This paper reports on the Australian component of a five nation study undertaken in Australia, Canada, Thailand, Bangladesh and Afghanistan examining policy networks that address women's health and domestic violence. It examines the relationship between health and domestic violence in Western Australia and analyses the secondary role assumed by health. The study adopted a qualitative research paradigm and semi-structured interviews. Snowball sampling was used to identify relevant and significant stakeholders and resulted in a final sample of 30 individuals representing three key areas: the ‘health policy community’, the ‘domestic violence prevention community’ and ‘other interested stakeholders’, that is, those who have an interest in, but who are not involved in, domestic violence prevention work. Results suggest that the secondary positioning of health is associated with the historical ‘championing’ of the issue in the women's movement; limited linkages between the health policy community and the domestic violence prevention community and within the health policy community itself; the ‘fit’ between domestic violence and the Western Australian Health Department mandate; and the mis-match between domestic violence and the medical model. The conclusion indicates a need for collaboration based on effective links across the domestic violence community and the health policy community.
This article reports on the findings of the Australian component of an international study of health and domestic violence in five countries (Australia, Canada, Bangladesh, Thailand and Afghanistan). It explores possible explanations for the secondary role taken by health services in Western Australia. It adds to analyses of the health implications for women experiencing domestic violence (Campbell, 2002; Hegarty, Gunn, Chondros, & Small, 2004; Mouzos, 1999; Parker & Lee, 2002; Quinlivan & Evans, 2001; Resnick, Acierno, & Kilpatrick, 1997; Roberts, Lawrence, O’Toole, & Raphael, 1997; Roberts, Williams, Lawrence, & Raphael, 1998; Taft, 2002; WHO, 2002). Further, the study has implications for the organisation and cost of women's health care. For example, the annual cost to the Australian economy of domestic violence has been estimated to be in excess of AUD8 billion dollars (Access Economics, 2004) of which approximately AUD388 million is attributable to health costs. Despite this, the role of the health sector in the process of the prevention and care for victims of domestic violence has been secondary to that of the legal system in Australia.
Given the poor health outcomes for women who have been victims of domestic violence and the Health Department's fitful commitment to addressing the issue in policy documents, it is evident from findings of this study that two issues need to be addressed. Firstly, there needs to be a commitment that extends beyond rhetoric to address domestic violence in terms of its health dimensions (Thurston & Eisener, forthcoming). Secondly, to be effective, the health sector must collaborate with the network of services and responses from other sectors through the forging and fostering of effective links (Howlett & Ramesh, 1995; Pal, 2001) between the domestic violence community and the health policy community in Western Australia as well as internally. The creation of a special health department unit could be a first step facilitating communication, as people from other departments and from grass roots organisations have an identifiable ally with whom to work. Both the grassroots and professional sectors have their own assumptions and language through which knowledge is imparted (Kleinman, 1980). Messages from different sectors often clash, complicating decision-making and action (Bacchi, 1999; Frankish, Kwan, Ratner, Wharf Higgins, & Larsen, 2002; Scott et al., 2002). It is a challenge for all, however, to ‘tame the beast’ and strategies for improving the health sector response must be concerned with effective collaboration and partnership to obtain what has been called the collaborative advantage (Huxham & Vangen, 2005). Conflicts may be inevitable as different policy networks come together (Bacchi, 1999); however, conflict can be productive (Scott et al., 2002) if managed with a common goal to put an end to the abuse of women in their homes.
