Wednesday, September 16, 2009

Violence Survivors Neglected in Health Care Debates

An important group of people who are often not mentioned in the health care debates (how health care should be delivered, who should receive it, and how it should be paid for) are violence survivors. As the controversy over health care increases, I worry about the lack of attention to survivors because research shows that women who have survived partner violence (also known as domestic violence) and sexual assault are far more likely to experience serious health problems than women who have not experienced violence.

(Note that the research shows that men who suffer violent victimization suffer fewer physical injuries than women. However, the research on the health effects of violence for men is limited. More research on this important topic is needed.)

For overviews of the research on the connections between health and violence, please see research by me and my colleagues, research by Dr. Jacquelyn Campbell, and this summary from the Centers of Disease Control and Prevention.

What are the health problems that survivors experience? Not surprisingly, partner and sexual violence often result in serious injuries, including broken bones, head trauma, and spinal cord injuries. Rape survivors are likely to have genital injuries. Even after such assault-related injuries have healed, survivors are likely to experience chronic pain disorders (migraines, pelvic pain, arthritis) and gastrointestinal disorders (stomach ulcers, spastic colon). Survivors also are likely to have reproductive health problems. And some research shows that survivors are at increased risk of hearing loss and heart disease. Survivors are also likely to have mental health problems, including depression, anxiety, posttraumatic stress disorder (PTSD), substance abuse, and suicidal ideations (thoughts about wanting to die or that life is not worth living).

With the many serious health problems survivors may experience, I'm concerned that so little attention is given to how survivors access health care and what types of health care are most helpful for survivors. For a research overview of the challenges that survivors face when they try to access health care see Dr. Stacey Plichta's excellent article. Plichta determined that partner violence survivors seek health care as much as other people, but survivors are less likely to receive the services that they need and more likely to have a poor relationship with their health care providers.

My worry about the neglect of survivors in the health care debate has been increased by a recent blog post reporting that domestic violence is a 'pre-existing condition' for insurers in some states (including my own state of North Carolina). Likewise, my colleague Dr. Sandy Martin and I have preliminary findings from a project to assess the needs of survivors who access domestic violence and sexual assault services. Our initial findings show that physical and/or mental health problems are a serious concern for nearly all the survivors. Further, these preliminary findings show that the majority of the survivors in this sample do not have health insurance.

Taken together, research shows that violence survivors are in need of health care but may not be able to access the services that they need because they lack the means and ways to pay for their health care. Personally, I find it outrageous that a person who experienced brutal violence may not be able to access needed health care. Beyond moral outrage, it seems to me that by not helping survivors with their health and safety, our society is likely incurring serious costs in the form of chronic health disabilities and lost productivity.

The Centers for Disease Control and Prevention report the costs associated with partner violence exceed 5.8 billion a year. I wonder how that number might be lowered if we were to ensure that every violence survivor received needed safety and health care services.


Karen Zgoda said...

It is inconceivable that some health care insurers would consider domestic violence a pre-existing condition. I've tweeted your post to all those in my network to help get the word out. Thank you for your informative post and for reinvigorating my support for health care reform!

gabriela said...

Hi, Rebecca, i'm social worker in the capital of Brazil, Brasília. I'm working with people in violece domestic an avance that you consider man suffer too. With the low "Maria da Penha" in Brazil the State have take some programs with this vision. We have a service that atend the family in a sistemic approach with the "victim" and the "agressor". Health, rights and justice pass to the integral attention!

Rebecca J. Macy said...

Karen & Gabriela, Thanks for your comments AND for reading my blog.