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Foreword
Contemporary Issues in Child and Family Health
Sandra Speedy
Emeritus Professor, Faculty of Law, Business and Creative Arts, James Cook University, Townsville QLD; Southern Cross University, Lismore NSW
Article Text
Why can Advances in Contemporary Child and Family Health Care (ISBN 978-0-9750436-3-3) be highly recommended? The range of topics demonstrates the diversity and currency of approaches to child and family health - and how wonderfully diverse this is. First, within the child health context, the topics addressed include chronic illness, disability, the experiences of hospitalisation for indigenous families, the role of fathers in providing care, and children's experiences of parents with a mental illness. Second, within the family context, this volume considers violence, single parenting, eating disorders, family support issues, immigration detention and family centred care. Third, within the community context, this volume considers important issues such as emergency contraception, childhood obesity, the value of nurse-led clinics, volunteerism and health assessment of primary school children. Overall, there is no doubt that this volume demonstrates the central role of women in building systems and health capacity for children, families and communities. Warner-Smith et al. (2004) remind us that there is a widening gap between urban and rural areas with respect to health opportunities and outcomes. It is particularly important that, because women are major users of health systems as carers and patients, research approaches need to be gendered in order to assess 'spatial inequality, but also the analysis of the distribution of and access to services' (Warner-Smith et al. 2004).
Clearly, it is imperative that we build the health capacity of families. This volume demonstrates that nurses play a crucial role in doing just this. Given that most nurses are women, it stands to reason that women play a major role in meeting this vital objective.
Heise et al. (1999) linked family and mental health, suggesting that domestic violence has a profound impact on the physical and mental health of those who experience it. As well as injuries, domestic violence was associated with an increased risk of a range of physical and mental health problems and is an important cause of mortality from injuries and suicide. The report identifies that domestic violence can be physical, sexual, or psychological. Physical and sexual violence by an intimate partner are common problems, affecting 20-50% of women at some stage in life in most populations surveyed globally; between 3% and 50% of women have experienced domestic violence in the past year.
What is implicit throughout the issues addressed in this volume is the vital importance of mental health. Mental health could be considered to represent the keystone to the acceptance of cultural diversity, and thus health in general. Women in their roles as wives, mothers and daughters continue to be the foundation/keystone of child and family health. To be equipped optimally, women need to be mentally healthier than ever. Women have never been more important in providing continuity and stability in these times of global disorder; in fact, women and families may be the key to community survival. So the question becomes, how can we teach all our children, and particularly our male children, to become responsible decision-makers regarding the sustainability of our communities and enviroment? We assume that equality for women will be a long time in coming. And why would we not make that assumption, given our experiences? However, I contend that we cannot afford to assume that women and families are not able to change our world. It is too important an issue to abandon - rather, women and families should drive the agenda for healthy communities and a sustainable planet.
One would not wish to discount the men, who, in more recent times, are voluntarily taking responsibility in a parental role, as is evidenced in this collection. This is a promising development. Unfortunately, from a global perspective, it is a small blip on our egalitarian radar, compared to the damage that men perpetuate throughout the world.
Amiel and Heath (2003) also focus on the impact of domestic violence on the community. They note that, in 1985, US Surgeon General C Everett Koop declared domestic violence to be the biggest public health crisis of the decade. In 1994, the United Nations recognised violence against women as a human rights abuse. In the late 1990s, national surveys in Canada and the United States reported that a third of women had been physically assaulted by an intimate partner, putting them at risk of injury, a range of physical and emotional health problems, and death. They also cite a 2002 World Health Organization report on violence and health, which indicated that up to 70% of female murder victims were killed by their partners or former partners.
Furthermore, we know from the global literature that every year, thousands of women and children are battered and killed in their own homes. Thousands of others find themselves the victims of rape in war. The killing features on our televisions, and then we have dinner. The rape is rarely acknowledged, except in some journals, where we learn that feminist activists put themselves at great risk in their own countries to bring these injustices to the world stage. They tell us that many of these crimes take place in the home and family, which we believe should be our 'safe havens'. These crimes are a product of a global culture which continues to discriminate against women, denying them equal value, equal rights and equal opportunities. Police protection, community support and legal redress are either lacking or ineffective in redressing the imbalance.
In an April 2004 snapshot, we see that we must continue to work for change:
- One in four women in Australia has experienced violence in their intimate relationships;
- Half of all murders in Bangladesh are women killed by their husbands;
- Every minute in Britain, there is a call for help against domestic violence;
- Each year in Pakistan, up to a thousand women and girls are murdered to preserve family 'honour';
- Over half of all women in Papua New Guinea have been the victims of spousal abuse.
Human Rights Defender (2004) Vol 23, No 2: 7
Note that these are peacetime statistics from a small selection of regions. Elsewhere, during war and post-conflict situations which permeate our global community with distressing frequency, women and girls suffer rape and sexual exploitation on a massive scale. It is fitting that the Guest Editorial in this volume by Professor Linda Shields, 'A last resort?' Impacts of the Australian government's immigrant detention policy breaching the United Nations Convention on the Rights of the Child (1989)' should critically examine the Howard government's policy of 'deter and deny' basic human rights to women and children refugees who are fleeing those situations to seek refuge in Australia. It is notable that this issue also received research interest in a Western Australian study that explores emotional distress in African women refugees (Tilbury and Rapley, 2004). This research is important because it challenges traditional biomedical approaches to grief and distress among refugee women, which serves to disempower rather than empower individuals. Tilbury and Rapley (2004) argue that the 'structural determinants of powerlessness' are what needs to be the focus of treatment, rather the individual women's problems.
In many ways, this special issue of Contemporary Nurse represents how Australian and New Zealand nurses fulfil their humanity, mission to care and life goals. It is most admirable. While it indicates the critical problems many families and communities face in our region, we know that we are but a small microcosm of our global community. Inevitably, we will need to add our intellectual and emotional weight to the world stage in order to create the changes that must occur if there is to be an acceptable world and future for us at all. There is no doubt that we must maintain the commitment and even the rage!
References
Amiel S & Heath I (eds). (2003) Family violence in primary care: violence against women: a physician's guide to identification and management. Oxford University Press, Oxford UK.
Heise L, Ellsberg M & Gottemoeller M (1999) Ending violence against women. Baltimore: Centre for Communication Programs, John Hopkins School of Public Health, Baltimore MD.
Tilbury R & Rapley M (2004) 'There are orphans in African still looking for my hands': African women refugees and the sources of emotional distress. Health Sociology Review, 13 (1): 54-64.
Warner-Smith P, Bryson L & Byles J (2004) The big picture: the health and well-being of three generations of women in rural and remote areas of Australia. Health Sociology Review, 13 (1): 15-26.
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