By: Emily Fanjoy, Tillamook County Women's Resource Center

Healthy relationships promote overall health and well-being. Unsurprisingly, unhealthy and abusive relationships contribute to poor health. Though many healthcare providers and much of the general public assume that abusive relationships are defined by the presence of physical violence, research shows what advocates and survivors already know-- that emotional and psychological abuse are often used long before any physical violence occurs. Advocacy and healthcare partnerships that address intimate partner violence are building capacity and transforming how both systems serve survivors, which in turn supports improved health outcomes for all Oregonians.

Psychological abuse is as important a predictor of health outcomes as physical violence.

Did you know that the use of psychological abuse on an individual is as important a predictor of health outcomes as physical violence (Coker, et al 2000)? Over time, survivors exposed to non-physical control tactics experience chronic, toxic stress.

This means a person can experience negative health consequences because of an unhealthy relationship without ever being physically harmed by their partner. Unhealthy, abusive relationships affect a person's immediate and long-term health--reproductive, physical, mental and behavioral health are all potentially impacted in abusive and controlling relationships.

The negative effects of controlling and abusive behavior inflicted upon an intimate partner extends to children living in the home. The Adverse Childhood Experience Study (ACEs) demonstrated that experiencing trauma can and does result in physiological disease via chronic, toxic stress. It makes the connection between growing up with violence in the home and experiencing long-term chronic health conditions, as well as behavioral and mental health conditions later in life. Our bodies are wired to respond to real or perceived threats by releasing the hormone cortisol to fuel the "fight, flight, or freeze" response in dangerous situations. This is often helpful for self-protection in the short term. However, if the body is constantly producing stress hormones, their effect is usually damaging over time. Cortisol directly affects blood sugar levels and heart rate, and chronic overexposure to this stress hormone has been linked to the development of gastrointestinal conditions, heart disease, diabetes, and other illnesses. As with Adverse Childhood Experiences, the experience of abuse can negatively impact a survivor’s health even after an unhealthy relationship has ended.

Successfully managing mental or physical health conditions while in an unhealthy relationship can be challenging, if not impossible. Both medical interventions and advocacy services for survivors are critical to supporting survivors' healing and resilience. Recent collaborations between advocacy and health systems in Oregon, such as Project Connect and the Safer Futures Project, demonstrate that advocates can support survivors in addressing their health needs, and in so doing support health systems in achieving common goals.

Health care providers know that what happens outside of their office has far greater effect on a patient’s overall health than by what they might observe during an office visit. These influencing factors are called social determinants of health. Economic stability, housing and food security, social and community context, education, and a person's health and access to health care are all important social determinants of health. Intimate partner violence is both a health indicator and a social determinant of health; it often has unique, negative effects on key determinants such as economic stability, housing, education, employment and more.

Intimate partner violence is both a health indicator and a social determinant of health; it often has unique, negative effects on key determinants such as economic stability, housing, education, employment and more.

While most healthcare systems and providers recognize the importance of social determinants of health, they cannot address every patient’s social determinants of health needs. In Oregon, Coordinated Care Organization (CCO) models were developed with a particular focus on social determinants of health and partnerships between social services and health care. To this end, the recently-updated CCO 2.0 plan emphasizes the focus on developing more partnerships between health care systems and community-based service providers. Domestic violence advocates are ideally positioned to collaborate with healthcare systems and providers by delivering supportive services that address the intersections of intimate partner violence and the social determinants of survivors' health. A person's relationships, past and present, are common contributing factors to acute and chronic health conditions. As healthcare systems develop strategies to successfully manage them, healthcare-advocacy partnerships are a promising approach to supporting survivors and health systems alike.

Domestic violence advocates are ideally positioned to collaborate with healthcare systems and providers by delivering supportive services that address the intersections of intimate partner violence and the social determinants of survivors' health.

Both Project Connect (2012-2015) and the Safer Futures Project (2013-2017) developed healthcare and advocacy partnerships with a focus on addressing the intersections of intimate partner violence and reproductive health for women to address the Affordable Care Act mandate that all women receive screening and brief counseling for intimate partner violence as part of their health visits. The culmination of the Safer Futures Project was the Coalition’s publication of the Oregon Guide to Health Care Partnerships. This document outlines the innovations and limitations of past health care projects and the passing of HB 2304 that established a committee to determine how to include survivor advocacy under the Traditional Health Worker designation as a potential pathway for advocates to receive reimbursement for their services.

Be on the lookout for a series of upcoming webinars on advocacy-healthcare partnerships, starting with a review of the Oregon Guide to Health Care Partnerships on February 12th. Additional webinars in the coming months will cover specific approaches to addressing intersections of intimate partner violence and health, including:

  • substance use and chronic pain;
  • mental health and IPV;
  • reproductive health including HIV and IPV; and
  • LGBTQ health and IPV.

To receive the latest updates, subscribe to the Coalition's mailing list (on the sign-up form, be sure to mark the checkbox for Healthcare Advocacy Partnerships).

  1. Centers for Disease Control and Prevention2016. About the CDC-Kaiser ACE Study. Retrieved 25 January 2019. 
  2. Centers for Disease Control and Prevention2018. Social Determinants of Health: Know What Affects Health. Retrieved 25 January 2019. 
  3. Coker, Ann L, PhD; Paige H. Smith, PhD, MSPH; Lesa Bethea, MD; Melissa R. King, MSPH; Robert E. McKeown, PhD. 2000. Physical Health Consequences of Physical and Psychological Intimate Partner Violence. Archives of Family Medicine 9:451-457.
  4. Massachusetts Medical Society. 2015. Affordable Care Act Provisions Concerning Intimate Partner Violence. Retrieved 25 January 2019. 
  5. Oregon Coalition Against Domestic and Sexual Violence. 2018. Oregon Guide to Health Care Partnerships. Retrieved 25 January 2019. 
  6. Oregon Health Authority. 2018. CCO 2.0: The Future of Coordinated Care. Retrieved 25 January 2019. 
  7. US Department of Health and Human Services. 2014. The Affordable Care Act: an FAQ Guide for Domestic Violence Advocates and Survivors. Retrieved 25 January 2019. 

About the author

Emily Fanjoy
Emily Fanjoy is the Health Programs Coordinator at the Tillamook County Women's Resource Center in Tillamook, OR where she coordinates the community based advocate and healthcare partnerships. She facilitates provider and advocate training to address IPV and health intersections in Tillamook Co. and statewide. She was a contributor to the recently released Oregon Guide to Health Care Partnerships and has spoken at several state and national conferences on the experiences and evaluation results of the Tillamook County Safer Futures Project, a project that funded community based advocates in health care settings to reach pregnant and newly parenting women who were victims of IPV from 2013-2017. Her previous work includes D/SV survivor advocacy as well as case management and interpreting in a community health clinic. Emily is a Returned Peace Corps Volunteer, Healthy Homes, Guatemala 2008-2010. She lives in a solar powered cabin and keeps bees with her partner at their homestead.
Blog Category: News