applied psych quiz 3 Flashcards
What do we know about domestic violence?
• Family violence:
- Between family members
- Typically perpetrator exercises power and control over another
- Most commonly intimate partner relationships
• Sexual violence:
- Behaviour of sexual nature carried out against a person’s will
- Perpetrated by anyone
• 1 in 6 women have experienced physical and/or sexual violence by a cohabiting partner since age 15
• 72,000 women, 34 000 children and 9000 men sought homelessness services in 2016-17 due to family/domestic violence
• 1 in 16 men have experienced physical and/or sexual violence by a cohabiting partner since age 15
Who is at greater risk? Domestic violence
• Women, more likely to know the perpetrator and occur in home
• Men, more likely to be violence from strangers in public
• Repeated occurrence
- 54% women who’d experienced current partner violence experienced more than 1 incident
• 2014-15: 8 women and 2 men hospitalised each day after assault by partner
• 2012-13/2013-14: 1 woman per week and 1 man per month killed as result of violence from partner
Who are most vulnerable groups? domestic violence
• Most at risk:
- Aboriginal and Torres Strait Islander women - Young women - Pregnant women - Women with disabilities - Women experiencing financial hardships - Women and men who experienced abuse or witnessed domestic violence as children
Who are the most vulnerable groups? Children - domestic violence
• Impact
- Long-term effects on development
- Increased risk of mental health issues
- Increased risk of behavioural issues
- Increased risk of earning difficulties
• 68% of mothers experiencing violence reported children witnessing violence
• 2015-16
- 45,700 children were subject of child protection substantiation
- 55,600 were placed in out-of-home care
Who are the most vulnerable groups? Indigenous people - domestic violence
• Family violence within Indigenous communities needs to be understood as both a cause and effect of social disadvantage and intergenerational trauma
• 2014-15
- 14% of Indigenous women experienced physical violence in past year
- 28% reported cohabiting partner was perpetrator
- Women 32x rate of hospitalisation due to family violence
- Men 23x rate of hospitalisation
What is the impact – Homelessness
• Impact on health
- Mental health conditions most prevalent
- 35% anxiety disorders
- 32% depressive disorders
• Groups likely under-represented in these figures:
- Indigenous women
- Pregnant women
- Women with disability
- Women experiencing homelessnessRegistering a birth
• 1/6 Indigenous children born in QLD do not have a birth certificate
- 15-18% of Indigenous births not registered
• Impacts:
- Enrolling in school
- Government benefits
- Medicare
- Driver’s licence
What can happen when police are called?
• Ms Dhu, 22 year old woman of Yamasaki-Nanda Nation and Banjima People (WA)
• Police responding to domestic violence report
- Partner was arrested for breaching violent restraining order
- Ms Dhu had unpaid fines and was arrested
Warrants of commitment for fines and costs $3622.34 accrued between 2009-2011
First fine $200
- Intention to hold Ms Dhu for 4 days to clear fines
- Ms Dhu indicated sustaining a broken rib and subsequently died in custody form sepsis secondary to her injuries
• In 2013, 1 in 3 women entering prison system did so to clear fines
When systems fail
• Indigenous women:
- Represent 35% of women in QLD prisons in 2015-2016
- More likely to be subject to breaches of discipline
- More likely to be in high security prisons and on safety orders than males
• 17.5x more likely to die due to homicide than non-Indigenous
• Indigenous women are least served by the legal system as men perpetrating violence against them are the least likely to be held accountable within the justice system
What is to be done?
• Ngaga dji (hear me) project – aims to change approaches to justice
- Actively on going
- How do we make changes to the system
- 42 individuals interviewed – stories recorded and documented
- Speak deeply to engaging with the justice system
- De-identified stories of children and young people currently or previously under youth justice supervision
- Their words and stories, de-identified
- Created composite accounts reflecting the real lives of many aboriginal children
- All events and experiences are real, details and names changed
- Stories reviewed by focus group of young people with lived experience of justice system
• Legislative change
- Victorian government committed to ‘home stretch’
- Providing young people with option to remain with carer until age 21
- Extending care allowance support to carers
- Tailored support from specialised workers helping obtain employment, education, training and life coaching
- Gradual and supported transition to independent living
- Improve outcomes for young people
- Lower costs to government long term
• Support aboriginal ownership of community infrastructure and gathering places:
- Transfer land and property to Wurundjeri Tribe Land and compensation cultural heritage council
- Preserving cultural heritage
- Manage land and sites of significance
- Provide Wurundjeri people opportunities to connect with culture
- Aboriginal people and organisations know the issues facing their communities and the best way to respond. Giving full control of these properties to Wurundjeri is self-determination in action
Sisters inside
• Community organisation in QLD advocating for human rights of women and girls in prison and their families
• Provides services to address individual needs
- Housing
- Income
- Health care
- Support in community
• Recognise complex factors leading to incarceration
Indigenous Australians health in Australia
• Aboriginal and Torres strait islanders have:
- Higher infant mortality rates - Higher unemployment rates - Lower weekly income than other Australians - More health risk behaviours - Poorer housing circumstances - Less access to education and child and maternal health
Indigenous Australians health in Australia/cancer
• Rates of liver and lung and other smoking related cancers are higher
• Breast, prostate, colorectal and skin cancer are lower
• Rates of lung cancer 2/3 times higher in rural aboriginal communities than for the rest of Queensland
• Rates of smoking related cancers as well as for breast and other cancers are increasing
• Cervical cancer:
- incidence in indigenous Australians 2x non-indigenous (20 vs 9/100,000)
- mortality rates 4x higher (8 vs 2/100,000)
Aboriginal and Torres straits islander’s health in Australia
• inequalities in sexually transmitted infections
• 2003, notification rates for people identified as indigenous were higher than rates for the total population for gonorrhoea, syphilis, and chlamydia
• Further research has suggested that rates of STI’s, as well as HIV/AIDS are also increasing in this population
• HTLV-1 virus, indigenous communities in central Australia. Highest in the world
- Associated with rapidly fatal forms of leukaemia, inflammation in organs, increased risk of other infections
• However, may be to do with higher susceptibility rather than a higher number of sexual partners
• Implications for the type of health interventions that get planned?
• Torzillo (1999):
- Difficulties in doing research with aboriginal and Torres straits islanders
- Political climate
- Should not detract from the need to do good quality research in the area
• This position is supported by a systematic review of clinical trials in this population, which found that there was a lack of such research
Closing the gap in a generation – WHO commission on social determinants of health
• Reducing health inequalities is an ethical imperative. Social injustice is killing people on a grand scale
• Overarching recommendations:
- Improve daily living conditions
Circumstances in which people are born, grow, live, work and age
- Tackle inequitable distribution of power, money and resources
Structural drivers of those conditions of daily life
- Measure and understand the problem and assess the impact of action
Expand knowledge base, develop work force trained in SDH, raise public awareness
What are adjustment to illness?
• Illness:
- Presents challenges to individuals
- Changes over time
• Required to deal with:
- Uncertainty
- Disruption
- Striving for recovery
- Restoration of wellbeing
• Mores and Johnson 1991 – generic model of emotional and coping responses
• Life changes:
- Time allocation
- Tasks that need completing
- Now strive for recovery – regain prior health, great effort requiredCancer example – stages
• Initial response
- Disbelief, denial, shock
- Lower capacity to process information
• Dysphoria
- Coming to terms with diagnosis
- Distress and related symptoms
• Adaption
- Lasts varying period of time
- Adapting more positively to their diagnosis
- Develop long-term coping strategies
- Holland and Gooen-Piels 2002 – stages of emotional response to cancer diagnosis
What do we know about health differences?
- In Australia, the better-off live, on average, two years longer than the por
- Similarly, people who occupy minority roles in society as a result of ethnic or other factors may experience more illness or die earlier than the majority of the population
- Findings that women live longer than men may be as much the result of social and psychological factors as biological ones
Health differentials
• Clear evidence of health differentials across whole populations both within and between countries
• WHO system for measuring life expectancy
- ‘equivalent of full health’
• In general, the richer the country, the longer its population lives and the longer its equivalent of full health is
Everyone can read – or can they?
• We assume that most people can read, can’t imagine what it is like to not read
* Therefore, we do not cater for people who cannot read; therefore information is not being accurately displayed
Impact of poverty on health
- People who live in developing countries live significantly shorter lives than those who live in more affluent countries
- Contributing factors are economic, environmental, and social lack of safe water, poor sanitation, inadequate diet and poor access to health care
- The problem now facing many developing countries in Africa is that of HIV infection and AIDS
Health inequalities
• Can be found in both rich and poor countries
• Are likely to be the consequence of social, economic, educational and environmental differences
- E.g. lack of safe water, poor sanitation, access to health care
• May be amenable to reduction by intervention at a societal level – but do we want to?
The impact of poverty on health
• Within industrialised countries, rich people live longer and have less illness than the economically less able
• There is a linear relationship between income (however measured) and health
• Subtle difference may also impact on health:
- Middle class executives who own one care are more likely to die earlier than equivalent earners with two cars
Homelessness in Australia
• Homelessness in Australia has increased 13.7% in 5 years – 116, 427 Australians now have no home
• 58% male, 42% female
• 20% indigenous
• 30% born overseas
• Where do people stay?
- Improvised dwellings, tents or sleeping out 7% (8200)
- Supported accommodation for the homeless 18% (21,235)
- Staying temporality with other households 15% (17,725)
- Boarding houses 15% (17,503)
- Other temporary lodging 1% (678)
- ‘severely’ overcrowded dwellings 44% (51, 088)
Social determinants of ill health
• The UK current health problems should be treated with agency
- Alarm about nation’s health is a rational response to recent evidence - Recent evidence has three components, probably linked: 1. Improvement in life expectancy, going on for 100 years has slowed since 2010 2. Health inequalities, which probably became smaller during the 2000’s have grown again since about 2012 3. There is a persistent North-South divide in health, particularly among younger people
The exception to the rule
• USA is below the OECD average for life expectancy
• Explanation include:
- Some social groups have extremely poor health – more characteristic of poor developing countries rather than a rich industrialised one
- The HIV epidemic caused a higher proportion of death and disability among young and middle-aged Americans than in most other advanced countries
Lack of harm minimisation interventions
War on drugs
- USA is one of the leading countries for cancers relating to tobacco
- The united states has high incidences of homicides compared to other industrial countries
Health inequalities within countries
- A problem within rich countries
- A failure of health care systems
- A technical problem to be addressed by improving access to services among those with poorer health
- Lifestyle, behavioural or cultural differences between socio-economic or ethnic groups that can be solved through health education and promotion
- Possibly also genetic differences between groups
Ethnic monitories
• Significant variations both
- Between the overseas born groups
- And between these groups and those in Australia
• Migrants to Australia have lower rates of cardiovascular mortality than Australian born people
• Deaths from lung cancer and breast cancer were higher in UK and Irish born residents than Australian born people but skin cancer was lower
• People born in Asia has significantly higher rates of mortality from infectious diseases, diabetes and homicide than the Australian born population
• The incidence of type 2 diabetes in Greek and Italian migrants to Australia is three times that of the Australian born population
• Incidence of cervical cancer is higher in groups of migrants from the former Yugoslavia
The ‘healthy migrant’ effect
- Have very controlled migration
- Those who come tend to be of higher economic status, more education etc.
- In general what can be found in Australia is what is called the ‘healthy migrant effect’
- The majority of people who migrate to Australia are as healthy if not healthier than the Australian born population
Social class
- Lawson and Black (1993) fond that marked differences in death rates according to social class exist
- If men of all social classes had the same mortality experiences as higher social class men the overall death rates for Australian men would be reduced by 60%
- They suggest that socio-economic status is the most important indicator of health status among Australians
- Australian socio-economic data
Social causation versus social drift
• Social causation model
- Low SES ‘causes’ health problems
- There is something about occupying a low socio-economic group that negatively influences he health of individuals
• Social drift model
- Health problems cause’ low SES
- When individuals develop a health problem, they may not maintain a job, or the levels of overtime required to maintain their standard of living. They therefore drift down the socio-economic scale
Health selection explanations
- People are not sick because they are poor
- Rather, poor health lowers income and limits earning potential
- There is little empirical support for this explanation
Statistical artefact explanation
- The poorest in any society are usually the sickest
- A society with high levels of income inequality has high numbers of poor and consequently will have more people who are sick
- There is little empirical support for this explanation
Explaining inequalities
- It is impossible to decide how much each of these causes is contributing to the gradients in illness and deaths
- Understanding the material, behavioural and locality-based causes, and the interactions between them is a priority
- Behavioural, material and local circumstances vary with SES
Explaining health differentials: different health behaviour
- More health-damaging behaviour
- Less health-promoting behaviour
- For example, in Australia the most socially disadvantaged people were twice as likely to smoke as those in the least socially disadvantaged group
Different health behaviour
- Poorer Australians are more likely to eat a less healthy diet, and take less leisure exercise than the better-off
- However, these differences do not provide the whole explanation for the health differentials
Differences in health-related behaviour
- Account for some of the socio-economic differences in health but not all
- Marmot, Shipley and Rose (1984) examined the impact of job level and health behaviour on health outcomes over ten years
- Smoking, alcohol, obesity, cholesterol and blood pressure removed
- Occupational status still remained independently predictive of health status
Health risk behaviours
• Poorer people doubly disadvantaged • Health-compromising behaviour • Why? - Possess insufficient knowledge - Lack of opportunities - Stress
Environmental insult
• Exposed to working in dangerous settings such as building sites
• Have more accidents
• Living in rented accommodation
- E.g. only 30% of the Indigenous population were homeowners compared to non-indigenous Australians
• Stress, strain and depression
Stress, strain and depression
• Childhood
- Family instability
- Overcrowding
- Poor diet
- Restricted educational opportunities
• Adolescence
- Family strife
- Exposure to smoking and own smoking
- Leaving school with poor qualifications
- Experiencing unemployment or low-paid and insecure jobs
• Adulthood
- Working in hazardous conditions
- Financial insecurity
- Periods of unemployment
- Low levels of control over work or home life
- Negative social interactions
• Older age
- No, or small occupational pension
- Inadequate heating
- Inadequate food
- Women aged over 65, increased homelessness
