AWA: Academic Writing at Auckland

Intimate partner violence is a serious national and global concern. This essay will outline intimate partner violence in a New Zealand context and compare national statistics with those from both developed and developing nations. Alcohol and gender, two determinants of intimate partner violence, will be explored. The links between the determinants, the corresponding risk factors and how they result in the health issue will be demonstrated. The five strands of the Ottawa Charter will be used as a base for proposing strategies to address the two determinants. Finally, the strategies addressing the determinants will be shown to incorporate equity, social justice and empowerment; values central to health promotion.

For New Zealand, intimate partner violence is a major concern. Reducing intimate partner violence is a recognised priority within the New Zealand Health Strategy (Miller, Thow, Hall & Martin, 2005), a focus of numerous policies and the subject of multiple studies (Goodyear-Smith, 2004). Studies have identified shocking rates of partner violence. One Auckland-based study reported one in three women had experienced one or more acts of physical or sexual violence by an intimate partner over their lifetime (Fanslow & Robinson, 2004). A study of women seeking emergency healthcare recorded 44% screened positive for lifetime partner violence (Koziol-Mclain et al., 2004). Intimate partner violence refers to behaviour which causes physical, psychological or sexual harm to someone in the relationship (Hegarty, 2006). Violence tends to be predominantly physical followed by sexual abuse (Miller et al., 2005). While men are also victims of partner abuse, as the severity of the consequences of men’s violence against women is generally greater this essay will focus on partner violence against women (Harne & Radford, 2008; Fanslow, 2004).

Not only is intimate partner violence a national concern because of its unethical nature, as a violation of human rights (World Health Organisation, 2010), but it also creates a burden on the health system. A 2004 study (Fanslow & Robinson, 2004) measured that those subjected to violence were twice as likely, within the last four weeks, to have visited a healthcare provider.  Victims of violence are more likely to experience a wide range of health problems, from direct physical injuries to long-term mental disorders such as depression and anxiety (Miller et al., 2005; Fanslow & Robinson, 2004). Rates of suicide attempts of those who had experienced partner violence are almost eight times higher than those who had not (Fanslow & Robinson, 2004). Financially, this violence is a huge financial cost to the country, an estimated annual 41 million in 1994 (Goodyear-Smith, 2004). Thus, even if one ignores the idea of violence as a human rights violation (WHO, 2010), the substantial economic burden highlights partner violence as an issue in desperate need of being addressed.

Using the lifetime statistic of 33%, New Zealand sits slightly at the lower side of the global average. The World Health Organisation conducted 48 population-based surveys globally identifying a range from 10% (Paraguay) to 69% (Managua, Nicaragua) of women physically assaulted by an intimate partner over their lives (Krug, Dahlberg, Mercy, Zwi & Lozano, 2002). However, New Zealand has high rates when compared to other developed nations, such as Norway (18%) and Switzerland (21%), further highlighting the gravity of the issue in New Zealand (Krug et al., 2002).

Identifying the determinants associated with intimate partner violence is crucial as they influence the risk factors and therefore the health outcome. Only when roots of the issue are addressed can progress occur. The World Health Organisation (2010) cites alcohol as a key determinant associated with partner violence. A Cape Town study discovered that, of men reporting sexual violence, 67% reported current alcohol use whereas only 13% categorised themselves as non-drinkers (Abrahams, Jewkes, Hoffman & Laubsher, 2003). A second study (Hoffman, Demo & Edwards, 1994) noted the link between alcohol and violent behaviour, particularly towards marital partners. For men enrolled in alcohol treatment programs in the United States up to 66% report intimate partner violence perpetration and within programs treating partner abuse up to 56% of men report alcohol abuse (Schumacher, 2008). Clearly the links are well established.

Alcohol (the determinant) and intimate partner violence (the health outcome) are linked by risk behaviours. Aggressive, violent and inappropriate risk behaviours are all exacerbated by alcohol use (Hoffman, Demo & Edwards, 1994; Leonard, 2001). This association is supported by a national study in the United States (Leonard & Blane, 1992) which surveyed young married men where high scores on the Alcohol Dependence Scale were consistent with high scores of marital aggression. Violent tendencies, aggression and inappropriate risk behaviours increase the probability of intimate partner violence of a both physical and sexual nature (Graham et al., 2002). The World Health Organisation (2002) identified alcohol as a consistent factor leading to aggressive behaviour and partner violence, from Spain and Canada to India and Venezuela.

Another determinant of intimate partner violence is gender. Gender goes beyond women being far more likely to be the victims of the violence than men (Miller et al., 2005). It influences risk behaviours, the attitudes and discrimination of women that leads to partner abuse. Abrahams et al. (2003) highlight the role of gender in intimate partner violence. They state that the inequalities of power between genders in relationships can be represented by sexual violence in particular, with forced sex demonstrating superior strength. Pickup, Williams and Sweetman (2001) argue that the root cause of violence against women is inequality in gender power relations within societies. They state that victims of violence are chosen because of their gender; supported by societal norms.

Discrimination of women can stem from gender norms and attitudes. Wood & Jewkes (2001) draws attention to the way conflict between partners is influenced by broader concepts and norms within the broader social environment. The theory of social learning suggests that norms can lead to the idea that violence against partners is acceptable (Jasinski, 2001). Gender leads to social norms, these norms promote discrimination and discrimination leads to partner violence.

The first strand of the Ottawa Charter, healthy public policy, identifies the vast capacity for policies across all sectors to promote health (Braum, 2008). Creating healthy public policy means creating environments which enable people to make healthy choices (Braum, 2008; WHO, 1986). An example of healthy public policy regarding alcohol is local authority regulation of alcohol-providing venues. Regulation of such venues could help to ensure that laws such as not serving intoxicated persons were upheld. This could reduce risk behaviours which lead to intimate personal violence.

The second strand of the Ottawa Charter is creating supportive environments, the idea that people and the environment are inextricably linked (WHO, 1986). Creating alcohol free areas within communities is one way to prevent alcohol abuse by encouraging recreation without alcohol. These areas could range from single enterprises such as restaurants to entire geographical regions within a community or town. Sydney provides a concrete example of this type of strategy, with its 44 alcohol-free zones soon to become 72 (Gibson, 2008). Promoting such areas decreases the availability and accessibility of alcohol within a community, thus decreasing aggressive and inappropriate risk behaviour linked to intimate partner violence.

Strengthening community action is another strand of the Charter with community empowerment central to this process (WHO, 1986). Social support and public participating in health areas require access to information, funding and opportunities for education regarding health (Braum, 2008). An example of this is the creation of anti-violence community groups. These groups could promote awareness ways in which alcohol and alcohol abuse can lead to violent behaviour and put the idea out there that, within their community, this is not acceptable.

Developing personal skills is strand four of the Charter. Promoting and funding support groups within the community that focus on both alcohol and violence issues would allow training and development of personal skills surrounding both alcohol abuse and anger management. Perpetrators of intimate partner violence could learn ways of dealing with stresses other than alcohol and violence.

Re-orientation of health services, strand five, involves sharing responsibility for health and health promotion among individuals, communities, health service providers and all levels of government (WHO, 1986). Training of health professionals, from general practitioners to counsellors, to raise awareness of the links between alcohol and intimate partner violence is one way to shift from a reactive approach to addressing alcohol as a determinant. At all service levels there would be an understanding of the role that alcohol could be playing in each case. Health professionals could then give information of methods and support for coping with alcohol problems to those linked with intimate partner violence.

The second determinant of intimate partner violence, gender, can also be approached through the Ottawa Charter strands. In terms of healthy public policy, the way that intimate partner violence is policed and dealt with links to gender. Creating public policy that demonstrates that gender discrimination will not be tolerated would help to reshape attitudes surrounding what is acceptable and discouraging future violence. An example of this in action is presumptive arrest policies, required arrests in any cases of partner violence. While this became law in New Zealand in 1987 (Newbold & Cross, 2008) studies show that arrests only occur in 20% of cases following reported violence (Cross & Newbold, 2010). Enforcing this law would give women the idea that their complaints and safety were taken seriously. As police currently interpret the policy and exercise discretion (Newbold & Cross, 2008) giving officers training regarding enforcement of this law would be crucial to improve knowledge of when and how to implement it.

Creating environments that support victims of violence takes away the shame and stigma associated with being a victim. One way to do this is to create safe houses within communities. These refuges need to provide more than just accommodation but also support and services (Levison & Harwin, 2001). This strategy helps to reduce stigma therefore promoting gender equality and showing that women discriminated against do not have to remain in harmful situations.

One way of strengthening community action is to promote participation in decision-making at a community, local and national level (Braum, 2008). Actively inviting opinion and participation from women’s refuge groups and ex-perpetrators of violence in decisions relating to gender, health and violence in health promotion or policy formation would provide valuable experience, information and ideas. Drawing on groups of men who have overcome gender discriminative tendencies would improve methods for raising awareness of gender equality and respect.

An example of developing personal skills is gender attitude change. As perceived gender norms influence risk behaviours, addressing these attitudes is an effective way of reducing intimate partner violence. Mullender & Burton (2001) discuss the need to work with primary and secondary school aged children to raise awareness of gender equality, stating studies show 75% of boys aged 11-12 believe women get hit if they make men angry. Gondolf (1997) incorporated attitude change into group programs with perpetrators of partner violence imploring its association with abuse. Raising awareness in New Zealand, both at a school level and among perpetrator groups, can help to reshape gender norms, decrease future discrimination against women therefore reducing on partner violence rates.

An example of re-orienting health services is routine enquiry by general practitioners. Studies have shown that asking questions regarding domestic violence issues is acceptable to women (Koziol-McLain et al., 2004). This would ensure that women felt supported but also send out the idea that discrimination against women will not go undetected (Taket, Beringer, Irvine & Garfield, 2004).

At the heart of health promotion lie three values: equity, social justice and empowerment. It is essential that these values are incorporated when developing strategies addressing determinants of health. Equity is a needs based concept, the idea of resources being allocated based on needs rather than an exact equal share being given to everybody. This concept is demonstrated by the strategies discussed previously in that they address in different ways both the perpetrators and the victims of intimate partner violence. For example, providing training on ways of dealing with alcohol and violence for men as part of the developing personal skills strand highlights the needs of those with alcohol abuse issues. While often the victims of violence are those that resources are allocated to this strategy identifies that another area of resource need is the perpetrators themselves. Equity does not mean that an equal amount of resources needs to go towards helping perpetrators and the victims of the violence. The focus is on need, where the resources are required the most at the time.

Social justice is the idea of a fair and just society in which resources are equitably distributed. Therefore social justice is equity in practice at a societal level. The strategies put forward all contribute to social justice in different ways. The public policy strategy proposed regarding enforcement of the presumptive arrest policy aims to ensure that rules are fair. In ensuring an arrest is made with every partner abuse event justice is served for both the victims and the perpetrators, in that all perpetrators get the same treatment. The strategy aimed at raising awareness at a school level works towards creating a socially just environment in the future.

Empowerment is the process where people increase control over the factors that determine their health and lives. Community development and empowerment are inextricably linked. Empowerment is both a means and an end. Encouraging participation of victims and ex-perpetrators in decision-making is one way of empowering groups to increase their control over their lives. Empowerment happens at more than just a community level. A vital component of empowerment is having the resources to be autonomous (Braum, 2008) such as providing personal skills and community support for those dealing with alcohol-related violence issues; empowerment on an individual level.

In conclusion, intimate partner violence is a violation of human rights, a drain on health services and an economic burden to New Zealand. Determinants such as alcohol and gender need to be addressed through strategies that incorporate the health promotion values of equity, social justice and empowerment. Only when these root causes are addressed can New Zealand move towards a socially just future free from the horrors of intimate partner violence.

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