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ProQuest Information and Learning 300 North Zeeb Road, Ann Arbor, MI 48106-1346 USA 800-521-0600 NOTE TO USERS This reproduction is the best copy available. PUITING HEALTH IN ITS PLACE: WOMEN'S PERCEPTIONS AND EXPERIENCES OF HEALTH IN HAMLTON'S NORTH END By TRACY FARMER, B.Sc., B.A., M.Sc. A Thesis Submitted to the School of Graduate Studies in Partial Fulfillment of the Requirements for the Degree Doctor of Philosophy McMaster University © Copyright by Tracy Farmer, July 2004 PUTTING HEALTH IN ITS PLACE DOCTOR OF PHILOSOPHY (2004) McMaster University (Anthropology) Hamilton, Ontario TITLE: Putting Health in its Place: Women's Perceptions and Experiences of Health in Hamilton's North End. AUTHOR: Tracy Farmer, B.Sc. (McMaster University), B.A. (McMaster University), M.Sc. (University of Toronto) SUPERVISOR: Dr. Ann Herring NUMBER OF PAGES: xi, 297 11 ABSTRACT This study explores the self perceived health status and health priorities of a diverse group of women living in the highly industrialized and stigmatized North End neighbourhood of Hamilton, Ontario. Through the use of qualitative methods such as in­ depth interviewing, focus group discussion, and participant observation, this medical anthropology research locates the health of the study participants (n = 46) within their neighbourhood, explores their experiences in this environment, and examines their understanding of the relationships between those experiences and their health. Guided by biocultural and critical interpretive perspectives, the study focuses on the personal knowledge and interpretations that women themselves assign to health concerns in their communities. The North End women in this study understand health as a multidimensional concept and articulate the ways in which their overall health and well being is enhanced and/or compromised by a variety of place-based characteristics. Despite the fact that they reside in the same neighbourhood, they offer diverse opinions about the effects that neighbourhood attributes have on their health. These differences reflect the variability in participants' health status and needs, socio-demographic circumstances, feelings of personal agency, satisfaction levels, time spent in the neighbourhood on a daily basis, and expectations of their neighbourhood. Because health experiences are embedded in everyday life, I assert that women's own perspectives, experiences and priorities must be incorporated into place-based health research and integrated into program and policy development. Women provide an invaluable and rich form of experiential knowledge about their health and their environment that differs from the "objective facts" put forth by outside individuals with no vested interest in the neighbourhood. Place is an important determinant of health that warrants serious attention by medical anthropologists who thus far have tended to view it merely as a backdrop for their research. iii ACKNOWLEDGEMENTS I first wish to express my gratitude to the women of the North End for their desire to participate in this research project and for their willingness to share their personal information and their knowledge of the North End. I hope that I have sufficiently represented the diversity of their experiences and perceptions in this thesis. I wish to extend my heartfelt appreciation to my supervisor, Dr. Ann Herring, without whom I do not think this dissertation would nave ever seen the light of day. Ann's sincere interest in my research topic, her insightful comments and her unwavering belief in my abilities kept me motivated throughout the thesis process. Her continued friendship, support, and humour over the years have been greatly cherished. Ann, I don't know what I would have done without you! I also want to thank my two other committee members, Drs. Tina Moffat and Wayne Warry, for their helpful suggestions throughout the writing and editing stages of this dissertation. Tina was particularly giving of both her time and her advice, always willing to sit down with me and chat about different aspects of my thesis. Wayne provided me with a number of challenging but extremely helpful comments that pushed my dissertation to the next level. Thank you both! I'd also like to say a special thanks to· Janis Weir for all her help in answering my many questions during my time in the Anthropology Department. On a more personal note, I'd like to thank my friend and fellow colleague, Kristen Jacklin, for always being at the other end of the phone line in good times and bad. Her willingness to listen and offer constructive suggestions while I worked through the writing process was invaluable. I wish to express my gratitude to my parents, Ian and Maureen Farmer, for their love and support throughout my academic career and for their obvious pride in my scholarly pursuits. In particular, I want to thank my mother for her stylistic input and for never hanging up when I called and asked "Does this sound okay?". I'd also like to thank my father for motivating me to finish the thesis by constantly asking if I'd "finished that damn thing yet?". Finally, I want to thank my husband, Greg Mayne, for standing by me throughout the whole thesis process. Not only did he selflessly give up his Sunday mornings to help me put up hundreds of interview advertisements but he has been one of my biggest supporters, acting as a sounding board and providing me with a different point of view from which to understand the information. iv TABLE OF CONTENTS Chapter 1: Introduction................................................................................................. 1 Outline and objectives of the study .................................................................... .7 Chapter 2: Women, Health and Place ..................................................................... )2 Why women's health? ....................................................................................... 12 The health of Canadian women......................................................................... 16 Prioritizing women's health needs .................................................................... 21 Life expectancy...................................................................................... 21 Mortality rates ........................................................................................ 22 Morbidity data ........................................................................................ 23 Special interest group opinions............................................................. 24 Lay women's perspectives..................................................................... 24 The place of women in anthropology ................................................................26 The place of women in medical anthropology................................................. .28 The meaning of place......................................................................................... 29 No space for place in anthropology.................................................................. ,30 Health and place.................................................................................................. 33 Summary............................................................................................................. 38 Chapter 3: The Research Process and the Study Group....................................... .40 Anthropology at home........................................................................................ 40 The research site ................................................................................................. 43 Community Health Centre #1 ............................................................... 44 Community Health Centre #2 ............................................................... 46 Continuing evolution of the project .................................................................. 48 Research methods............................................................................................... 49 ·rriangulation.......................................................................................... 50 Interview recruitment ........................................................................... 50 The interviews........................................................................................ 54 The questionnaire................................................................................... 55 The focus group ..................................................................................... 57 Participant observation .........................................................................