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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 sociopolitical 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.
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