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Posts Tagged ‘Health Care Access’

For valentine’s day, I thought I would post something about preventing spousal violence.

Earlier this year, a Justice Canada federal study was released, which details the incidents and costs of spousal violence. There are some interesting findings from the study. For one thing, the study estimates that the costs of spousal violence are very high: an estimated 7.4 billion per year in Canada (and this is said to be a deliberately conservative estimate). The costs include things like legal bills, emergency room visits, lost wages due to time off from injuries, the costs of personal safety measures such as paying for call display to identify stalking spouses, and possible moving expenses to escape the spouse.

Here is the findings on the incidence of spousal violence as reported by The Toronto Star:

Drawing on a Canada-wide police database, researchers found almost 50,000 cases of spousal violence reported to police that year, more than 80 per cent of them involving female victims. The cases included 65 homicides, 49 of them women. (Source: Beeby)

Here is the break-down of the costs associated with spousal violence by gender:

Altogether, total costs were conservatively estimated at $4.8 billion for female victims and $2.6 billion for male victims. (Source: Beeby)

I think that is interesting. Note that according to the study, 80% of the victims of spousal violence are women and 20% are men, but violence committed against men accounts for 35% of the costs associated with spousal violence. The Star article does not describe why the costs are higher for men than for women. If I had to guess I would say that the higher costs are likely associated with the wage gap, since men earn more than women on average, their time away from work would be more expensive. But that is just a guess. Perhaps the issue is that men have more disposable income on average than women do, and so men spend more on their own protection than women do. Beeby mentions that the study found that 80% of the costs of violence are born by the victim themselves (the remainder is born by public services and employers). I am not sure what else might account for the difference.

So this study shows that shelters save money. But they also save lives. It is interesting to note, however, that shelters tend to save men’s lives more than women’s lives:

Let us look at the statistics and see who is murdering whom. Going back to the 1970s we learn that the domestic homicide rates in the U.S. were about the same for men and for women, around 1,000 such killings per year.

Coming to today, the latest figures available from the Bureau of Justice Statistics provide a comparison of intimate homicide rates for 2005 compared with 1976. Here is the official breakdown for 2005: 329 males and 1,181 females were killed in that year by their intimate partners. Clearly men are much more likely to kill their partners than women are to kill theirs. We know from other research that same-sex homicide is predominantly male, a fact of some significance in the statistical breakdown because some of the male intimate homicide victims are not killed by women at all but by their male partners.

Returning to the discrepancy between the decline in the rates of female-on-male domestic homicide and the male-on-female rates, Statistics Canada (1998, 2005, 2010), and other Canadian sources reveal the same trend has occurred in Canada since the years that the women’s movement took shape. For the year 2009, for example, three times as many Canadian women were killed by spouses and ex-spouses as were men.

So what is the explanation for this striking decline in women killing their partners? Researchers including myself attribute the decline to the fact that women who often killed out of fear for their lives now had an alternative avenue of escape thanks to the availability of women’s hot lines and domestic violence services, including shelters. (Keep in mind that women who kill their partners are generally battered women, whereas men who kill are often striking out due to a break-up or threatened break-up.)

“Exposure reduction theory” is the term coined by Wells and DeLeon-Granados in a 2004 article to explain this phenomenon of the significant decline in male homicides by their partners. This theory holds that if a woman can escape from a dangerous battering situation, she will do so, and that if she resorts to using lethal partner violence, it is most likely a protective mechanism. In any case, it is a paradox, rarely realized that the proliferation of domestic violence prevention for which women and victims’ advocates have fought so hard is saving the lives of battering men more than of battered women. Many of the female victims who obtain help from domestic violence services are eventually stalked and killed. (Source: van Wormer)

Shelters provide women a way of escaping violent relationships, and this is more likely to save their male partner’s life than to save the woman’s own life. Clearly, we still need to be doing more for women, but what exactly? Would men’s shelters help reduce homicide of female partners? Van Wormer’s article is not as clear on that. She does suggest that stresses like job loss might increase the rate at which men kill their partners:

So we can conclude that socio-economic status is clearly a correlate of the male-on-female killings. In contrast, the economic factor is less striking in the female-on-male intimate homicide rates. We should also consider the fact that the recent rise in the numbers of murder-suicides and whole family slaughters is correlated with the high unemployment rates for men. (Source: van Wormer)

So shelters clearly help, and if job loss is correlated with spousal homicides by men, shelters should continue to be funded during times of recession. It is great that shelters save men’s lives, but we still have work to do thinking about how we can reduce the rate of women who die at the hands of their intimate partners.

Link Round-Up

Dean Beeby “Spousal violence costs Canadians billions, study findsThe Toronto Star. December 24, 2012.

Katherine van Wormer “Women’s Shelters and Domestic Violence Services Save the Lives of Men,” Psychology Today. December 11, 2010.

Katherine van Wormer “Reducing the Risk of Domestic Homicide” Social Work Today. Vol. 9 No. 1 P. 18. January/February 2009.

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Here is an interesting discussion about Melissa, a Republican who had to move to Canada and changed her mind about Universal Health Care after experiencing it. She also discusses abortion policy in Canada a little bit. In a separate post Melissa describes why she used to fear Universal Health Care.

The comments on the first piece are interesting, too. Many sound like they learned something. There are a number of Canadians showing up to gloat (we love talking about how great our health care is). But this is probably the saddest comment I read there:

I am not in favor of Universal Health Care on principle. it all sounds so good, but you are giving your freedom of choice completely away. The government becomes your provider, not God. You become dependent on the government and worship it instead of God.

I don’t think Obama care is the solution. Government taking away from some to give to others is not charity is stealing. you can’t force charity on people. God doesn’t do it, why should government or anyone do it??

on the surface, UHC looks good, but it’s a web of deceit.

PS I don’t have insurance and I pay cash for all my health care. I have 4 children.

This outlook is very unfamiliar to me.  I think this (anon) commenter is wrong about giving your freedom away: we have lots of choice in Canada. But the idea that the government replaces God? That is what seems unfamiliar to me. I don’t see how a company providing insurance doesn’t replace God in the exact same way.

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I often see these commercials for the Cancer Treatment Centers of America, and I find them misleading and unethical. I can’t seem to embed the video, but it can be found at this link. Most of their commercials are all about giving the patient “hope” where there was no hope before. But each commercial also carries a disclaimer: “No case is typical. You should not expect these results.” So the CTCA are suggesting that you should have hope and that they will offer you hope when other MDs fail to do so, but that you should also no have hope that it will work for you (although here “hope” is replaced with “expect”).

You need more than a second opinion. You need a second chance.

You need more than a second opinion. You need a second chance.

1. Legal Reasons for Disclaimers in Medical Advertisements

The reason for the disclaimer results from a lawsuit in the 1990s:

Cancer Treatment Centers of America was the subject of a Federal Trade Commission (FTC) complaint in 1993. The FTC alleged that CTCA made false claims regarding the success rates of certain cancer treatments in their promotional materials. This claim was settled in March 1996, requiring CTCA to discontinue use of any unsubstantiated claims in their advertising. CTCA is also required to have proven, scientific evidence for all statements regarding the safety, success rates, endorsements, and benefits of their cancer treatments. CTCA was also required to follow various steps in order to report compliance to the FTC per the settlement.

Cancer centers and hospitals in general (including Cancer Treatment Centers of America) have been the subjects of some controversy over their advertising. Many doctors and other observers have noted that many cancer organizations’ advertising are sparsely regulated and, therefore, often contain unsupported and misleading claims as to the efficacy of their cancer treatments.

In 2001, the FDA issued CTCA a Warning Letter concerning three clinical trials that were conducted in violation of FDA requirements. (From Wikipedia)

I understand that there are legal reasons for the disclaimer. Nevertheless, I find it creates an odd message overall. It also illustrates some of the problems with advertising in medicine.

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This will be just a quick posts with some links to further reading.

Recently, the groups The National Center for Transgender Equality (NCTE) and the National Gay and Lesbian Task Force (NGLTF) released a survey “Injustice at Every Turn: A Report of the National Transgender Discrimination Survey” about discrimination based on gender identity and expression in the United States. The Report abstract states:

Transgender and gender non-conforming people face rampant discrimination in every area of life: education, employment, family life, public accommodations, housing, health, police and jails, and ID documents…

Questioning Transphobia summarizes some of the findings:

  • Respondents were four times more likely to live in extreme poverty, with incomes lower than $10,000
  • Respondents were twice as likely to be unemployed
  • One in four reported being fired for their gender identity or expression
  • Half said they experienced harassment or other mistreatment in the workplace
  • One in five said they experienced homelessness because of their gender identity or expression
  • 19% said they had been refused a home or apartment
  • 19% said they had been refused health care
  • 31% reported harassment or bullying by teachers
  • 41% reported attempting suicide, compared to 1.6% for the general population

Similar statistics about discrimination apply to Canadians.

As Jill from Feministe writes:

Much of this discrimination, it’s worth noting, is entirely legal. Trans people are routinely left of out anti-discrimination laws that protect citizens from discrimination based on age, gender, race, religion, nationality, etc.

In Canada, we have a chance to correct this problem. Bill C-389, An Act to amend the Canadian Human Rights Act and the Criminal Code (gender identity and gender expression), is up for a vote in the House of Commons. The last vote was really close, passing by only 12 votes (Yeas: 143; Nays 131).

Bill C-389 is coming up for a final vote this Wednesday, February 9th. This time opponents of the bill have organized a letter-writing campaign to petition MPs to vote against the bill.

If you want to support the bill to prohibit discrimination based on gender identity or expression, there is an online letter writing campaign organized by the Public Service Alliance of Canada. If any readers are from Canada and wish to support the bill, please consider sending a letter to your MP from the link above.

I will include links for further reading below the fold.

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I recently found the article, “Who Decides?” by Scott Lemieux via a post on Figleaf’s blog (I left a comment there and this post is a modified version of that comment).

Lemieux muses about abortion access in Canada:

In Canada, late-term abortions are not legally restricted, and Canada also doesn’t have the other kinds of restrictions found in many American states and doesn’t exclude abortion from guarantees of health care. As far as I can tell, there’s no evidence that Canadian women get late-term abortions at significantly higher rates (and historically overall abortion rates in Canada have actually been lower). Essentially, absent evidence to the contrary, I think the presumption in favor of a woman’s decision-making capacity is justified, and further restrictions are likely to do more harm than good.

I find Lemieux’s musings on what abortion and abortion access might be like in Canada to be highly misleading. Canada does not have the kind of easy access to abortion that Lemieux implies.

Lemieux is right when he says that there are no laws restricting abortion in Canada. But that does not mean there are no restrictions. Most abortions in Canada are done in hospitals (rather than clinics) and hospitals are left to make their own policy regarding abortion. Most hospitals do have policies that restrict late-term abortion access. Hospitals used to set a cut-off of 21 weeks (with exceptions made for mother’s health or foetal health), but recently with advances in prenatal testing (especially prenatal genetic testing) many hospitals have increased this limit to 24 weeks (again with health-based exceptions). In these cases hospital policy does not seem to reflect a commitment to women’s decision-making (after the early period of the pregnancy), instead the policies reflect changes in medical technologies and the dates at which reliable test results become available. Some clinics also place limits on when they will perform abortions.

Second, even though abortions are legal, no hospital or doctor is required to perform them. So Canada also has issues with access when women cannot find a doctor in their area willing to perform an abortion. In some cases this effectively means there is no access. One province (PEI) has no abortion providers at all; and a second (New Brunswick) has virtually no abortion providers. Canada is also a large country with a small population so even in the provinces that do have abortion providers, women in the northern or rural areas of those provinces might not be able to access abortions.

Third, while it is true that abortions are covered under most provincial insurance plans (so they are a part of our guaranteed health coverage, as Lemieux states), abortion is one of the few services that are excluded from reciprocal billing (PDF).  Part of the guarantees made in the Canadian Health Act is that insurance coverage is portable from province to province. This means that if I live in Ontario, I am covered by the Ontario Health Insurance Plan (OHIP), but if I go on vacation to BC and have an accident I can still use my insurance in the BC hospitals. One of the few exceptions to this promise is abortion coverage. Most provincial insurance plans will cover abortion within that province, but will not cover abortions if you travel to another province. Obviously this can cause significant access problems for women in PEI and New Brunswick who cannot find access in their own province. It also limits access to abortion for college and university aged women who go to school outside of their home province. Most students remain covered under their home province, and if they find they need an abortion while in another province they will have to pay out of pocket.

Canada might not have any laws restricting abortion access, but this does not mean that access to abortion in Canada is unrestricted.

I include some links for further reading after the fold.

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About ten years ago I was at a meeting and we were discussing what the policy on female genital cutting (FGC, female genital mutilation (FGM), or female circumcision) should be in the hospitals of the Canadian city where I was living at the time. The woman who was giving the presentation about the facts of FGC said at one point in the presentation that there was “no benefit” to FGC that could be weighted against its harms. Now, I do not support FGC in any way, but I was also quite bothered by this statement because it is one that renders the women who engage in FGC unintelligible and irrational, which makes discussing FGC with women impossible. I have been thinking about this issue again because I recently saw this video about the increasing requests for labiaplasty in Australia (The video is NSFW):

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