How to build health care Aboriginal and Torres Strait men would actually use

Aboriginal and Torres Strait Islander men have a life expectancy of 71.9 years – 8.8 years less than non-Indigenous men.

Rates of potentially avoidable deaths in men under the age of 75 is almost three times higher for Aboriginal and Torres Strait Islander men.

The reasons for these health disparities are complex. One is limited access to culturally appropriate health care, as well as language barriers, racism and discrimination when seeking care.

Our new paper outlines what’s needed for Aboriginal and Torres Strait Islander men to have more equitable access to primary care – the care people receive in their community before they need a hospital.

This goes beyond merely having Aboriginal or Torres Strait Islander artwork in waiting rooms.

What does the evidence say?

Aboriginal and Torres Strait Islander men are not simply “hard to reach”, nor are they uninterested in their health.

Our research has found Aboriginal and Torres Strait Islander men engage in health care when it is accessible, relevant and delivered in an environment where they feel culturally safe and respected.

The barriers are often much more practical and structural: long waiting times, difficulty getting appointments, lack of male health professionals, concerns about confidentiality, previous negative experiences, shame or embarrassment, culturally inappropriate environments and services that simply do not feel designed with men in mind.

Those barriers can look different for everyone.

A man in a remote community may face long distances to access health care and a shortage of health workers.

Someone in a regional town may have a doctor’s clinic nearby but not feel culturally safe using the service.

Another man may have previously had a poor experience with his local service and decides he will only return when he is really sick.

Just because a clinic is there, doesn’t necessarily mean people will use it.

What’s working well?

Aboriginal Community Controlled Health Organisations are probably the clearest example of best practice service delivery for Aboriginal and Torres Strait Islander people.

They are governed by Aboriginal communities and provide holistic care combining health care with prevention, social support, cultural knowledge and community priorities.

As such, they can reduce barriers to access and deliver strong health outcomes.

We have also seen this with individual programs. The Enough Talk, Time for Action men’s health and wellbeing program created a men’s group in an Aboriginal primary health care service.

The program was built on existing relationships, culturally safe engagement and men’s own priorities as a pathway into health care. The program not only provided culturally safe health checks. It created an environment in which men wanted to engage.

Enough Talk, Time for Action also supported the establishment of a men’s group in the Daly River community of Nauiyu, where men requested a male-only pop-up clinic that came to them.

Coordinated with NT Health, a mobile clinic of male health staff now provides regular visits. This has been welcomed by local men who, as one Naiyu men’s group member told us, “have been asking for years for this”.

What makes these approaches work is community control, trusted relationships, cultural safety, flexibility and continuity of care.

What practical changes can all clinics make?

As we outline in our recent paper, every health clinic can take action to better engage Aboriginal and Torres Strait Islander men. They can:

• ask local Aboriginal and Torres Strait Islander men what makes the service easy or difficult to use, and listen to what they want and need

• employ Aboriginal and Torres Strait Islander health workers and, where possible, male staff

• provide genuine cultural safety training to ensure all staff, not just clinical staff, are trained to provide safe, appropriate and respectful care

• review the waiting room, appointment system and ensure patient confidentiality

• offer longer or more flexible appointments to make time for discussing complex or multiple health conditions

• build relationships with local Aboriginal and Torres Strait Islander organisations and groups

• make annual health checks easy to access and invite men to participate

• have flexible hours and set up outreach clinics, where services come to community spaces

• measure success by whether men come back, build relationships and receive ongoing care – not simply by how many appointments are processed.

That means designing services for and with Aboriginal and Torres Strait Islander men.

What practical changes can governments make?

Governments can:

• extend funding timeframes for Aboriginal and Torres Strait Islander men’s health programs from two to three years to at least five years. Short-term funding leads to staff turnover, disrupts relationships and forces organisations to spend enormous energy repeatedly applying for funds

• properly fund male health workforce positions

• strengthen Aboriginal and Torres Strait Islander community control in decision-making and governance

• undertake evaluations that measure health, wellbeing, engagement and learning, rather than simply counting activities.

Australia has spent decades asking what works. In many areas, we already know the answer. We need to embed what works into the health system rather than continually funding them as exceptions and add-ons.

Thanks to Celina Gaweda (JCU) and James Smith (Flinders University) for their co-authorship of the research on which this article is based.