Suicide+and+Rural+Australian+Men

n8098514

Dr Mangalam Sankypellay

Social Identities, Physiologies and Human Health: How does geography affect morbidity and mortality?
 * 1. **** TOPIC **

This artefact is a man sitting working at his desk. For most this would be a typical scenario however this is not the case as this man is representing a rural Australian. This man’s desk is a camping table and chair in the middle of a dry, harsh Australian landscape. There are no people or buildings you would normally see just a few sparse trees. This picture portrays the feelings of loneliness and isolation often felt by those living and working in rural environments and the lack of support available around them.
 * 2. PRESENT YOUR ARTEFACT **

Life expectancy varies with geographic location and those living in rural and remote communities of Australia have significantly lower health outcomes and life expectancy. This is contributed by the decreased access to healthcare and healthcare professionals. It is particularly important when discussing this public health issue to focus on the health of rural men as they experience not only the disadvantages that rural Australians face but also the generally poorer health outcomes associated with being male. A growing concern is the mental health of rural men with reported high rates of depression and suicide paired with limited access to mental health professionals.
 * 3. NAME THE PUBLIC HEALTH ISSUE CENTRAL TO YOUR ANALYSIS **

Despite Australia being a _ country, men living in rural and remote areas are still experiencing significant health disparities. Rural and remote Australian men have higher rates of cardiovascular disease, obesity and diabetes than Australians living in metropolitan areas. They are also more likely to engage in risky drinking behaviour, be a daily smoker and have a low exercise level (ABS, 2011). To add to this list of negative health outcomes men living in rural areas also experience suicide rates of up around double than those of men living in urban areas (Kolves, 2009). Action needs to be taken to reduce the number of preventable deaths of rural Australian men to suicide. This review will address the literature and studies around the suicide rates of rural and remote Australian men. The findings and how they are contributing to the issue will be discussed and whether they are distinctly related to geographical location will be determined. Only recent studies released within the last 10 years were examined however some national data is dated prior.
 * 4. LITERATURE REVIEW **

Over the past 10 years there has been extensive research conducted on the health disparities experienced by rural Australians, in particular the high suicide rates of rural men. Whilst reviewing the results of these studies it is important to take into consideration that the definitions of ‘rural’ and ‘remote’ are not exact parameters (Hirsch, 2006; Judd, 2006; Miller, 2008.) When classifying remoteness certain researchers have used the Accessibility/Remoteness Index of Australia (ARIA) (Alston, 2010), some used the Rural Remote Metropolitan Classification (RRMA) (Taylor, 2005; Page, 2007) and other studies used address to categorize regions (Miller, 2008; Judd, 2006.) Adding to this, the variety of subjects examined within the studies are not clearly defined. As not all men living in remote and rural areas are part of the farming industry it is important that the subjects chosen are reflective, although it is generally men of the farming industry who are most at risk (Miller, 2008; Hirsch 2006). Having unclear parameters increases the discrepancies between studies and limits their use for understanding this complex issue.

Despite these uncertain parameters, historically rural and remote Australian men have always had lower health status than rural and remote women, and Australian’s urban population (Alston, 2010; Alston, 2008; Weerasinghe, 2009). When compared to urban environments, suicide rates are higher in rural areas (Fraser, 2007; Miller, 2008; Page, 2007; Phillips, 2009), with male youth most at risk (Hirsch 2006; Philips, 2009; Taylor, 2005). Data from the Queensland Suicide Register shows that the relative suicide rate amongst men in rural areas was 1.99 compared to the rate experienced in urban environments (Kolves, 2009).

These high suicide rates may be contributed to by a number of factors. These include a limitation on available health services, economic pressures and social isolation (Hirsch, 2006; Judd, 2006). The Australian Bureau of Statistics found that Men living in rural and remote areas are more likely engage in risky alcohol behaviour and misuse drugs. These factors may also have a role to play in the high levels of suicide in these areas (Miller, 2010). Further insights address issues associated with the farming industry and the financial stressors related to climate change (Alston, 2010).

Studies have provided insight into masculine behaviours of Australian farmers and how this creates vulnerability to poor health outcomes and high rates of suicide (Alston, 2010; Alston, 2008; Fraser, 2005). Rural and remote Australia men are perceived to be both physically and mentally tough and expected to be leaders for their families and the wider community (Alston, 2010). With the farming industry in crisis rural families are turning to women to be employed in off-farm work to keep their farming businesses profitable. However the reliance on women for income has negative implications on the personal identity of rural men due to the social construction of masculinity. (Alston, 2010; Fraser, 2005).

The stereotype of masculinity complements the substantial research associated with help seeking by rural Australian men. Help seeking may be observed as an indication of weakness in rural culture, which contradicts the notions of rural male masculinity (Alston, 2010; Fraser, 2005; Fuller, 2009; Hirsch, 2006; Judd, 2006). When men’s usual behaviours no longer serve their purpose, these beliefs prevent them from seeking help. This leads them to “blame themselves and see themselves as failures because they are not living up to traditional notions of successful rural masculinity. Thus many see no option but to end their lives because it is, for them, the end of their traditional lives as they know and understand them” (Alston, 2010). Reduced access to health care facilities and professionals may also be a contributing factor in the low levels of men seeking help (Judd, 2006; Taylor 2005). Additionally where health care is available, it may not be relevant or appropriate for suicide prevention in rural men.

Before considering the complex topic of suicide in rural and remote Australian men, the context and culture of rural Australian must be understood (Alston, 2010; Taylor, 2004). Although particular risk factors related to suicide may be unrelated to geographic location, there are undeniable factors specific to rural communities. Increased understanding about suicide and further studies into rural Australian men are needed to help improve community capability and capacity, to support men vulnerable to suicidal behaviours (Fuller, 2009). Real help and protection for rural men will only be achieved when the stigma attached to help seeking and suicide is dissolved.

Suicide is a widely dynamic issue that is driven by various cultural and social factors. Therefore when addressing issues not only associated with the mental health of rural Australian men, but their health in general it is crucial to consider the contextual social and cultural aspects influenced by the feminist social theory. Australians living in rural and remote areas are most affected by this public health issue, however the impact it poses on the farming industry could have national repercussions (Fuller, 2009).
 * 5. CULTURAL AND SOCIAL ANALYSIS **

Rural men adopt a socially constructed role of masculinity, which affects the way they access health care, particularly for mental health. Independence and resistance to seeking help are common traits in men who identify as a rural or remote Australian (Alston, 2010). In rural culture asking for help is a sign of weakness and goes against the socially constructed norms. Reluctance to seek help and access health care exacerbates the effects of the negative health behaviours rural men are predisposed to, such as risky drinking behaviour, smoking and low levels of exercise (Phillips, 2009).

In 1976 around two thirds of Australian’s lived in rural areas of Australia, social change has lead to these figures steadily decreasing with now only around 30% of the population living outside major cities (ABS, 2000). With rural populations declining community services and engagement decreases and social isolation increases (Alston, 2010). Even where health care services and facilities are still available the use of these for mental health purposes may be ineffective. A study of Queensland’s Suicide Register (QSR) data indicates that around 40% of Queensland farmers who died by suicide between 1990-2008 had some form of contact with a mental health professional death.

While providing access to mental health care is the first step to addressing this issue more needs to be done from a public health perspective to deliver care that is both socially and culturally appropriate (Alston 2010). Suicide is a preventable cause a death and it should be a public health priority to reduce its prevalence particularly in rural Australian men. Although the suicide rates of rural and remote Australian men only directly affect the communities involved increasing the awareness of the issue will have a much wider benefit. Public health experts need to dress this issue from a social and cultural perspective by addressing the stigma of health seeking and the strong social construction of masculinity.

This artefact represents the feelings and emotions, such as loneliness and isolation that are felt by the rural and remote Australian men who turn to suicide. It is particularly specific to men working in farming and agricultural industries as the setting also shows a contributing factor of drought. The image provides insight into how different living and working in rural and remote Australia is compared to major cities. This leads to the idea need to tailor the way suicide prevention and mental health care are delivered in these areas to accommodate the social and cultural factors.
 * 6. ANALYSIS OF THE ARTEFACT AND YOUR OWN LEARNING REFLECTIONS **

Having personally experienced the effects of this public health issue, losing my father, a rural Australian man to suicide this artefact provides me with insight to help aid my understanding of this issue that has greatly affected my life. I believe there needs to be far greater awareness of the issue and that work needs to be done to remove social constructs preventing men from seeking adequate health care.

As a result of this assessment piece it has become increasingly apparent the extent that the effect the culture and society have on the health of individuals. I previously believed that access to health care facilities was enough to treat and prevent injury and disease. However I now understand that the healthcare must also be delivered in a socially and culturally appropriate manner in order to be effective and I will carry this though to my future studies and career. ** REFERENCES ** Alston, M., & Kent, J. (2008). The Big Dry: The link between rural masculinities and poor health outcomes for farming men. //Journal of Sociology//, //44//(2), 133-147. doi:10.1177/1440783308089166

Alston, M. (2010). Rural male suicide in Australia. //Social Science & Medicine//, //74//(4), 515-522. Retrieved from []

Australian Bureau of Statistics (2000, July 4). //4102.0 - Australian Social Trends, 2000//. Retrieved October 20, 2013, from []

Australian Bureau of Statistics (2011, March 23). //4102.0 - Australian Social Trends, Mar 2011//. Retrieved October 20, 2013, from []

Fraser, C. E., Smith, K. B., & Judd, F. (2005). Farming and mental health problems and mental illness. //International Journal of Social Psychiatry//, //51//, 340-349. doi:10.1177/0020764005060844

Fuller, J. D., Kelly, B., Law, S., Pollard, G., & Fragar, L. (2008). Service network analysis for agricultural mental health. //BMC Health Services Research//, //9//(87). doi:10.1186/1472-6963-9-87

Hirsch, J. K. (2006). A review of the literature on rural suicide: Risk and protective factors, incidence, and prevention. //Crisis//, //27//, 189-199. doi:10.1027/0227-5910.27.4.189

Judd, F., Cooper, A. M., & Fraser, C. (2006). Rural suicide-people or place effects?//Australian and New Zealand Journal of Psychiatry//, //40//, 208-216. doi:10.1080/j.1440-1614.2006.01776.x

Judd, F., Jackson, H., & Fraser, C. (2006). Understanding suicide in Australian farmers.//Social Psychiatry and Psychiatric Epidemiology//, //41//, 1-10. doi:10.1007/s00127-005-0007-1

Kolves, K., Milner, A., & De Leo, D. (2009). //Suicide risk in different subpopulations in Australia (Queensland). A Report to the Commonwealth Department of Health and Ageing. Brisbane//. Retrieved from Australian Institute for Suicide Research and Prevention. website: []

Miller, K., & Burns, C. (2008). Suicides on farms in South Australia, 1997-2001.//Australian Journal of Rural Health//, //16//, 327-331. doi:10.1111/j.1440-1584.2008.01011.x

Page, A. N., Morrell, S., & Taylor, R. (2007). Further increases in rural suicide in young Australian adults: Secular trends, 1979-2003. //Social Science & Medicine//, //65//, 442-453. Retrieved from []

Phillips, A. (2009). Health status differentials across rural and remote Australia. //Australian Journal of Rural Health//, //17//, 2-9. doi:10.1111/j.1440-1584.2008.01029.x

Taylor, R., Page, A., & Morrell, S. (2005). Social and psychiatric influences on urban-rural differentials in Australian suicide. //Suicide & Life-Threatening Behavior//, //35//, 277-290. Retrieved from [|http://search.proquest.com.ezp01.library.qut.edu.au/docview/224871345#]

Tayor, R., Page, A., & Morrell, S. (2005). Mental health and socio-economic variations in Australian suicide. //Social Science & Medicine//, //61//, 1551-1559. Retrieved from []

Weerasinghe, D. P., Yusuf, F., & Parr, N. J. (2009). Life lost due to premature deaths in New South Wales, Australia. //International Journal of Environmental Research and Public Health//, //6//, 108-120. doi:10.3390/ijerph6010108

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 * LEARNING ENGAGEMENT AND REFLECTION TASK**