BCIFV home > Newsletter > Summer 2005

This Issue in Aware:

More than broken bones

Lynne Melcombe

When those who do not steep themselves daily in family-violence research or violence-prevention work think about health care in relation to family violence, they naturally think first of immediate and short-term consequences: physical injuries, emergencyroom visits, physician time. With more information, they become aware of longer-term issues, such as unplanned pregnancies, sexually transmitted diseases, mild to severe depression, and substance misuse.

But most of us would not think to place family violence among contributing or causal factors for sleep disorders, eating disorders, migraines, diabetes, heart disease, hypertension, fibromyalgia, cancer, osteoporosis, asthma, anemia, lung disease, liver disease, thyroid malfunction, arthritis, gastric ulcers, irritable bowel syndrome, inflammatory bowel disease, fetal trauma, and poor neonatal outcomes, with all the implications that accompany each one of those problems alone.

The Osteoporosis Society of Canada estimates that 1.4 million Canadians suffer from osteoporosis, at a cost to the health-care system of $1.3 billion per year. Of 25,000 hip fractures in Canada in 1993, 70 percent were osteoporosis-related. Hip fractures result in death in up to 20 percent of cases. The Arthritis Society notes that arthritis is actually a group of about 100 bone-and-joint disorders that affect young and old alike at an annual cost in Canada of roughly $4.4 billion. The Heart and Stroke Foundation of Canada does not make such a cost estimate, but does note that 80 percent of Canadians are at risk of cardiovascular disease.

In other words, we know that each of the health issues to which family violence can contribute is costly. We know that prevention of any disorder saves money and suffering. We know that for some people, it’s too late for prevention and the only remaining option is treatment. We do not know what percentage of those individuals diagnosed with any of these health issues may have experienced family violence as a contributing factor.

We do not know how much of the budgets for research and treatment of each of these diseases could be redirected with timely treatment for victims of family violence. We do not know how many health-care dollars could ultimately be saved—or how many lives salvaged—by investing in preventing family violence.

We don’t know, but some researchers have tried to find out. In a study completed in 2003, Bowlus et al concluded that, in any given year, the cost of providing immediate, intermediate, and long-term care to children and adults whose current ill health may be related to child abuse is a staggering $2,041,200,981. It is difficult to imagine another health issue with such potential for suffering, loss of life, and expense that would not be declared a pandemic and evoke immediate, proportional allocation of human and fiscal resources.

This issue of Aware is devoted to family violence and health care. Along with a series of feature articles that chronicle the connections between family violence, health, and the health-care system, we include a series of sidebars describing innovative programs throughout BC after which many more initiatives should be modeled in the near future.

It is always our agenda in Aware to provide information that piques the curiousity of all our diverse readers; suggestions as to where they can learn more, and observations about research gaps and potential. But with this issue—the last we will publish until our own funding situation changes—we hope to convey, not only interesting and useful information, but a sense of urgency.

The time has come. The research is in. The evidence abounds. Family violence is one of the most costly healthcare issues Canadians have ever faced. It is also perhaps one of the most complex issues we’ve ever tried to avoid facing— until reality left us with no alternative.

— Lynne Melcombe

REFERENCES:

A&S Perspectives (2000) “Another Factor for Smoking: Early Abuse,” in A&S Perspectives, Joseph, N (Ed), University of Washington College of Arts and Sciences Arthritis Society, www.arthritis.ca

Bowlus, A, McKenna, K, Day, T, and Wright, D (2003) The Economic Costs and Consequences of Child Abuse in Canada, Law Commission of Canada.

Coker, AL, et al (2000) “Physical health consequences of physical and psychological intimate partner violence,” in Archives of Family Medicine, 9: 451-7.

Cromie, WJ (2003) “Childhood abuse hurts the brain,” in Harvard University Gazette, www.news.harvard.edu/ gazette/2003/05.22/01-brain.html.

Franko, DL, et al (2001) “Pregnancy complications and neonatal outcomes in women with eating disorders,” in American Journal of Psychiatry, 158: 1461-6.

Heart and Stroke Foundation of Canada, www.heartandstroke.ca Perspectives, 2000)

Murphy, CC, Schei, B, Myhr, TL, DuMont, J (2001) “Abuse: A risk factor for low birth weight? A systematic review and metaanalysis,” in Canadian Medical Association Journal, 164(11).

National Clearinghouse on Family Violence (2003) Health Effects of Family Violence, Ottawa ON: Health Canada.

Osteoporosis Society of Canada, www. osteoporosis.ca

Zipfel, S, et al (2001) “Osteoporosis in eating disorders: a follow-up study of patients with anorexia and bulimia nervosa,” in Endocrine Care, 86(11): 5227-33.