Academic journal article Canadian Journal of Public Health

Relations of Care: A Framework for Placing Women and Health in Rural Communities

Academic journal article Canadian Journal of Public Health

Relations of Care: A Framework for Placing Women and Health in Rural Communities

Article excerpt

ABSTRACT

Living rurally creates geographic and socio-economic challenges for women, which negatively affect their health and well-being. Gender ideologies, expectations and practices that assign domestic and familial unpaid care work as "women's work" serve also to disadvantage women. How these ideological and material forces together affect health are difficult to assess with a health determinants model. Drawing from relational theories of place and gender, articulated in geographic and feminist literature, we offer a nuanced relational framework that builds on insights of health determinants explanations but situates women as recipients and providers of care within a "relations of care" context. We discuss how this framework can contribute to a better understanding of rural women's health and well-being. We focus on the context of neo-liberalism and the subsequent restructuring of rural Canadian society but note how our framework is applicable to other high-income nations, such as Finland, Iceland and Norway. We argue that it is critical to consider how contemporary political and ideological changes interact with place and gender relations to affect conditions of dignity for women as recipients and providers of care in rural places. We conclude with suggestions for policy directions.

Key words: Rural health; feminism; geography; self-care; health care; health care reform

RÉSUMÉ

La vie en milieu rural présente des défis de nature géographique et socioéconomique pour les femmes, ce qui nuit à leur santé et à leur bien-être. Les idéologies, les attentes et les pratiques sexospécifiques, qui considèrent la prestation bénévole de soins au sein du ménage et en milieu familial comme un « travail féminin », défavorisent également les femmes. Lorsqu'on utilise un modèle axé sur les déterminants de la santé, il est difficile de savoir comment ces forces idéologiques et matérielles se conjuguent pour nuire à la santé. À partir des théories relationnelles du lieu et du sexe présentées dans la documentation géographique et féministe, nous proposons un cadre relationnel nuancé qui fait fond sur les explications des déterminants de la santé, mais situent les femmes en tant que bénéficiaires et dispensatrices de soins dans un contexte de « relation de soin ». Nous indiquons comment un tel cadre peut contribuer à améliorer les connaissances sur la santé et le bienêtre des femmes en milieu rural. Nous nous attachons au contexte du néolibéralisme et de la restructuration subséquente de la société rurale canadienne, mais notre cadre peut s'appliquer à d'autres pays à revenu élevé comme la Finlande, l'Islande et la Norvège. Selon nous, il est essentiel d'étudier comment l'interaction entre les changements politiques et idéologiques contemporains, le lieu et les relations entre les sexes influe sur les conditions essentielles à la dignité des femmes en tant que bénéficiaires et dispensatrices de soins en milieu rural. Nous concluons en proposant des orientations stratégiques.

Mots clés : santé rurale; féminisme; géographie; autosoins; soins de santé; réforme des soins de santé

The notion that where one lives affects how well one lives is now part of mainstream health and policy discourses. A Canadian study, "How Healthy are Rural Canadians", finds that as distance from an urban centre increases, health decreases in quality.1 This study demonstrates that geography matters to health status and that geographic and socio-economic disadvantages work to create negative health conditions for rural people. In particular, rural women are less healthy compared with their urban counterparts and compared with rural men.1 Rural women have significantly higher mortality rates than urban women, including at least a 20% excess among women aged 20-64 over a 10-year period.2 Accidental deaths and chronic diseases, such as diabetes and heart disease, contribute significantly to this rural-urban health gradient. Certain subsets of rural women are considered especially vulnerable, including Aboriginal, elderly and disabled women. …

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