Gender and Power as Social Determinants of Health and Wellbeing

Response from the perspective of women’s health and safety service provision

Celia Karpfen Southern Primary Health – Southern Women’s

Affirmation

What the numbers tell us (from one service)

Drawing the threads: Social determinants, life course or life stage and intersectionality

Affirmation

Affirmation

> That the Southgate Institute and the Families @ Flinders Research Group have recognised gender and power as social determinants

> That six women and a man have carefully prepared presentations

> That over 60 people, overwhelmingly women have booked in … and what that 60 represents in terms of advocacy and service delivery that advance the work of gender as a social determinant

Affirmation

> On an individual level, the importance of days like this for enabling us to stand back and consider the importance of gender and power as social determinants

What the numbers tell us … from one service

What the numbers tell us …

1:1 work for July 1 2008 – June 30 2009> The top 5 reasons women contacted

Southern Women’s for a service• DV current or DV survivor – 240• Emotional health – other 26• Child Sexual Assault – 17• Depression - 16• Housing - 16

What the numbers tell us (cont) …

The top 5 reasons for women accessing Southern Primary Health overall

> Depression and anxiety - 714> DV current and survivor - 673> Diabetes type 2 - 466 > Family and other relationship issues – 301> Development Delay - 141

What the numbers tell us (cont) …

The top five reasons for menDiabetes 406Depression and anxiety 239‘DV perpetrator’ 108Family and Relationship Issues 70Obesity 70

Behind the numbers> Approaches taken by Southern Women’s and other sites in

addressing dv as part of SPH Family Violence priority area• Individual support, including in terms of support and

advocacy with the child protection, criminal justice and legal systems – as well as providing a space for women to do self advocacy

• DV Support groups + and advocacy for parenting groups for women addressing the impact of dv on their children

• Work with and across other areas of SPH’s work most noticeably Mental Health and Early Childhood

• Contributing to the work of the SA Women’s Health Action Plan

• Support of collaborative approaches – eg Onkaparinga Collaborative Approach,

• Support of community education and action through DVAGs etc

Behind the numbers

> “All the different aspects of DV not just being physical violence. Everywoman should know that information”

> “Realising that control and power come in many different ways and forms, and not all at once”

> “I’m not alone. Other people have been successful leaving violent relationships. Listening to their stories has given me more understanding and how the subject of fear is being analysed. Now we are dealing with ways of handling it”

> “That its his actions and behaviours. Understanding control and how he manages to control”

> Quotes from the DV Support Group term 2

Drawing the threads …social determinants, life course or life stage and intersectionality

Drawing the threads

In the new National Women’s Health Policy, the following priorities were identified/ affirmed

> Gender equity > Health equity between women > A focus on prevention > A strong and emerging evidence base > A life course approach

Drawing the threads (cont.) The introduction of a life span (or life course) perspective can be interpreted as a direct response to a number of factors: persistent conflations of women’s health with reproductive and gynecological health (Pinn 2003; Healey 1991), the need to better document, comprehend and respond to the specific challenges and contributing factors that influence girls’ and women’s lives from birth to death; and the need to show that appropriate policies and programs are developed, monitored, and evaluated so that ‘all women across life stages have access to reasonable care that emphasises health promotion and disease prevention’ (Correa-de Araujo, 2004)

Ola HankivskyMore than Age and Biology: Overhauling Lifespan

Approaches to Women’s Health

Drawing the threads (cont)> Over the past two decades, scientific understanding

of the role of risk factors and their impact on health has been further informed by studies showing that events and exposures early in life have implications for the risk of disease in adult life. These studies show that both biological and social risks accumulate and interact over the life cycle. Rather than a static view of health and disease, the lifecourse approach recognises the impact of different types of risk exposure at each stage of life, and the cumulative impact of these exposures as a person ages

> Development of a New National Women’s Health Policy: Consultation and Discussion Paper 2009

Drawing the threads (cont)> However, taking into account the ways in which

women’s health is differently affected across the lifecourse is fundamental to good health outcomes. Women have particular physical and mental health needs at different stages of life. For example, during and following pregnancy, women experience increased risk of intimate partner violence, post-natal depression and economic insecurity, due to barriers to maternal employment. Women’s economic health and wellbeing is also influenced by different life stages and events such as child-rearing, caring for elderly parents, retirement and the death of a partner who had previously provided economic security34 .

Drawing the threads (cont.)

> A lifecourse approach must recognise gender equity in health and how this may change over a time. Although, on average, women live longer than men, women’s later years, in particular, are often affected by disease and disability. Women’s longer lifespan can also contribute to social isolation later in life when women, who have often been carers themselves, often have few people to care for them35 . Discussions of women’s health should therefore focus on quality, not only length, of life.

> AWHN’s submission to the New National Women’s Health Agenda Consultations

Drawing the threads

… Intersectionality refers to the idea that gender is experienced by women simultaneously with their experiences of class, race, sexual orientation, size and other forms of social difference.

Colleen Varcoe, Olena Hankivsky and Marina MorrowIntroduction: Beyond Gender Matters

www.awhn.org.auwww.health.gov.au