“Is there any other point to which you would wish to draw my attention?”
“To the curious incident of the dog in the night-time.”
“The dog did nothing in the night-time.”
“That was the curious incident,” remarked Sherlock Holmes.
— “Silver Blaze”
In its report, The Health of Australian Males, issued in July 2011, the Australian Institute of Health and Welfare outlined the important health issues facing men and boys in this country. A significant feature of the report is the absence of any references to circumcision. The fact that the word does not appear at all is good evidence – proof, in fact – that Australia’s leading health research and advisory body considers that circumcision is irrelevant to male health outcomes. Indeed, none of the health problems and issued discussed in the report have the slightest connection with circumcision (or even “lack of circumcision”).
This conclusion is something of a slap in the face for those few circumcision promoters and advocates (who shall remain nameless) who have, for the past decade or so, been uttering dire warnings about the public health catastrophe that is sure to lie “just around the corner” as a consequence of Australia’s low and declining incidence of circumcision. Really? Well, as it happens, we have turned many corners over the past decade, and the catastrophe somehow keeps failing to arrive.
1. Nutrition: They don’t eat enough fruit and vegetables. The report found that 54% of men 18 years and over don’t eat enough fruit, that 92% don’t eat enough vegetables, and only 5% get enough of both. The figures for boys 5 to 17 are better (22% eat enough – obviously they have conscientious mothers who make them eat their greens), but are still far from satisfactory. Not much scope for circumcision here: even Brian Morris would be hard-pressed to argue that circumcised men eat more broccoli.
2. Exercise: Men don’t get enough physical exercise, especially after age 24.
3. Weight: Men tend to be overweight: 42% of men 18-plus are overweight, and 26% are regarded as obese. (These figures may be somewhat exaggerated, as the definitions of overweight and obese are rather broad; but even if the figures were halved there would still be cause for concern.)
4. Smoking: As every schoolboy knows, smoking is the most serious preventable cause of poor health and disease, including many cancers (not just lung cancer). The good news is that only 18% of men 14 years and older are daily smokers, and the number is in decline.
5. Violence: Contrary to popular opinion, men are far more likely than women to be victims of violence (other than domestic or sexual violence). Men aged 18 to 24 were especially likely to be victims of violence, usually from other males in public places.**
The leading causes of all male deaths in Australia are as follows: heart disease (17%), lung cancer, stroke, respiratory disease, prostate cancer (4%). For males 15 to 44 years, however, the leading cause of death is “intentional self-harm” (i.e. suicide). The report does not give reasons for this, but it probably arises from psychological issues, such as depression.
This is confirmed by the list of the most serious diseases affecting men (in descending order of importance): heart disease, diabetes, anxiety and depression, lung cancer, stroke, other respiratory diseases, hearing loss, self-inflicted injuries, prostate cancer. Speaking of cancers specifically, the report names cancer of the prostate, bowel, lung and testes in that order. Another slap in the face for circumcision advocates is the absence of cancer of the penis from this list: it is simply too rare to rate a mention.
Some circumcision advocates (notably Brian Morris) have claimed that uncircumcised men are more vulnerable to prostate cancer and have urged circumcision of infants as a precaution against this risk. When the Royal Australasian College of Physicians investigated this claim, however, they found the only evidence in its favour to be the speculative ramblings of an American crank called Abraham Ravich, way back in the 1940s. In its policy statement on circumcision the RACP comments: “This association [between lack of circumcision and prostate cancer] has not been consistent, and more recent reviews have failed to confirm it.” [1] This is a polite way of saying that the claim of a connection is bullshit.
There is, however, evidence that circumcision can increase the risk of other prostate problems and urinary symptoms, such as enlargement of the prostate. Research on Australian men by McCredie et al concluded that “being circumcised, or not currently living as married, were associated with increased prevalence of urinary symptoms.” [2] These findings are important because urinary symptoms are often an indication of benign prostatic hyperplasia (BPH). Enlargement of the prostate is a common male ailment, often requiring surgery such as transurethral resection of the prostate (TURP) to improve the sufferer's quality of life. In about 80% of cases, TURP results in infertility (because the semen goes into the bladder rather than being ejaculated) and in 5% to 8% of cases, TURP results in impotence. About 400,000 TURPs are performed annually in the United States. If being circumcised increases a man’s risk of BPH by 50% (as found in the study above), then if 60% of the at risk population in the USA have been circumcised, almost 100,000 of the 400,000 TURPs (25%) were the result of circumcision. Quite apart from the loss of function, think what a waste of surgical resources this represents.
There was no media coverage of this paper, but you can be sure that if the study had, on the contrary, shown that being circumcised was associated with reduced prevalence of urinary symptoms, there would have been newspaper headlines, and the circumfanatics would have been crowing about yet another reason to circumcise baby boys.
Further information on (the lack of a link between) circumcision and prostate cancer
This is looking more promising: surely the report is going to say something about circumcision in relation to male sexual and reproductive health. After all, many circumcision advocates insist that circumcision is an essential component of male sexual health. Bad luck: the report makes no mention of circumcision at all. The principal problems facing males in this area are: low testosterone, erectile dysfunction, urinary tract symptoms and prostate disease (both of which, as suggested above, may be worsened by circumcision).
The report does not find sexually transmitted infections to be a serious problem among Australian males. As you would expect, nearly all (94%) of HIV cases are male, the vast majority of which are homosexual men. As we have pointed out elsewhere on this site, there is no heterosexual HIV problem in Australia, and even among gay men, HIV infections are steady or in decline. [3] The most common STI experienced by Australian men is chlamydia (234 per 100,000); but there is no evidence from Australia that uncircumcised men are at greater risk of this or any other STI, [4] and even if they were, most STIs are easily cured with antibiotics. (In the case of chlamydia, a single pill does the job.)
The inescapable conclusion is that circumcision is not relevant to the health of Australian males. As Sherlock Holmes would say, we draw your attention to the significant remarks of the AIHW on circumcision and male health. “But Holmes, the AIHW says nothing about circumcision and male health.” That silence, Watson, is what is so significant.
** Though many would argue that circumcision without informed consent is in itself sexual violence. In other parts of the world, notably underdeveloped countries and regions of war and conflict, men and boys are certainly victims of sexual violence on a large scale.
References
[1.] RACP, Policy statement on circumcision, October 2010, p. 13.
[2.] McCredie M; Staples M; Johnson W; English DR; Giles GG. Prevalence of urinary symptoms in urban Australian men aged 40-69. J Epidemiol Biostat 2001;6(2):211-8.
[3.] See the analysis by ACON - which again makes no mention of circumcision.
[4.] See study by Ferris et al 2010.
There is increasing awareness that males and females have distinct health needs and concerns related to their biology and roles in society. This is illustrated by different rates of injury, illness and mortality; different attitudes towards health and risks; and the way each group uses, or does not use, health services. In this context, in May 2010 the Australian Government launched the National Male Health Policy, which provides a framework for improving the health of Australia’s males (DoHA 2010a). This report is the first in a series funded under the Policy. Drawing on a range of data sources, this report presents a snapshot of the health and wellbeing of Australia’s males. It is not intended to be exhaustive, but to provide a summary for policymakers, researchers and others interested in male health issues, and set the scene for future reporting and research.
Australia’s males at a glance
In June 2010, there were 11.1 million males living in Australia –just under half of the total population (ABS 2010a). The median age was 36 years; 20% of males were aged under 15 years and 12% were aged 65 years and over. The male population is continuing to age, associated with increasing life expectancy.
Some males make healthy lifestyle choices and have positive health outcomes:
But many males are still at risk of poor health:
And many males are already experiencing poor health:
With under-use of some health services and over-representation in others:
The full report, The Health of Australian Males, is available from the Australian Institute of Health and Welfare.
Confirming previous studies summarised on this site, reports issued this year by the Australian Institute of Health and Welfare show that the health of Australian children continues to improve, and that while males generally are less healthy than women, their problems have nothing to do with lack of circumcision. Most strikingly, the infant mortality rate has more than halved since 1986, the very period during which the incidence of routine circumcision fell from around 40 per cent of boys under 6 months to around 12 per cent today. The most serious child health problems identified by the report are asthma, lack of breast feeding, and arising from social factors such as poverty and Aboriginality.
These reports offer good empirical proof that “lack of circumcision” does not increase child health problems. Even more significantly, it is a decisive refutation of “scientific” predictions by various antiquated circumcision enthusiasts that the fall in the circumcision rate would lead to an explosion of genito-urinary problems in boys. No such problems are identified in these reports, which do not even mention any health problems affecting the genito-urinary area.
If we were to be as unscrupulous in mixing up correlation with causation as many pro-circumcision zealots tend to be, we could reasonably conclude that Australian children have become healthier because the incidence of circumcision has fallen, not merely at the same time. But there is no need to go that far. At the very least, A Picture of Australia’s children is definitive proof that there is zero connection between circumcision and improved child health outcomes. The reporst tels a similar story with male health, finding that the main risk factors for poor health problems to be living in remote or country areas; being poor; getting old; and being of Aboriginal or Torres Strait Islander descent. None of these social factors has anything to do with circumcision.
Further information on this site
Circumcision and public health
This report is the second in a series on the health of Australia’s males. It examines the distinct health profiles of five population groups, characterised by Aboriginal and Torres Strait Islander status, remoteness, socioeconomic disadvantage, region of birth, and age.
Key findings
Aboriginal and Torres Strait Islander males generally experience poorer health than the overall population, highlighted by a life expectancy of 67 years (11.5 years less than that for non-Indigenous males). Factors that contribute to this poorer health status include:
Remoteness is associated with poorer health. Males living in remote areas generally have a shorter life expectancy and poorer self-assessed health status. As remoteness increases, the following health-related factors also increase:
Socioeconomic disadvantage is also associated with poorer health. Males living in more socially disadvantaged areas generally have a shorter life expectancy. As socioeconomic disadvantage increases, the following health-related factors also increase:
Males born overseas generally enjoy better health than other males, with fewer risk factors and lower overall mortality and hospitalisations. There are areas where males born overseas experience poorer health, compared with males born in Australia, with:
Older males (aged 65 and over) are living longer than ever before, and generally have fewer risk factors such as overweight/obesity and tobacco smoking than younger males. As age increases, the following health-related factors also increase:
The AIHW is a major national agency set up by the Australian Government to provide reliable, regular and relevant information and statistics on Australia's health and welfare.
The full report can be downloaded from the AIHW website
A picture of Australia's children 2012 provides the latest information on the health and wellbeing of Australia's children aged 0-14. Many are faring well, but there is scope for further gains, particularly among Aboriginal and Torres Strait Islander children and those living in areas with the lowest socioeconomic status.
The good news
Death rates for infants (aged under 1) and children (aged 1-14) more than halved between 1986 and 2010, with rates slightly ahead of the Organisation for Economic Co-operation and Development (OECD) average for infants, and equal to the average for children under 5. Notably, child deaths from injuries halved between 1997 and 2010.
The prevalence of asthma has decreased, while the incidences of diabetes and cancer have remained stable.
Almost three-quarters of children aged 0-2 have stories read or told to them regularly, and most children achieve above the national minimum standard for reading and numeracy. Australia's average score for mathematics was in the top half of OECD countries.
Smoking in households with children has decreased, while rates of risky drinking and smoking among children have declined.
Most parents rate their health as excellent, or (very) good, and the majority of households with children perceive their neighbourhood as safe. Most households with children, including Indigenous, reported that they could get assistance from outside the household in times of crisis.
Areas where improvement needed
Around 1 in 7 women smoked during pregnancy, and about half of pregnant women drank alcohol.
Exclusive breastfeeding was initiated for 90% of infants at birth; however only 2 in 5 infants were exclusively breastfed to around 4 months.
An estimated 45% of children aged 6 and 39% of children aged 12 experienced dental decay.
Almost a quarter of children were developmentally vulnerable on one or more domains of the Australian Early Development Index at school entry.
About 15% of parents were affected by mental health problems.
Aboriginal and Torres Strait Islander children experience higher death rates, including from injuries, than the national average. They were less likely to have achieved the reading and numeracy minimum standards, and had higher smoking rates than the general child population.
Children living in the lowest socioeconomic status (SES) areas were less likely to have stories read or told to them regularly, more likely to be exposed to tobacco smoke in the home, and more likely to smoke themselves than children living in the highest SES areas.
Teenage birth rates were higher in the lowest SES areas than in the highest SES areas, and parents living in the lowest SES areas were more likely to report fair/poor health and poorer mental health compared with those in the highest SES areas.
AIHW media release
Most Australian children are doing well in terms of their health and wellbeing, but there is room for improvement for some, according to a report released by the Australian Institute of Health and Welfare (AIHW). The report, A picture of Australia's children 2012, shows that death rates for infants and children halved since 1986, the prevalence of asthma among children has dropped, and rates of risky drinking and smoking among children aged 12-14 are down. Smoking in households with children has also dropped.
Almost three-quarters of children aged 0-2 have stories read or told to them regularly and most children achieve above the national minimum standard for reading and numeracy. The majority of households with children in Australia perceive their neighbourhood as safe. Most households also reported that they could get assistance from outside the household in times of crisis. “The report indeed shows that most Australian children are faring well, but despite this good news, there are several areas where improvements could be made,” said AIHW spokesperson Dr Fadwa Al-Yaman. For example, while exclusive breastfeeding was initiated for 90% of infants at birth, only 40% of infants were exclusively breastfed to around 4 months (exclusive breastfeeding is recommended to 6 months). Around 45% of children aged 6 have dental decay, as do 39% of children aged 12. The report also shows that almost one-quarter of children are developmentally vulnerable at school entry.
About 7% of Australian children had a disability in 2009 and, of these, over half had profound or severe core activity limitations. The most common disability types among children were intellectual, affecting 161,600 children (3.9%), and sensory/speech (119,100 children or 2.9%). Injury and cancer are the two leading causes of death in children. In 2008-2010, injuries contributed to 662 deaths of children-a rate of 5 per 100,000 children. Infants (aged less than one year) had the highest rate of injury death (11 per 100,000 infants). Over the period 2004-2008, an average of 583 new cases of cancer were diagnosed annually among children, and in 2008-2010, there were 274 cancer deaths among children-a rate of 2.2 per 100,000 children. This accounted for around 5% of all child deaths.
Additional challenges exist among Aboriginal and Torres Strait Islander children and children living in areas of low socioeconomic status. Aboriginal and Torres Strait Islander children experience higher death rates than the national average. They also had higher smoking rates than the general child population and were less likely to have achieved reading and numeracy minimum standards.
Children in the lowest socioeconomic status (SES) areas were less likely to be read to on a regular basis than children living in the highest SES areas, and their parents were more likely to report poorer physical and mental health.
The full report can be downloaded from the AIHW website