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Health experiences of women who are street-involved and use crack cocaine : inequity, oppression, and relations of power in Vancouver's Downtown Eastside Bungay, Victoria Ann

Abstract

Women who live in Vancouver’s Downtown Eastside experience some of the most devastating health problems among residents of British Columbia. While crack cocaine use has been associated with many of these problems, we lack an understanding of how women who use crack cocaine experience these health problems and what they do to manage them. Informed by tenets of intersectionality and social geography, a critical ethnographic approach was used to examine the scope of health concerns experienced by women who are street-involved and use crack cocaine, the strategies they used to manage their health, and the social, economic, political, personal, and historical contexts that influenced these experiences. Data were collected over a seventeen month period and included a cross sectional survey (n=126), participant observations, and interviews (n=53). The women described experiencing poor physical and mental health throughout their lives; many of which were preventable. Respiratory problems, anxiety, sadness and insomnia were the most frequent concerns reported. They endured severe economic deprivation, unstable and unsanitary housing, and relentless violence and public scrutiny across a variety of contexts including their homes and on the street. These experiences were further influenced by structural and interpersonal relations of power operating within the health care, legal, and welfare systems. The women engaged in a several strategies to mitigate the harmful effects of factors that influenced their health including: (a) managing limited financial resources; (b) negotiating the health care system; (c) managing substance use; and (d) managing on your own. These strategies were influenced by the types of concerns experienced, perceptions of their most pressing concern, the nature of interpersonal relations with health care providers, and the limited social and economic resources available. Changes in the organizational policies and practices of the welfare, legal, and health care systems are needed to improve women’s health. Possible strategies include increased access to welfare and safe, affordable housing, safer alternatives to income, and improved collaboration between illness prevention and law enforcement programming. New approaches are required that build on women’s considerable strengths and are sensitive to ways in which gender, race, and class can disrupt opportunities to access services.

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Attribution-NonCommercial-NoDerivatives 4.0 International

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