Social Policy in Ontario

The Centre for Research on Inner City Health, housed in St. Michael’s Hospital, picks up where the illness treatment system leaves off.

It examines the links between health and all the other factors that shape a person’s life: family, education, employment, socio-economic status, race, gender, housing and neighbourhood. It assembles teams of doctors, psychiatrists, epidemiologists, sociologists, urbanologists and service providers to look at a problem from every perspective. Its mission is to make urban life safer, more equitable and healthier.

Unlike other research organizations, it always starts by talking to the people experiencing a problem, not reviewing the literature, poring over the statistics or finding out what other analysts think. Unlike academic institutions, it never ends a project with “this problem needs more study.” It keeps digging until it gets answers.

One of its principal areas of research is domestic violence. The think-tank has spent seven years probing the tangle of factors that leads to intimate partner abuse.

It has just launched new phase of its work investigating what makes a neighbourhood safe — or unsafe — for women and what kind of support they need. “People think what is missing is physical support,” says lead researcher, social epidemiologist Patricia O’Campo. “But women are telling us that the psychological abuse and controlling behaviour are often worse than the beatings.”

In health care, a misdiagnosis leads to flawed — or partial — response. That is what O’Campo sees here. Toronto Community Housing does a relatively good job of putting a roof over the head of a woman fleeing abuse. But she is left to deal with mental damage, the shattered sense of self-worth and the sudden loss of income.

That is one of her findings from 41 in-depth interviews she conducted with women who had been trapped in abusive relationships for at least five years. She also learned:

• Many women wait too long to leave because they don’t know what services are available or how to get them.

• Women who live in strong, stable neighbourhoods are safer than those in weak, transient communities. The popular belief that it is a random form of violence, crossing socio-economic boundaries, doesn’t match the reality.

• Agencies serving victims of domestic violence often fail to work together, leaving women to run from place to place to rebuild their lives.

Over the next month, O’Campo will disseminate her findings to people working in the housing, health-care, justice and social service fields. She will then head to Hamilton, Ottawa, Sudbury and Thunder Bay to discuss ways to improve collaboration, close the gaps and knit better safety nets for vulnerable women.

One of the advantages of working on multi-year projects is that researchers can draw on earlier findings.

O’Campo knows, for instance, that aboriginal women are four times more likely to experience domestic violence than their non-aboriginal counterparts. A team of her colleagues who investigated this problem found that ethnic and cultural factors — long believed to be the primary cause — accounted for only half the discrepancy. The rest was explained by poverty, poor education and deleterious forms of self-medication (alcohol and drugs).

She can also spread the word that the long-standing assumption that men don’t hit, choke, kick or punch pregnant women is wrong. The Centre for Research on Inner City Health asked a statistically representative sample of new mothers across the country about their experiences. Eleven per cent reported sexual abuse during pregnancy or after childbirth. Among low-income women, the proportion shot up to 28 per cent; single mothers, 35 per cent.

Piece by piece, CRICH is building a complete picture of one of society’s most pervasive — and little-understood — forms of trauma. This allows researchers to make more informed policy recommendations. It helps turn an intractable problem into a knot that can be untangled.

Research has its limits, however. “We’re trying to piece together a co-ordinated system against an unstable backdrop,” O’Campo acknowledges. “Budgets are cut, services are taken away, there just aren’t enough resources.”

But scientists don’t throw up their hands in lean times. They keep producing evidence, making the case that society pays a higher price for neglecting symptoms than fixing pathologies and trying to convince policy-makers health doesn’t end at the hospital door.

< http://www.thestar.com/opinion/commentary/2014/03/06/toronto_research_centre_takes_a_deeper_look_at_domestic_violence_goar.html >