The behaviors and health status of a countries individuals are largely based around not only policy and structure but also the social determinants of health (Wilkenson & Marmot, 2003). Political outputs that influence societal outcomes and in turn health status, include laws, taxes, public services, etc. In some cases, making drastic changes too quickly can have large negative implications, such as war or genocide (Mackenbach, 2014). In China, only in the last three years were laws implemented to make domestic violence/intimate partner violence in marital relationships a public affair and an illegal event. Still, laws banning domestic violence in non-marital or same sex couples cease to exist (Leggett, 2017). In this case, it seems policy could be stronger without causing any massive uproar, but other factors are involved in the domestic violence issues in China. The main risk factors of intimate partner violence are sexual jealousy, patriarchal beliefs, lower female support towards household income, stress, low socioeconomic status, women’s disempowerment, substance abuse and rural residency (Parish, Wang, Laumann, Pan, & Luo, 2004). As discussed in previous posts, not wanting to ask for social support is also a large issue. Based off this, the social determinants of health relating most to domestic violence cases against women in China are: social gradient, social exclusion and discrimination, social support, unemployment or work, addiction and stress (Parish et al., 2004). In China, nearly 90% of domestic abuse cases stem from men abusing women (Lancet, 2016). To me, this statistic makes it simple that the overarching most important social determinant contributing to domestic violence against women in China is social gradient. Social gradient allows us to see that diseases and health issues are more common the further down the social latter you go (Wilkenson & Marmot, 2003). In China, men have been seen as superior to women for most of history, so this allows us to understand why women would be considered lower on the social gradient latter than men, and why the health issue of domestic violence is much worse for women than men. Not only can social gradient explain the discrepancies between men and women, but it also explains why the prevalence of domestic violence in rural China is more prevalent than in urban areas (Legget, 2017). Studies show that those lower on the social gradient latter, eg. those that are illiterate or living in poverty, are also more likely to view intimate partner violence as justified and accepted (Jesmin, 2017).
Social gradient and health status can also interlink with other determinants and risk factors such as stress, self-esteem, social support and social environment (Kosteniuk & Dickinson, 2003). For example, in Chinese society where men are seen as superior, female victims fall into a ‘spiral of silence,’ meaning that because they are in a minority (female domestic violence victims are not the majority of the country), they need to avoid drawing attention to themselves or upsetting the peace, and they suffer in silence and do not tell anyone they are abused (Laggett, 2017). Not only is this a direct effect of social gradient, but it makes it so there is little to no social support for victims. In order to lower domestic violence in China, similar to the case of abolishing Chinese footbinding, cultural perception surrounding the male to female hierarchy must also change. If there were no social gradient between men and women and they were seen as equals, one would be much less likely to beat the other. Up until 2015, domestic violence was seen as a private affair that did not require legal intervention (Leggett, 2017). Similarly, cultural perception surrounding the acceptance of domestic violence as a normal part of life must also end. People must end the silence and speak up about their experiences, so others do not feel alone in doing the same. Only then will everyone start to realize this is not a normal part of being with a partner, and things can change.
Jesmin, S. S. (2017). Social determinants of married women’s attitudinal acceptance of intimate partner violence. Journal of Interpersonal Violence, 32(21), 3226. doi:10.1177/0886260515597436
Kosteniuk, J. G., & Dickinson, H. D. (2003). Tracing the social gradient in the health of canadians: Primary and secondary determinants. Social Science & Medicine, 57(2), 263-276. doi:10.1016/S0277-9536(02)00345-3
Lancet, T. (2016). Domestic violence in china. Lancet, the, 387(10023), 1028-1028. doi:10.1016/S0140-6736(16)00689-9
Leggett, A. (2017). Online civic engagement and the anti-domestic violence movement in china: Shifting norms and influencing law. VOLUNTAS: International Journal of Voluntary and Nonprofit Organizations, 28(5), 2251-2277. doi:10.1007/s11266-016-9680-9
Mackenbach, J. P. (2014). Political determinants of health. European Journal of Public Health, 24(1), 2-2. doi:10.1093/eurpub/ckt183
Wilkenson, R. & Marmot, M. (2003). Social determinants of health: The solid facts. World Health Oraganization Europe.Retrieved from http://anthropology.msu.edu/anp270-us18/files/2015/05/Soc-Determs-of-Hlth-the-solid-facts-WHO-2003.pdf