Health Promotion from a Feminist Perspective: A Framework for an Effective Health System Response to Woman Abuse

Article excerpt

W.E. Thurston

Department of Community

Health Sciences and Office of Gender and Equity Issues

Faculty of Medicine

University of Calgary

Calgary, Alberta

Wife abuse is widespread and is a threat to well being both directly and through the limits imposed on a woman's capacity for health. While the impact on women is reason enough for the health sector to make wife abuse a priority issue, the impact on health care utilization should also be a concern. After fifteen years of research and education, however, the health system response has been inadequate. Risk reduction and primary prevention models cannot capture the complexities required for successful prevention programs. With feminist analysis, health promotion models provide a more promising starting point.

La violence faite aux femmes par un conjoint est tres repandue et menace le bien-etre des femmes non seulement directement mais aussi a travers les limites imposees sur la sante d'une femme. Quoique l'impact sur les femmes constitue en luimeme une raison suffisante pour que le secteur de la sante fasse de la violence faite aux femmes une priorite, l'impact sur l'utilization des services de sante devrait aussi engendrer de l'inquietude. Cependant, au bout de quinze ans de recherches et d'education, la reponse du systeme de sante a ce probleme demeure inadequate. La reduction du risque et les modeles de prevention premiere ne peuvent tenir compte de la complexite exigee par des programmes de prevention reussis. Grace a une analyse feministe, les modeles de promotion de la sante offrent une point de depart plus prometteur.

Introduction

There are three points I intend to make in this paper: first, wife abuse is a serious health issue which demands response from the health sector; second, the health sector has not addressed this issue, or has responded ineffectively; and third, if a feminist analysis is included, a health promotion framework would improve the health system response to wife abuse. The available research on wife battering and health supports the conclusion that wife abuse is a prevalent and serious health issue. Wife abuse can result in loss of women's potential to protect and promote their own health and well-being, as well as in serious injuries and illnesses which require utilization of health services. Wife abuse is a preventable health problem with enormous personal and social costs. The health sector has played a limited role in addressing wife abuse and when one looks at the patriarchal model of health care, this is not surprising. Few health professionals routinely screen for abuse, and policies to promote this practice have often been ineffective. The professions, furthermore, have not addressed the impact of personal experiences of violence on the lives and practices of their own members. In addition, advocates for a health system response to wife abuse have experienced both backlash and cooptation.

In the past decade, health policy makers have articulated that the health system must adopt an expanded view of health and of the role of the health system in prevention and health promotion. Many health policy and program analysts have written about the necessity of a multi-sectoral and coordinated response to health issues because the social determinants of health play a greater role than health services in maintaining the health of populations (e.g., Minister of Supply and Services Canada, 1994). There is a congruence between this view of health, health promotion and the issues raised by feminists concerning an effective response to the issue of violence against women. Health promotion, therefore, provides a useful framework for working on wife battering in the health sector. The challenge will be ensuring that feminist theory and a gendered analysis of policy and practice remain integral. (1)

The concept of health or women's health used in this paper was defined by Phillips (1995, p. …