POLICY RESEARCH PAPER Healthy Women – Healthy Communities

Transcription

POLICY RESEARCH PAPER
Healthy Women – Healthy Communities
Copyright
February 2005
National Rural Women's Coalition
PO Box 178
Deakin West ACT 2600
www.ruralwomen.org.au
ABN 74 950 044 044
NRWC– Health and Well Being of Rural Women
February 2005
Table of Contents
Table of Contents .............................................................................................................................2
Executive Summary .........................................................................................................................3
1.
Consulting with rural women....................................................................................................5
2.
Depression and mental health in rural areas.............................................................................6
3.
Healthy Communities...............................................................................................................8
4.
Access to Services....................................................................................................................9
5.
Maternity Services..................................................................................................................11
6.
Foetal Alcohol Syndrome.......................................................................................................12
7.
Women affecting change........................................................................................................13
8.
Family Violence .....................................................................................................................14
9.
NRWC Position......................................................................................................................15
10. Recommendations ..................................................................................................................16
11. References ..............................................................................................................................17
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Report written by:
Judy Swann OAM
Executive Officer
NRWC
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Executive Summary
The National Rural Women’s Coalition (NRWC) was formed in June 2002 and comprises the
following member organisations:
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A rural Indigenous Woman
Australian Local Government Women's Association
Australian Women in Agriculture Ltd
Country Women's Association of Australia
Foundation for Australian Agricultural Women
National Rural Health Alliance
Rural Doctors Association of Australia (Women’s Section)
Women's Industry Network Seafood Community
The NRWC is funded through the Office for Women (OFW). A key element of our contract with
the OFW is to provide policy advice to the Australian Government. As rural women, our
objective is to ensure better social and economic outcomes for women living in regional, remote
and rural Australia.
Consultation with rural women has been the primary driver of all NRWC activity since its
inception in 2002. The NRWC prides itself on the robustness of these consultations and the
variety of strategies undertaken to capture the voice of women in rural, regional and remote
Australia. This Paper outlines the key communication methods and, most importantly, expands
on the ‘Healthy Women – Healthy Communities’ forum hosted by the NRWC which attracted
over 150 rural women and community stakeholders. These consultations and in particular, the
success of the rural women’s health forum, provided invaluable and fundamental feedback from
‘grass roots’ women. The Healthy Women – Healthy Communities Forum Report outlining the
process and outcomes of the 2 day Forum is available through the NRWC Office.
To enhance this valuable anecdotal evidence, the NRWC provided partial funding for the ‘Rural
Women’s Indicator Project’ conducted through the Rural Social Research Unit at the Charles
Sturt University (CSU) in Wagga Wagga. The involvement of the NRWC, through resources and
access to national networks, allowed the research to expand to include national sampling.
Additionally, NRWC funded a literature review to compile contemporary research and empirical
data to further expand on the key areas of concern voiced by rural women. This research has
been invaluable and will certainly complement the longitudinal, cohort-based, research
undertaken by the Australian Women’s Health Network.
In the following report, the NRWC presents the key recommendations from rural women which
have arisen through our consultations, surveys and the NRWC national forum addressing the
health and wellbeing of rural women. The recommendations are supported by the above research
and will be advocated by the NRWC through the appropriate departments, stakeholders and
Ministers.
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A gendered approach to health and wellbeing in rural areas is important. Increasingly feminist
critiques have challenged medical discourse. Women are the most frequent users of health
services, have problems caused by stereotypical roles and experience more disease or illness than
men.
The issues raised in the following paper reflect the most common concerns highlighted through
NRWC consultations and research. These include:
a. Depression and mental health,
b. Healthy Communities,
c. Access to Services,
d. Maternity Services,
e. Foetal Alcohol Syndrome,
f. Family Violence and
g. Women as agents for change.
The NRWC believes that supporting rural communities and developing policies that enhance
capacity building is the key to long term success. Community capacity building is a whole of
community responsibility and should incorporate a collaborative approach including government,
non government organisations and community stakeholders.
The NRWC is committed to using its unparalleled access to state and national women’s networks
to promote the recommendations made by rural women. Further, the NRWC, as a fully funded
body under the Australian Office for Women, will work in partnership with government and nongovernment organisations to promote the needs of women in maximising their health and
wellbeing in rural Australia.
The NRWC would like to thank the rural women, medical practitioners, allied health
professionals, service providers and government and community stakeholders who provided such
valuable contributions to our project.
We hope you enjoy the following Position and Policy Paper. It clearly states the position held by
the NRWC in relation to the health and wellbeing of rural women and identifies what activities
the NRWC will undertake to progress the key areas of concern. Importantly, the paper also
outlines the recommendations that the NRWC wish to make to government on behalf of rural
women.
Healthy Women create and contribute to healthy families and communities. By investing in
women’s health, particularly in the rural context, we are investing in stronger families and
communities.
Women are the most frequent users of health services, have health
problems caused by stereotypical roles and experience more illness or
disease than men.
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1. Consulting with rural women
The NRWC is committed to widespread communication and consultation with rural women. This
occurs in a number of ways within the NRWC and is part of NRWC’s inclusive and collaborative
approach to policy discussion.
Fundamentally, the NRWC consults with rural women through the NRWC’s member bodies.
Through the member organisations, NRWC is able to communicate with approximately 200,000
individuals through regular newsletter articles, email and internet. In addition to this internal
communication, the NRWC has developed a robust strategy for external communication.
We recognise that many rural women are not members of non government organisations and we
strive to keep these women informed of NRWC activities and projects. The NRWC achieves this
through targeting rural media, particularly rural radio. The media activity surrounding the
consultation for the NRWC Healthy Women-Healthy Communities included the following:
• media releases,
• 12 regional radio interviews,
• 15 minute talkback segment on ‘Bush Telegraph’ and
• A televised panel discussion.
Through this integrated approach, the NRWC was able to communicate with rural women and
encourage them to participate in the Healthy Women-Healthy Communities project. Women
participated in NRWC’s online discussion boards; forwarded their experiences and
recommendations to the NRWC office and many women completed the CSU survey. Most
importantly however, 150 rural women and stakeholders attended the 2 day NRWC national
forum on the health and wellbeing of rural women. Their feedback and valuable contributions
were vital to the processes that resulted in the recommendations contained within this Policy
Paper.
“(I most valued)… sharing information and knowledge and using this to
formulate direction for government policy; feeling we might be able to make
a difference.”
Direct quote from Forum Participant Evaluation Form
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2.
Depression and mental health in rural areas
One of the key issues identified through the NRWC consultations and the national forum, was
that of mental well-being in rural areas. The direct and indirect nature of depression and mental
health on rural women is particularly concerning. Recent stressors such as commodity prices and
the drought have caused immeasurable stress on rural women and their families, which in turn
has an adverse effect on their ability to contribute to rural communities.
It is important to consider the social determinants of health when looking at mental health in the
rural context. Socio-economic factors impacting on health include income levels, education,
employment and the quality of the physical and social environment1. Whilst access to services
and the importance of communities in rural Australia will be considered in this paper, it is
important to note that rural women self-elected depression as one of the key issues of concern.
Rural women have identified their own stress and mental health as an issue. However as the
primary carer in families, rural women have also identified the mental health of their loved ones
as a major concern for them.
Research conducted through CSU indicates that 53% of rural women felt that mental health
services in their area are difficult to access and 43% found it difficult to access counselling in
their area. This reflects the findings of the NRWC Forum where rural women identified the
following specific concerns:

the impact of mental and emotional health problems on physical health,
the lack of mental health practitioners in rural and remote areas,
the lack of information and knowledge about how to get help,
pre-teen and teenage mental health issues and
women as caregivers will often put their own needs second to the needs of other family
members.
During the NRWC Health Forum, the participants were particularly disturbed by statistics
provided through beyondblue: a national depression initiative. Statistically there is a significant
rising trend towards depression in the 15-24 year old age range, particularly in young males2. For
rural mothers, sisters and wives this can impact on their own wellbeing, particularly where access
to services and information is poor. Further, rural women have less access to post natal
depression services and information3.
A recent study comparing service access by rural or urban adolescents, found that structural
disadvantage in rural areas had most impact on health status and also limited service use,
particularly of mental health services4.
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Rural women have identified social isolation as a major issue in rural areas. Whilst isolation may
be real in a geographical sense, many rural women reported their concerns for those who become
socially isolated in rural areas. During the NRWC Health Forum, the importance of community,
and contributing in community activities, was raised consistently in conjunction with discussion
on mental health and well-being in rural areas.
A survey of rural General Practitioners (GPs) by the Hunter Valley Mental
Health Service identified depression as the most commonly seen mental
disorder in general practice and that GPs felt there was a lack of
psychological services to deal with depression in rural areas.
Media Release Hunter Health 13/2/04
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3.
Healthy Communities
The concept of place and community are extremely important in rural women’s health selfassessments5. Consistently rural women place importance on social and environmental conditions
in their health self-assessments and the rural context is an important factor in satisfaction,
dissatisfaction and wellbeing.
The role of rural women in their communities is one of reciprocity and inter-connectedness. High
levels of social capital have been linked with a general feeling of well-being. Importantly, low
levels of community participation are linked with low incomes and low self-assessed mental and
physical health6. It has been reported that social capital, once established, crosses barriers of
disadvantage, gender and class and has the capacity to increase the well-being in all sectors of the
community7.
Invariably women volunteer in greater numbers than men in support of community programs and
this is often in addition to their other employment and familial responsibilities. The responsibility
for community sustainability and support therefore becomes the responsibility of women.
The level of support provided to communities through volunteer work has been widely reported.
The CSO Research has highlighted that whilst 79% of respondents were in the paid workforce,
66% of respondents noted that they volunteer in some capacity in their community.
This enthusiasm of rural women to keep their communities and community services functional
conveys the value of rural communities to the residents. Rural women attending the NRWC
Health Forum strongly recommended that the NRWC advocate for improved funding of rural
community services. It was strongly recommended that government should focus on developing
rural community capacity and services through integrated and multi-faceted solutions.
Rural women felt that a holistic approach to building rural workforces and supporting rural
community capacity should be a primary aim of government in considering the health and well
being of rural Australians.
Approximately 30% of rural women volunteer over 5 hrs a week in their
rural communities.
CSU ‘Rural Women’s Indicator Project’ 2004
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4. Access to Services
The NRWC’s extensive consultations with rural women identified access to services possibly the
most significant issue of concern when considering health and wellbeing in rural areas. The
inadequate funding of services in rural areas has resulted in limited facilities that offer restricted
services8. Whilst the people working in these health facilities are dedicated professionals coping
as well as they can, lack of funding is impacting on the services they can provide.
Rural women have reported that accessing services, particularly specialist services, is a major
impediment in maintaining optimal health and wellbeing in rural areas. Treatment often
necessitates staying away from home to receive specialist services, often without family support
and incurring financial costs. A lack of public transport and affordable private transport has been
consistently noted as a significant factor in access to health services for rural dwellers9.
It has been reported that rural women have fewer visits to General Practitioners (GP) and
specialists, a greater likelihood of being overweight, a higher level of alcohol consumption and a
greater likelihood of gynaecological surgery10. Locally available services tend to be more
expensive in rural than urban areas and GP consultations are less likely to be bulk-billed11.
Throughout the NRWC Health Forum, rural women also identified the need for greater
communication and information about existing services. Whilst telecommunication services has
improved access to information for all Australians, geographical remoteness and lower income
levels continues to impact on access in rural areas.
Transport difficulties are a substantial barrier for all rural communities. The CSU Research
highlighted that a high 66% of respondents noted that they need to travel to a regional centre to
access health services but 84% stated that public transport is not available to this centre.
Transport is a particularly serious issue in Indigenous rural communities12. Older, less educated
and Indigenous rural dwellers are the least likely to access health services, particularly if they
have low incomes and restricted transportation.
Many rural women stated the perceived lack of confidentiality as an issue affecting the access of
services in rural areas. Many women felt uncomfortable discussing private medical issues with a
service provider that they know on a social basis in their community. Many women also
perceived that confidentiality in rural areas as tenuous in very small communities.
Services for the aged and for carers in rural Australia seemed to be particularly lacking. The
CSU Research indicates that 72% of respondents have the responsibility for caring for a child,
aged person, disabled person or someone with special needs. The research goes on to show that
31% of these found caring information is hard to access in rural areas and 51% are not able to
access respite. Importantly only 32% felt that there were adequate services to support mothers.
Social conditions affecting health and wellbeing in rural areas are often exacerbated by the
stereotypical views of rural people, particularly men. Injury and illness is often managed at home
and consultations with medical practitioners are delayed. The statistically later presentation for
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treatment amongst rural dwellers, compared to urban dwellers, often results in poorer outcomes13.
Whilst this statistic may be more reflective of rural men, the worry and stress of an untended
illness often falls on the female carer.
The issue of aged care is a serious one for rural women. Women statistically outlive men making
the care of the aged in rural areas, predominantly a gendered issue. Compounding this, older
women are one of the most socially and economically vulnerable demographics in Australia
today. This is exacerbated in rural and remote areas. This social phenomenon requires specific
services to address the needs of this group. The World Health Organisation (WHO)
acknowledges the lower income levels, mobility issues and generally poorer health of older (over
70) women. WHO now uses terms such as ‘healthy life expectancy’ rather than life expectancy to
reflect the different quality of life experienced by older people suffering poor health.
Community services make up the second largest industry group in regional cities with over 21%
of the total workforce14. However, the workforce is largely casualised, feminised and still relies
heavily on voluntary efforts. The large scale withdrawal of services in regional and rural
Australia over recent years has resulted in a clear need for carefully targeted services as well as
community development programs. The NRWC believes that this requires a ‘whole of
community’ approach through the collaboration of service providers, consumers, government and
community.
65% of rural women find it difficult to access medical specialists in their
area and 60% find it difficult to access bulk billing in their area.
CSU ‘Rural Women’s Indicator Project’ 2004
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5. Maternity Services
Whilst access to services in rural areas was an issue across many health concerns, the lack of
maternal issues was of particular concern to the rural women we consulted. The CSU research
indicates that 51% of rural women report difficulty in accessing maternity services and 58% find
it difficult to access birthing centre services.
Recent increases in medical indemnity costs has made it increasingly difficult and in many cases
impossible for rural GP’s to offer maternity services. Fewer rural GPs are delivering babies and
fewer rural GPs are doing antenatal care. Rural health issues significantly impact on ante and post
natal care of the mother and baby. These include:
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Higher rate of teenage pregnancies,
Poor access to perceived confidential health care,
Higher rates of smokers,
Lower access to antenatal care,
Less antenatal screening,
Social isolation,
Less access to postnatal home visits by midwives and family services and
Less access to postnatal depression services.
Adolescent pregnancy is also significant issue in rural areas. This may be due to the lack of
contraceptive advice, limited or no abortion services, limited confidentiality from health workers
because worker and client know each other in community settings and lack of health workers.
High rates of adolescent pregnancies in remote areas are consistent with high rates in socially
disadvantaged communities generally 15.
The NRWC was pleased to note the high profile activity occurring in the area of rural maternity
services through such organisations as the National Rural Health Alliance and the Maternity
Coalition. The NRWC is committed to supporting these organisations in promoting the needs of
women and babies in rural Australia.
The rate of deaths related to complications from pregnancy is 3 – 4 times
higher among women who receive no prenatal care compared to women
who received prenatal care.
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6. Foetal Alcohol Syndrome
The seriousness of Foetal Alcohol Syndrome (FAS) was highlighted through a moving
presentation at the NRWC Health Forum by Lorian Hayes. Participants at the forum felt strongly
that this is a serious issue for Indigenous and non-Indigenous communities. This was felt to be
particularly important in rural communities where access to information and counselling is
limited.
Studies have consistently identified the serous nature of the effects of alcohol on foetal
development. These include: intellectual disability, cognitive impairments, learning difficulties,
speech and language delay, and behavioural and emotional problems.
During pregnancy alcohol is not only carried to all organs and tissues, it has the potential to cross
the placental barrier and transfers from mother to foetus. The amniotic fluid is considered a
reservoir for ethanol, which increases the availability of the drug to the foetus. When a pregnant
woman drinks alcohol the concentration of alcohol in her unborn baby’s bloodstream is the same
level as her own. The liver of the developing foetus cannot process the alcohol at the same rate
as the adult. High concentrations of alcohol stay in the foetus longer. The unborn baby’s blood
alcohol concentration is even higher than that of the mother’s during the second and third hour
after a drink is consumed by the mother16.
Indigenous women are vulnerable for many reasons particularly when their lives and social
interaction are linked with alcohol use. Subsequently it is vital that the relationship between
alcohol use and pregnancy is explored from the viewpoint of health; but also the within the
boundaries of a socio-cultural context that this relationship plays in women’s lives17.
The National Drug Strategy FAS Literature Review acknowledges that FAS has not been the
subject of national research or policy development in Australia17. This makes Australia one of the
few western countries that have not acted on this serious issue. With one child born in Canada
every day with FAS18, it is clear that the Australian government has not done enough to
investigate or act on FAS in Australia.
Raising the awareness of Foetal Alcohol Syndrome amongst women, community members, and
health professionals in the community will make an important contribution to the improvement in
health and wellbeing of women and their babies in rural areas.
In the USA, Foetal Alcohol Syndrome is recognised as the leading
preventable cause of mental retardation.
Institute of Medicine 1996
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7.
Women affecting change
The most powerful outcome of NRWC’s consultations was the overarching theme of the
capacity of women to affect change. The themes of women in leadership and the contribution of
women to balanced policy development have been consistent recommendations throughout
NRWC’s consultations across all projects.
The number of women in leadership positions in rural areas is an issue of great concern to rural
women. It is felt that leadership opportunities are not as accessible to rural women due to
infrastructural and social restrictions such as lack of accessible child care, lack of mentoring or
female role models and stereotypical issues in rural Australia.
Whilst it is recognised that women are targeted for leadership potential in a variety of rural
programs, the rural women we consulted felt that these programs are under communicated.
Women who are caring for children or other dependants find it difficult to access these programs.
Also, lack of personal confidence, particularly with regard to Information and Communication
Technology, is a major barrier to women taking on more decision-making roles in rural areas.
Overwhelmingly, rural women want to influence policy that affects their quality of lives. Top
heavy, silo-based service delivery models within government have resulted in ‘grass roots’
individuals having very limited access to real policy development. The people whose lives will
be most affected by policy initiatives, particularly women, often have the least say in the
development and implementation of these policies.
Since its inception in 2002, the NRWC has consulted rural women in a strategically developed
programme to develop bottom-up policy recommendations. We recognise the enormous value of
grass roots input and the positive effect this has on making robust and balanced policy
recommendations.
Feedback from rural women indicates the enormous value of a national policy advocacy body for
rural women, such as the NRWC. The NRWC is able to consult with rural women in a way that
makes them feel comfortable and positive. Their contribution is then turned into policy advice
provided directly to government. This is a powerful tool in developing health and wellbeing in
rural women. The positivity surrounding personal empowerment, mental stimulation and
professional satisfaction cannot be underestimated. This has a vital flow-on effect in rural
communities that builds capacity and resiliency.
“The atmosphere created right from the start made me feel part of the
process and part of the solution”.
Direct Quote, NRWC Health Forum Participant
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8. Family Violence
Family Violence in rural Australia has been a topic of concern for the NRWC since its inception
in 2002. Consistently, rural women have raised their concern for the higher incidence and
seriousness of domestic violence in non-urban areas compared to urban areas.
The Womens Services Network Report (WESNET) 2003 states the following:
• Compared to women living in metropolitan areas, women in regional, rural and remote
areas were less likely to use crisis services or report to police.
• Women are subjected to high levels of violence and abuse at the hands of their spouses
and other family members in rural and remote areas.
• Data shows disproportionately high rates of domestic and family violence in remote areas,
which is three times the rate in other geographical areas. Rates in rural areas are also
higher than metropolitan rates, as were rates in regional areas.
• The highest rate of apprehended violence orders (AVO's) or Intervention Orders (IO’s)
are in rural areas.
• In 1999, it was found that nationally 61% of women homicide victims were killed as a
result of domestic and family violence. This rate is higher in rural and remote areas.
• There is a direct link between dominant rural ideologies and community acceptance of
domestic violence. The complex interplay of community values and attitudes present in
regional, rural and remote areas and its acceptance and condoning of domestic and family
violence are directly linked to its increased incidence.
Rural women are also concerned with the issue of family violence in Indigenous communities.
The physical, psychological and emotional repercussions of family violence are obvious. Healthy
relationships and healthy partnerships are pivotal to the health and well being of women in rural,
remote and regional Australia.
The NRWC has previously identified the benefits of establishing a cross organisational approach
to addressing the complexity of family violence in a rural community. However, the three tiers of
government in Australia must look seriously at the resources devoted to family violence in rural
communities.
The provision of services in rural areas must become a priority. Accessible safe houses, financial
support and transport are essential to the safety of women and children at risk. Importantly,
communities must be supported in a way that suits the local residents and community
stakeholders.
There are estimates that one third of Aboriginal women in the Northern Territory are
assaulted each year. In addition to this, 33% of all reports of violent crimes experienced
by indigenous women were family violence, compared to a national average across all
cultural groups of 9.5%.
WESNET Report 2003
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9. NRWC Position
As a result of the NRWC’s consultations, research and national forum, the NRWC Council
supports the following positions and undertakes the following actions:
The NRWC believes:
a. Rural women and families have a democratic entitlement to the same quality, accessibility
and affordability of health care as urban women.
b. Healthy women create, and contribute to, healthy communities.
c. Rural Indigenous women, older rural women and women in remote communities are
possibly the most disadvantaged groups in Australia today; in terms of access to
appropriate health services.
d. That the incorporation of Indigenous knowledge and experiences is essential for future
policy development.
The NRWC will:
a. Investigate the opportunities of a targeted partnership with Lifeline and beyondblue: a
national depression initiative to address mental health amongst rural women.
b. Establish a cross-organisational working group to support awareness of Foetal Alcohol
Syndrome in Australia.
c. Work with the National Rural Health alliance and the Maternity Coalition to address
maternity services deficiencies in rural Australia.
d. Investigate the possibilities of expanding rural leadership opportunities for rural women.
e. Advocate the recommendations arising from the NRWC’s Healthy Women – Healthy
Communities project to all levels of government.
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10. Recommendations
The NRWC will advocate the following recommendations to all levels of government.
The NRWC recommends:
a. The development of a cohesive and comprehensive national mental health strategy for
rural Australia.
b. Equity of access to health services and information in rural Australia.
c. Equity of access and affordability to Information Technology in rural Australia.
d. Appropriate funding of health services in rural communities based on a collaborative,
community-based, approach to modelling services to meet the needs of individual
communities.
e. Maintaining and expanding maternity services in rural Australia.
f. The development of a national strategy to raise awareness of, and address the
consequences of, Foetal Alcohol Syndrome
g. Community capacity building solutions in rural communities, including increased housing
availability, independent living and appropriate public transport.
h. Increased child care in rural communities.
i. Targeting rural women for leadership opportunities and involvement in real decision
making.
j. The ongoing funding and support of a rural women’s peak policy advocacy body.
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11. References
1
Beyondblue: a national depression intitiative. Presentation NRWC Healthy Women-Healthy
Communities National Forum, October 2004
2
Beyondblue: a national depression intitiative. Presentation NRWC Healthy Women-Healthy
Communities National Forum, October 2004. Australian Bureau of Statistics March 2000
3
Dr. L. Walters. Presentation. NRWC Healthy Women-Healthy Communities National Forum,
October 2004
4
Quine et al 2003
5
Thurston and Meadows 2003
6
Savage et al 2003
7
Kawachi, Kennedy and Lochner 1997
8
Ryan-Nicholls 2004
9
Warner-Smith & Brown 2002
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11
Brown, Young and Byles 1997
Young and Dobson 2004
12
SCRGSP 2003
13
Elliot-Schmidt and Strong 1997
14
Beer, A., Bolam, A. & Maude, A. (1994) Beyond the Capitals. Urban Growth in Regiona
Australia. Urban Futures Research Programme: Canberra.
15
Thompson 1998
16
Lorian Hayes, NRWC Healthy Women – Healthy Communities October 2004
17
National Drug Strategy 2001- 2003/4
18
Health Canada URL 2002
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