Foundation of Australia, submission 72, p.2

[47] AIHW, Australia's Health, op cit, p.87

[48] The Hon Nicola Roxon MP, Minister for Health and Aging, New Breast Cancer Nurses for Regional Australia,13 October 2008. http://www.health.gov.au/internet/ministers/publishing.nsf/Content/mr-yr08-nr-nr134.htm  (Accessed 18 May 2009)  The committee notes that the Prostate Cancer Foundation and the Cancer Council of Victoria already offer scholarships to encourage registered nurses to undertake a training course specialising in prostate cancer care.

[49] Andrology Australia, Prostate Enlargement or BPH, 2006    http://www.andrologyaustralia.org/pageContent.asp?pageCode=PROSENLARGE  (accessed May 2009)

[50] Prof. J. Best, submission 30, p.1

[51] Prof. J. Best, committee transcript, 9 April 2009, p.53