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Using intersectionality to inform health services for Aboriginal women experiencing marginalization Varcoe, Colleen 2009

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Alycia Fridkin, Annette Browne, Colleen Varcoe NEXUS Spring Institute 2009 April 17th, 2009 This research is funded by the Canadian Institutes of Health Research Presentation Objectives € To describe challenges in health services for women experiencing intersecting marginalizations € To describe intersectionality € To show how an intersectional analysis can be applied to health services for women experiencing marginalization An overview of the research € Lessons from two Urban Aboriginal Health Clinics € Community-based and participatory € Mixed methods informed by critical perspectives € Research objectives include to develop primary health indicators € Findings inform health services and policy Contextualizing Health Services Service users € face issues related to housing, income, poverty, disability, sex work, food security, barriers to accessing health services € have complex health needs including addictions, mental health problems, chronic pain and illness, HIV/AIDs and Hep C, trauma, violence, abuse Intersectionality Ableisml i Colonialisml i li Classisml i Heterosexism and   Homophobia  i      i Racismi SexismiAddictionsddictions HIV/AIDSI / I S Chronic PainChronic Pain Mental           Health   Problems  ental           ealth   Proble s PovertyPovertyViolenceiolence Service  User Applying an intersectional analysis to health services € Health services are provided in the context of patient’s lives € An intersectional lens can inform the ways in which knowledge about health services is constructed and exchanged An intersectional analysis challenges what is constructed as “the problem” I was put on Tylenol #3s when I was 12…. I have pain every single day…. So, I’ve been in and out of the hospital lots, you know, being addicted to morphine and pills and everything (Woman, age 31). An intersectional analysis highlights the inter-relatedness of poverty, addictions, trauma, violence and chronic pain € Addictions are foregrounded as the problem and the underlying factors are ignored € Strategies to address underlying factors that impact health are needed An intersectional analysis informs the development of ways of responding to women’s intersecting needs I got the subsidy from them [the nurse and social worker at the Health Centre] for housing and I got the kids back now… That really made me look in the mirror at myself …I knew that I wanted to go to rehab. I’ve been thinking about it for a whole year since I got the subsidy… [The subsidy] is like winning a lottery to me. [Other people] don’t realize the vacancy rate, the homelessness, living in the inner city hotels, the infestations of bugs. [With] the subsidy, I thought, I’ve really got to smarten up, pull up my socks and start really watching the company I keep and start getting my life on track. And it’s getting there. [First Nations woman, HIV positive, and “clean” for 3 months] Implications for health services research € Informing effective delivery of health services € “Giving back” to the community at the policy, organizational and individual level An intersectional analysis… € informs new ways of thinking about health services, € sets the stage for the development of strategies that respond to the broader determinants of health that impact women’s lives


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