AWA: Academic Writing at Auckland

Intimate partner violence (IPV) is a significant health issue in New Zealand. This assignment will attempt to explain the link between the emerging determinants of gender and racism and IPV in a New Zealand context. The Ottawa charter will used in an attempt to mitigate the effects of gender and racism on IPV. The values of equity, social justice and empowerment are paramount.

In New Zealand IPV has significant social and economic consequences (Koziol-McLain, Giddings, Rameka & Fyfe, 2008, Martin, Langley & Millichamp, 2006). The World Health Organisation (WHO) defines IPV as any physical, emotional, sexual or psychological abuse which occurs between adults in a partnership (WHO, 2005). However victims usually experience a combination of forms of abuse (WHO, 2002). In a New Zealand review, of women reporting physical abuse, 42% had also been sexually abused (Robertson & Oulton, 2008).

IPV can be carried out by either partner in heterosexual or same sex relationships (WHO, 2005). However the overwhelming burden is experienced by women in heterosexual relationships internationally (WHO, 2002). WHO estimates rates of IPV vary between 15% and 71% (WHO, 2005). In New Zealand one in two Maori women, one in three European and Pacific women, and one in 10 Asian women have experienced some form of IPV (Fanslow, Robinson, Crengle, & Perese, 2010).

The impacts of IPV on the individual include physical injury, death, mental health and addiction issues, sleep problems, sexually transmitted infections, anxiety and headaches (Kozoil-McLain et al., 2008; WHO, 2005, Robertson and Outlon, 2008). IPV costs the US $2.5 billion per year and in New Zealand sexual violence costs $1.2 billion per year (WHO, 2002, Robertson & Outlon, 2008). However the effect is not just individual and social. Between 2003 and 2005 30,000 New Zealand children were affected by IPV, and it is estimated one quarter of New Zealand kids have witnessed violence within the household (Martin et al., 2006).

The determinants of health suggest why IPV occurs. In a study asking women why they thought IPV occurred, nearly all focused on a failure by the women to meet male demands (WHO, 2002). Overseas research has found many women support the hegemony which justifies violence against women (Fanslow et al., 2010). Society portrays males as dominant with uncontrollable sexual urges (Fanslow et al., 2010). Furthermore it infers young men must assert their heterosexuality by actively pursuing women whilst the female sexual role is to accommodate (Robertson & Outlon, 2008). Determinants create risk environments which then lead on to risk behaviours and subsequently IPV.

These gender constructions create an environment sexual violence literature refers to as western rape culture (Robertson & Outlon, 2008). This is where masculinity becomes associated with aggressive and dominating behaviour, which then causes sexual violence to become normalised (Robertson & Outlon, 2008; WHO, 2005). Males who subscribe to rape myths such as 'women who are raped are promiscuous' are significantly more likely to become sexually violent (Robertson & Outlon, 2008). This rape culture is prevalent within relationships, with more women assaulted within a relationship than from external perpetrators in New Zealand (Robertson & Outlon, 2008). This is perhaps because there is a perception that marriage and sexual consent are synonymous (Fanslow et al., 2010). Gender constructs also create homophobic environments which have been shown to lead to hyper-masculinity and increased risk of IPV (Robertson & Outlon, 2008).

The status of women in our society is both reflected and reinforced by IPV. This is further enhanced by economic inequities between male and female, which can create an environment of dependence for many women (Robertson & Outlon, 2008). Interestingly a New Zealand study found all women, were universal in their belief that violence against women is unacceptable (Fanslow et al., 2010). This is not the case worldwide and suggests male hegemonic power is not unquestioned in New Zealand.

Racism is an emerging determinant of health which is strongly interlinked with gender. Robertson and Outlon (2008) give a clear description of how changing gender constructs have created an IPV endemic, where once it was unheard of. In traditional Maori society IPV was not a social issue. However the process of colonisation created an environment of harassment and rape by white settlers and a subsequent portrayal of Maori women as impure under a male dominated school and church system. There was also an erosion of whanau protective structures which protected women from IPV (Robertson & Outlon, 2008). It is the view of the Maori taskforce that this process of colonisation, which in itself is defined by its racism, has resulted in IPV becoming a learned behaviour over several generations (Kruger et al., 2004).

A discourse of racism is therefore a key determinant to understanding how an environment of risk was created over time. Maori women now have rates of IPV which are high by international standards with more than half of all Maori women experiencing some form of IPV (Fanslow et al., 2010). It is also important to acknowledge how current institutional racism disempowers Maori by acting as a barrier to the re-establishment of protective processes and contributes to the risk environment (Kruger et al., 2004). It has also created a perception that IPV is normal for Maori, a process which has been named imposter tikanga, and is a form of racism which perpetuates the trends of IPV (Kruger et al., 2004).

The Ottawa charter will serve as the basis to address the discussed determinants. Healthy public policy is about understanding the impact of all policy on health and utilising this to increase health outcomes. It has a particular focus on equity and uses means such as legislation, taxation and organisational policy change (WHO, 1986). Policy and legislation has the potential to ameliorate some of the effects of gender and racism on IPV rates. Economic policies which support female economic independence would have the direct effect of removing one of the key reasons some women remain in abusive relationships (Fanslow et al., 2010). However income is also a sign of status. Removing inequities between genders may have the effect of promoting an equitable perception of male and female worth.

There is some rhetoric that Maori IPV cannot be solved by governmental policy due to the colonial heritage and it is only through increased self determination that improvements can be made (Kruger et al., 2004). Therefore it may be appropriate that Maori are given greater self determination through legislation which allows self governance, in a similar way to local government organisations. This is a complex plan. However if Maori feel they need self determination to overcome a history of colonialism and racism, legislation may be able to provide this.

Using a socioecological approach, creating supportive environments has two main focuses. One is to encourage a positive relationship between people and their natural environments based on mutual respect. The second is around transforming work and social environments into those that are health promoting not sickness promoting (WHO, 1986). One possible example is the media environment. The 'it's not ok " family violence campaign in New Zealand utilised women who had experienced family violence as well as males who had committed abuse. It also portrayed community as important in assisting those experiencing IPV. These are all themes highlighted as necessary within the literature to combat gender and racist stereotypes (Fanslow et al., 2010).

However an example of creating supportive media environments would be to also assess other media sources for themes. For example the 'Its not the drinking campaign" designed by the Alcohol Adivsory Council [ALAC] depicts an intoxicated woman being dragged into an alley with a "sinister" man; below the title "it's not the drinking, it's how we're drinking". This reinforces rape myths touched upon above; that intoxicated women are targets and responsible for sexual assault (Robertson & Outlon, 2008). It is a difficult but important task to ensure that media does not create or reinforce stereotypes around gender or ethnicity, as it impacts on societies perceptions and attitudes (WHO, 2002). Some authors advocate a complete removal of any images in the media which demean women (Robertson & Outlon, 2008). Whilst this may be difficult to balance with other rights, an achievable first step is for government media releases to adhere to just depictions of women and Maori.

Supporting community action is based upon the community being empowered to establish their own priorities and how they will meet their identified needs. The role of the health promoter here is to provide support and access to resources (WHO, 1986). Maori have stated that their leaders and practitioners are at times unable to use Maori models due to legislation and policies from the mainstream system (Kruger et al., 2004). According to Laverack (2007) the defining factor of empowerment is the quest for political liberation. Laverack (2007) also believes the community must take power from those who possess it and therefore operates in a theory of zero-sum power. Many Maori clearly want to take the power to self determine their community (Kruger et al., 2004). Health promoters advocating with Maori for greater self determination may allow Maori to remove pakeha perceptions of tikanga, such as the normalisation of whanau violence, as well as having a positive impact on many other health and social outcomes. Overseas research supports strengthening culturally defined communities is a means of rectifying racism and colonisation (Robertson & Outlon, 2004).

A health promoter has a responsibility to assist the community in developing personal skills which allow them to take control over their health and environments (WHO, 1986). This is therefore a means to empowerment which is also focused around gaining control (Laverack, 2007). Improved access to training, as well as other supportive structures, will allow women to decrease the inequity between male and female incomes, and in some instances improve the risk environment by removing female financial reliance.

A further opportunity to develop personal skills is in youth education. Adolescence is a time where sexual roles and identity is being established (Robertson & Oulton, 2004). Therefore it may be a time where it is appropriate to assist young people to discuss social constructs of gender, and to learn the skills to combat rape myths and homophobia. This will not only mean young people are less likely to commit sexual violence, but that they may also become leaders in community action against gender inequities and other social issues.

Reorientating health services should focus on the shift from clinical health to health promotion and from disease aetiology to the needs of the person in their context (WHO, 1986). Research has shown that screening of IPV in secondary care assists women to feel empowered through information and also promotes discussion in families (Koziol-McLain, 2008). Screening for risk behaviours such as subscription to rape myths and homophobia can identify individual aspects of gender inequities. This can provide information and a basis for primary health care to move into comprehensive primary health care with a health promotion role (Baum, 2008).

Another means health care can affect the determinants of racism is to act as a leader and role model. Primary health care often uses epidemiology and prevalence rates to inform its screening and interventions. However this can also act as a source of institutional racism. As mentioned earlier it is institutional racism which reinforces that family violence is normal among Maori (Kruger et al., 2004). It is appropriate for primary health care, in particular, to simultaneously acknowledge the inequities Maori experience, but move away from a profiling system which enforces discriminative stereotypes.

Health promotion is underpinned by key principals. Equity seeks fairness in the outcomes of different groups. There is a global focus on the importance of equity, however when health promotion is evaluated, often the focus is on efficacy (Potvin, Manatara & Ridde, 2007). If equity is not a primary focus the risk is that as health outcomes are improved inequity may widen (Potvin et al., 2007). In New Zealand the burden of IPV is distributed inequitably. Maori women have the highest rates of lifetime IPV exposure (Fanslow et al., 2010). Therefore the determinants of health were examined with a specific focus on Maori. Subsequent interventions were directed towards Maori autonomy as a self identified need. However there are also other inequities; Pacific women are more likely to stay in abusive relationships, and Asian women more likely to not report IPV (Fanslow et al, 2010). Therefore the determinants of IPV in these communities should be examined with a focus on interventions to meet their needs.

Social Justice is about a society which is fair and just for all peoples. The social justice movements, such as feminism and the anti-war movement, have traditionally been communities opposing governments. Therefore social justice from a health promotion perspective is a social response to the knowledge external social movements have provided (Labonte, 1994). Blaming women for the violence perpetrated against them is fundamentally unfair. Removing these preconceptions , particularly in youth, is a means of reducing this injustice.

Maori have stated they do not feel whanau violence can be solved using a government perspective (Kruger et al., 2004). Therefore, my response to this external knowledge is to step back from a model of government solutions, and to instead develop a process where Maori are allowed to find their own solutions, with government providing resource support.

Community empowerment is about a journey from initial community readiness and participation to action and empowerment, which has a social and political function (Laverack, 2007). The literature was clear regarding who needed to be involved in any health promotion around IPV. Women who had experienced IPV needed to be empowered to speak for themselves (Koziol-McLain et al., 2008). Men needed to be engaged in order to shift this from a female problem to a community problem (Fanslow et al., 2010). Maori needed to be able to speak for and control themselves (Kruger et al., 2004). I have attempted in every aspect to involve these groups and to frame IPV as a community issue. As power must be taken, a health promoters duty is to ensure the community is supported to take the power needed to improve health (Laverack, 2004).

IPV is a complex and significant issue in New Zealand. When a determinants perspective is taken, particularly focusing on the emerging determinants of racism and gender then the "problem" of IPV is framed differently. Using the Ottawa charter (1984) I have shown that it is possible to address these determinants and effect the environment which allows IPV to occur. Above all it is important that all interventions are underpinned by equity, social justice and empowerment in more than just rhetoric.

References

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