A Critical Analysis of Gay Men's Health Policy Documents

Article excerpt

Abstract

Gay men experience disparity in health in many areas when compared with non-gay men and one response to this has been the development of gay-focused health policy. This article presents a critical review of 17 policy documents to investigate their adequacy (or otherwise) in attending to the health needs of gay men. Specific attention is paid to: (a) who gets a say in gay men's health issues, (b) how gay men's health is framed, (c) what is the role of the medical profession and gay men in gay men's health, and (d) what is the role of research in establishing gay health needs. The findings suggest that gay men's health is framed very negatively, highlighting deficits and problems, and largely offering individualised solutions for complex problems. It is suggested that a more holistic (and social) framing of health would allow the influence of sexuality to be properly accounted for; and a reorientation of research efforts to critically examine the existence and prevalence of discriminatory practices and discourses that work against population-level improvement in gay men's lives is advocated. A greater role for gay men in these processes is recommended.

Key words: gay men's health, heterosexism, policy analysis, critical psychology, social determinants of health

Introduction

While health policy and research have routinely evaluated the influence of a variety of factors such as age, sex, gender, and ethnicity (Loue, 1999), there is an increased recognition that looking at men just as men offers too broad a basis for understanding the subtle particularities of the health of different groups of men (e.g., gay men and/or Indigenous men and/or older men). One outcome of genderbased approaches to health is that the health needs of gay men are overlooked or treated inadequately. In Australia, for example, the lack of consideration of GBT men's health in the governments Men's Health Policy has been critiqued (Filiault, Drummond, & Riggs, 2009), while in New Zealand the invisibility of gay men's health issues in debates and discussions about men's health has also been challenged (e.g., Neville, 2008; Neville 8i Adams, under review).

Because of this a gay-specific health focus has been developed at the community level, and among academics and professionals (e.g., Adams, Braun, & McCreanor, 2007; Guthrie, 2004; Meyer, 2001; Meyer & Northridge, 2007; Pega, 2007; Rofes, 1998; Saxton, 2001). Despite an obvious focus on HIV/AIDS (which continues today), interest in non-HIV/ AIDS health issues for gay men is increasing. In the US, for example, a 'grassroots' health movement has challenged the disease model view of gay men in which they are portrayed as, among other things, inherently sick and self-destructive (Rofes, 2005) and recognised that while HIV is important, it is no longer the only 'rallying poinf for gay men's health (Scarce, 2000). In Australia, national LGBTI health conferences are held (Health in Difference), while the involvement of gay organisations and individuals has been central to the development of gay (and LBTI) specific health policy and strategies (e.g., Ministerial Advisory Committee on Gay and Lesbian Health, 2003). In addition, the National LGBT Health Alliance was launched in 2007 to be an advocate for the greater recognition of LGBT health needs and to build the capacity amongst those who work with and for LGBT people (National LGBT Health Alliance, n. d.).

Although much of the community-based gay men's health movement takes an asset based approach, there is also a strong and developing (academic and professional) body of health disparities research. This research has pointed to a number of health indices where it is demonstrated that gay men have poorer outcomes than heterosexual men or the male population in general (e.g.. Drabble, Keatley, & Marcelle, 2003; Wolitski, Stall, & Valdiserri, 2008). For example, and compared with heterosexual men, gay men have been found to have a higher incidence of eating disorders (Russell & Keel, 2002; Williamson, 1999; Williamson & Spence, 2001), suicide and suicide attempts (Bagley & Tremblay, 1997, 2000; Fergusson, Horwood, & Beautrais, 1999; Nicholas & Howard, 1998; Skegg, Nada-Raja, Dickson, Paul, & Williams, 2003), cigarette smoking (Dilley, Simmons, Boysun, Pizacani, & Stark, 2010; Ryan, Wortley, Easton, Pederson, & Greenwood, 2001; Stall, Greenwood, Aeree, Paul, & Coates, 1999), sexually transmitted infections (Saxton, Hughes, & Robinson, 2002), depression, panic attacks and psychological distress (Cochran, Sullivan, & Mays, 2003), and to have an elevated risk for anxiety, mood and substance use disorders (Bostwick, Boyd, Hughes, & McCabe, 2009; Gilman et al. …