Compromise, country women and cancer: Women's health policy in Australia
Karen Willis
School of Sociology and Social Work, University of Tasmania, Launceston, TAS
Abstract
In the 1990s, mammography screening became the key site for women's health policy. Randomised control studies are reported to demonstrate that population-based screening using mammography will reduce the mortality from breast cancer by 30 per cent (Shapiro et al 1982; Tabar et al 1985). This provides a ready rationale for the introduction of this program although there is countervailing evidence that these figures are questionable (For example, Schmidt 1990; Foster 1995). Those in support of screening also acknowledge that it is difficult to ascertain the precise impact of screening, due to the range of other variables that may be implicated in reductions in mortality from breast cancer (Smith, Kricker & Armstrong 1998).
Given the strong focus on a social view of health within the feminist health movement, the existence of the National Policy for Women's Health, and the continuing existence of women's health centres funded as a result of the National Women's Health Program, the notion of a technological response to women's health such as mammography confronts ideas and values about women's health services generally.
In the 1970s and 1980s, the women's health movement developed as a challenge to dominant ideas around health and medicine. For feminist theorists, health status is inextricably linked with society, culture and the socio-economic structures within which women live their lives (see for example, Oakley 1993; Doyal 1995). For Broom (1991: 107), 'Feminist theory affirms the social model of health and actively rejects the limitations of the traditional medical model'.
The National Women's Health Policy endorsed by governments in 1989 overwhelmingly recognised the social model of health in putting forward its health priorities, which were identified as: reproductive health and sexuality; the health of ageing women; women's emotional and mental health; violence against women; occupational health and safety; health needs of women as carers; and the health effects of sex role stereotyping (Commonwealth Department of Community Services and Health 1989: 5).
These contradictions between the medical approach to breast cancer screening and the National Women's Health Policy provide a good opportunity for a sociological analysis of an important Australian health initiative. My analysis focuses on whether or not the basic premises of the women's health movement are compromised by programs such as mammography screening. The research for this paper explores the tensions and contradictions that accompany the changed public health focus in the shift away from a view of health where women's health is perceived as socially created and defined, towards a view of women's health that is centred around a disease process. This research suggests that there are considerable tensions in maintaining a commitment to women's health at both the socio-political level, and at the level of policy implementation.
After outlining the research methods used in the study, the paper examines what it is about health policies and services that would characterise them as feminist. I report the views of women involved in key roles in the implementation of mammography screening on the practical limits to the implementation of a feminist health policy. In doing so, the political context as observed by participants in the research will also be explored as providing the essential framework for what is possible within a policy setting. Then, by taking one of the key principles of the National Women's Health Policy, that relating to information provision, it is possible to explore some of the tensions between the two policy approaches.
References
Adelsward V and Sachs L (1996) The meaning of 6.8: Numeracy and normality in health information talks, Social Science and Medicine 43(8): 1179-1187.
Atterstam I (1999) Mammography has hard critics, Svenska Dagbladet 20 July: 1.
Australian Institute of Health and Welfare (AIHW) (1998) Breast and cervical screening in Australia 1996-1997, Australian Institute of Health and Welfare, Canberra.
Barger-Lux MJ and Heaney RP (1986) For better and worse: The technological imperative in health care, Social Science and Medicine 22(12): 1313-1320.
Broom DH (1991) Damned If We Do: Contradictions in women's health care, Allen & Unwin, North Sydney.
Burgmann V (1993) Power and Protest-Movements for change in Australian society, Allen & Unwin, St Leonards.
Commonwealth Department of Community Services and Health (1989) National Women's Health Policy; Advancing women's health in Australia, report presented to Australian Health Ministers in Burnie, 21 March 1989, Australian Government Publishing Service, Canberra.
Dowse S (1983) The women's movement's fandango with the state: The movement's role in public policy since 1972. In Baldock CV and Cass B (eds) Women, Social Welfare and the State in Australia, Allen & Unwin, Sydney.
Doyal L (1995) What Makes Women Sick? Gender and the political economy of health, Macmillan, London.
Foster P (1995) Women and the Health Care Industry: An unhealthy relationship? Open University Press, Buckingham.
Gray G (1999) Women's health in a restructuring state. In Hancock L (ed) Women, Public Policy and the State, Macmillan Education, South Yarra.
Hunt L (1996) Social movements and the construction of health knowledge: A case study of the women's health movement, Annual Review of Health Social Sciences 6: 157-172.
Hunt L (1998) Primary health care for women: An evolving speciality. In Rogers-Clark C and Smith A (eds) Women's Health: A primary health care approach, MacLennan & Petty, Sydney.
Ingram H and Schneider A (1993) Constructing citizenship: The subtle messages of policy design. In Ingram H and Rathgeb Smith S (eds) Public Policy for Democracy, The Brookings Institution, Washington DC.
Kaufert PA (1996) Women and the debate over mammography: An economic, political, and moral history. In Sargent CF and Brettell CB (eds) Gender and Health: An International Perspective, Prentice Hall, New Jersey.
Kavanagh A (in press) Epidemiology and technologies of quantification. In Daly J, Guillemin M and Hill S (eds) Critical Compromise, Oxford University Press, Melbourne.
Little M (1998) Assignments of meaning in epidemiology. Social Science and Medicine 47(9): 1135-1145.
Lupton D (1993) Risk as moral danger: The social and political functions of risk discourse in public health, International Journal of Health Services 23(3): 425-435.
Marlin A, Redman S, Clarke C, Clark R and Boyle F (1996) Breast Cancer Research in Australia: Current research and future priorities, NHMRC National Breast Cancer Centre, Sydney.
Nettleton S (1996) Women and the new paradigm of health and medicine, Critical Social Policy 16: 33-53.
Oakley A (1993) Women, health and knowledge: Travels through and beyond foreign parts, Health Care for Women International 14: 327-344.
Office of the Status of Women, Department of the Prime Minister and Cabinet (1992) National Agenda for Women: Implementation Report, Australian Government Publishing Service, Canberra.
Schmidt JG (1990) The epidemiology of mass breast cancer screening - A plea for a valid measure of benefit, Journal of Clinical Epidemiology 43(3): 215-55.
Shapiro S, Venet W, Strax P, Venet L and Roeser R (1982) Ten- to fourteen-year effect of screening on breast cancer mortality, Journal of the National Cancer Institute 69(2): 349-355.
Short LM (1995) Only the tip of the iceberg: A consumer perspective on breast cancer screening research and policy development, Annual Review of Health Social Sciences 5: 99-114.
Slaytor EK and Ward JE (1998) How risks of breast cancer and benefits of screening are communicated to women: Analysis of 58 pamphlets, British Medical Journal 317(25): 263-264.
Smith CL, Kricker A and Armstrong BK (1998) Breast cancer mortality trends in Australia: 1921 to 1994, The Medical Journal of Australia 158(05 January): 11-14.
Socialstyrelsen, The National Board of Health and Welfare (1998) Mammography Screening for Early Detection of Breast Cancer in Sweden, abbreviated version in English of the report, Mammography Screening for Early Detection of Breast Cancer, NBHW Series Publication No 17, National Board of Health and Welfare.
Stone DA (1993) Clinical authority in the construction of citizenship. In Ingram H and Rathgeb Smith S (eds) Public Policy for Democracy, The Brookings Institution, Washington DC.
Tabar L, Fagerberg CJG, Gad A, Baldetorp L, Holmberg LH, Grontoft O, Ljungquist U, Lundstrom B, Manson JC, Eklund G, Day NE and Pettersson F (1985) Reduction in mortality from breast cancer after mass screening with mammography, The Lancet 13 April: 829-832.
Tornberg S (1999) Director, Cancer Cause and Control, Karolinksa Institute, Stockholm (personal communication): 16 September 1999.
Wardle J and Pope R (1992) The psychological costs of screening for cancer, Journal of Psychosomatic Research 36(7): 609-624.
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