Abstract
Despite the increasing public profile of same-sex issues, health policies are often shaped by heteronormative assumptions. The health concerns of lesbian, gay, bisexual, transsexual/transgender, two-spirit, intersex, queer and questioning (LGBTTTIQQ) people are complex and require broadening from an often exclusively sexual health and risk focus to a more holistic approach. In this context, this paper illustrates how a critical feminist geography of health, with its focus on the mutual construction of gender relations, space and place, potentially enhances and extends current understandings of public health policy and practice. Moreover, the use of a policy lens foregrounding gender and other power relations suggests that feminist research and coalitions facilitate participatory processes that address “the politics of discourse.” In particular, public health nursing practice can enhance the construction of spaces of resistance that challenge heteronormative discourse through research strategies focused on sexual minority communities’ health experiences and their visions for supportive care. In this respect, two strategies consistent with public health priorities to increase knowledge and participate in alliances are described. Ethnographic research with childbearing lesbians demonstrates that attention to institutional dynamics that foster safe spaces can facilitate access to public health services. Public health nurses’ involvement in community coalitions can enhance dissemination of community knowledges. The implications for gender inclusive and place-sensitive public health nursing practice include the development of sensitive educators, meaningful educational curriculum and related program planning, explicit policies, community partnerships and political leadership in institutional and research venues.
Similar content being viewed by others
References
Adler, S., & Brenner, J. (1992). Gender and space: Lesbians and gay men in the city. International Journal of Urban and Regional Research, 16, 24–34.
Allen, J. (2003). Lost geographies of power. Oxford: Blackwell Publishing.
Allison, M., & Harpam, T. (2002). Editorial: South African perspectives on the geography of health. Health and Place, 8(4), 223–226.
Andrews, G. J. (2003). Locating a geography of nursing: Space, place and the progress of geographical thought. Nursing Philosophy, 4(3), 231–248.
Andrews, G. J. (2006). Geographies of health in nursing. Health and Place, 12(1), 110–118.
Andrews, G. J., & Moon G. (2005a). Space, place and the evidence base: Part one – an introduction to health geography. Worldviews on Evidence-Based Nursing, 2(2), 55–63.
Andrews, G. J., & Moon G. (2005b). Space, place and the evidence base: Part two – rereading nursing environments through geographical research. Worldviews on Evidence-Based Nursing, 2(3), 142–156.
Andrews, G. J., Wiles, J., & Miller, K. L. (2004). The geography of complementary medicine: Perspectives and prospects. Complementary Therapies in Nursing & Midwifery, 10, 175–185.
Andrews, G. J., Sudwell, M., & Sparks, A. (2005). Towards a geography of fitness: An ethnographic case study of the gym in bodybuilding culture. Social Science and Medicine, 60, 877–891.
Barrett, F. A. (2000a). Disease and geography: The history of an idea. Toronto: Becker Associates.
Barrett, F. A. (2000b). Finke’s 1792 map of human diseases: The first world disease map? Social Science and Medicine, 50, 915–921.
Bensimon, E. M., & Marshall C. (1997). Policy analysis for postsecondary education: Feminist and critical perspectives. In C. Marshall (Ed.), Feminist critical policy analysis: A perspective from primary and secondary schooling (pp. 1–21). Philadelphia: Falmer Press.
Blunt, A., & Rose, G. (1994). Introduction: Women’s colonial and postcolonial geographies. In A. Blunt & G. Rose (Eds.), Writing women and space: Colonial and postcolonial geographies (pp. 1–15). New York: Guilford Press.
Bowlby, S., Lewis J., McDowell L., & Foord, J. (1989). The geography of gender. In R. Peet, & N. Thrift (Eds.), New models in geography: The political-economy perspective (pp.157–175). London: Unwin Hyman.
Brodie, J., 1996. Canadian women, changing state forms, and public policy. In Women and Canadian Public Policy (pp. 1–28) Toronto: Harcourt Brace.
Brody, H., Rip, M. R., Vinten-Johansen, P., Pareth, N., & Rachman, S. (2000). Map-making and myth-making in Broad Street: The London cholera epidemic 1854. The Lancet, 356, 64–68.
Butler, R., & Parr, H. (1999). Mind and body spaces: Geographies of illness, impairment and disability. London: Routledge.
Canadian Nursing Association (2000). Nursing is a political act—The bigger picture. Nursing NOW: Issues and Trends in Canadian Nursing, 8, 1–4.
Canadian Public Health Association (CPHA). (1996). Action statement for health promotion in Canada. Ottawa: Author.
Chacko, E. (2001). Women’s use of contraception in rural India: A village level study. Health and Place, 7, 197–208.
Chouinard, V. (1999). Life at the margins: Disabled women’s explorations of ableist spaces. In R. Butler., & H. Parr (Eds.), Mind and body spaces: Geographies of illness, impairment and disability. London: Routledge.
Coalition for Gays and Lesbians in Ontario (CLGRO). (1997). Systems failure: A report on the experiences of sexual minorities in Ontario’s health care and social-services systems. Ottawa: Health Canada.
Davidson, J. (2001). Fear and trembling in the mall: Women, agoraphobia and body boundaries. In I. Dyck, N. D. Lewis, & S. McIafferty (Eds.), Geographies of women’s health (pp. 213–230). London: Routledge.
Dorn, M., & Laws, G. (1994). Social theory, body politics and medical geography: Extending Kearns’ invitation. Professional Geographer, 46, 106–110.
Duncan, K., Clipsham, J., Hampson, E., Kreiger, C., MacDonnell, J., Roedding, D., & Chow, K. (2000). Improving the access to and quality of public health services for lesbians and gay men Position paper. Toronto: OPHA.
Dyck, I. (1998). Women with disabilities and everyday geographies: Home space and the contested body. In R. A Kearns, & W. M. Gesler (Eds.), Putting health into place (pp. 102–119). Syracuse: Syracuse University Press.
Dyck, I. (1999). Body troubles: Women the workplace and negotiations of a disabled identity. In R. Butler, & H. Parr (Eds.), Mind and body spaces; Geographies of illness, impairment and disability (pp. 119–137). London: Routledge.
Dyck, I., Lewis, N., & McIafferty, S. (2001). Why geographies of women’s health? In I. Dyck, N. D. Lewis, & S. McIafferty (Eds.), Geographies of women’s health (pp 1–20). London: Routledge.
Dyck, I. (2003). Feminism and health geography: Twin tracks or divergent agendas? Gender, Place, and Culture, 10(4), 361–368.
Epp, J. (1986). Achieving health for all: A framework for health promotion. Ottawa: Ministry of Supply and Services.
Frey, L. (2002). Romanow vs. Kirby: Two visions for the future of health care. Registered Nurse Journal, 14(6), 20–21.
Gatrell, A. (2003). Complexity and geographies of health: A modern and global synthesis? 10th International Symposium in Medical Geography. July, 2003. Manchester, England.
Gastaldo, D., Andrews G. J., & Khanlou, N. (2004). Therapeutic landscapes of the mind: Theorizing the intersection of health geography, health promotion and immigration studies. Critical Public Health, 14(2), 157–176.
Gay and Lesbian Medical Association. (2001). Healthy people 2010 companion document for LGBT health. Washington: Author.
Gustafson, D. L. (2002). Cultural sensitivity as a problematic in Ontario nursing policy and education: An integrated feminist con/textual analysis. Dissertation Abstracts International 63(06), 2375A. (UMI No. NQ69241).
Halford, S., & Leonard, P. (2003). Space and place in the construction and performance of gendered nursing identities. Journal of Advanced Nursing, 42(2), 201–208.
Hallman, B. (1999). The transition into eldercare: An uncelebrated passage. In E. Kenworthy-Teather (Ed.), Embodied geographies: Spaces, bodies and rites of passage. London: Routledge.
Hamilton, N., & Bhatti, T. (1996). Population health promotion: An integrated model of population health and health promotion. Ottawa: Health Promotion Development Division.
Hoy, C. (2001). Adolescents in China. Health and Place, 7, 261–272.
Kearns, R. A. (1993). Place and health: Towards a reformed medical geography. The Professional Geographer, 46, 67–72.
Kearns, R. A. (1994a). Putting health and health care into place: An invitation accepted and declined. The Professional Geographer, 46, 111–115.
Kearns, R. A. (1994b). To reform is not to discard: A reply to Paul. The Professional Geographer, 46, 505–507.
Kearns, R. (2003). Connecting landscapes of health and medicine, 10th International Symposium in Medical Geography. July, 2003, Manchester, England.
Kearns, R., & Moon, G. (2002). From medical to health geography: Novelty, place and theory after a decade of change. Progress in Human Geography, 26, 605–625.
Liaschenko, J. (1994). The moral geography of home care. Advances in Nursing Science, 17(2), 16–18.
Liaschenko, J. (1996). A sense of place for patients: Living and dying. Home Care Provider, 1(5), 270–272.
Liaschenko, J. (1997). Ethics and the geography of the nurse–patient relationship: Spatial vulnerable and gendered space. Scholarly Inquiry for Nursing Practice, 11(1), 45–59.
Liaschenko, J. (2001). Nursing work, housekeeping issues, and the moral geography of home care. In D. N.Weisstub, D. C. Thomasma, S. Gauthier, & G. F. Tomossy (Eds.), Aging: Caring for our elders (pp. 123–137). Netherlands: Kluwer Academic Publishers.
MacDonnell, J. (2001a). Facilitating support for expectant lesbians in a public health context: Encountering resistance in the research process. Journal of the Association for Research on Mothering, 3(1), 109–120.
MacDonnell, J. A. (2001b). Educational needs perceived by expectant lesbian couples. St. Catharines, Canada: Master’s thesis, Brock University.
MacDonnell, J. A. (2005). Situating the political in nurses’ lives: The intersection of policy, practice and career for lesbian health advocates. Doctoral dissertation, University of Toronto, Canada.
Mahon-Daly, P., & Andrews, G. J. (2002). Liminality and breastfeeding: Women negotiating space and two bodies. Health and Place, 8(2), 61–76.
Malone, R. (2003). Distal nursing. Social Science and Medicine, 56(11), 2317–2326.
Marshall, C. (1997). Dismantling and reconstructing policy analysis. In C. Marshall (Ed.), Feminist critical policy analysis: A perspective from primary and secondary schooling. Vol I (pp. 1–39). Philadelphia: Falmer Press.
Massey, D. (1994). Space, place, and gender. Minneapolis: University of Minnesota Press.
Mayer, J. D., & Meade, M. S. (1994). A reformed medical geography reconsidered. The Professional Geographer, 46, 103–106.
Mayer, J. D. (1996). The political ecology of disease as one new focus for medical geography. Progress in Human Geography, 20, 441–456.
McDowell, L. (1999). Gender, identity and place. Minneapolis: University of Minnesota Press.
McLeod, K. S. (2000). Our sense of snow: The myth of John Snow in medical geography. Social Science and Medicine, 50, 923–936.
McMurray, A. (2003). Primary health care: Enabling health and wellness. In A. McMurray (Ed.), Community health and wellness: A socioecological approach, 2nd ed. (pp. 33–53). Toronto: Mosby.
McKeever, P. (1996). The family: Long-term care research and policy formulation. Nursing Inquiry, 3, 200–206.
Moss, P. (1993). Feminism as method. The Canadian Geographer, 37, 48–61.
Moss, P. (1997). Negotiating spaces in home environments; Older women living with arthritis. Social Science and Medicine, 45, 23–33.
Moss, P. (2002). Feminist geography in practice. London: Blackwell.
Moss, P., & Dyck, I. (2003). Women, body, illness: Space and identity in the everyday lives of women with chronic illness. Baltimore: Rowman and Littlefield.
O’Hanlan K., 1998. Lesbian health and homophobia. Retrieved 24 September, 1998, http://www.ohanlan.com/lhr.htm
Onken, S. J. (1998). Conceptualizing violence against gay, lesbian, bisexual, intersexual, and transgendered people. In L. M. Sloan, & N. S. Gustavsson (Eds.), Violence and social injustice against lesbian, gay and bisexual people (pp. 5–24). New York: Harrington Park Press.
Parr, H. (1998). The politics of methodology in post-medical geography: Mental health research and the interview. Health and Place, 4(4), 341–353.
Parr, H. (2002). Medical geography: Diagnosing the body in medical and health geography, 1999–2000. Progress in Human Geography, 26(2), 240–251.
Parr, H. (2003). Medical geography: Care and caring. Progress in Human Geography, 27(2), 212–221.
Parr, H. (2004). Medical geography: Critical medical and health geography? Progress in Human Geography, 28(2), 246–257.
Paul, B. K. (1994). Commentary on Kearns’ ‘Place and health: Toward a reformed medical geography’. The Professional Geographer, 46, 504–505.
Pearson, M. (1989). Medical geography: Genderless and colorblind? Contemporary Issues in Education, 3, 9–17.
Peter, E. (2002). The history of nursing in the home: Revealing the significance of place in the expression of moral agency. Nursing Inquiry, 9, 65–72.
Pope, C. (2001). Babies and borderlands: Factors that influence Sonoran women’s decision to seek prenatal care in southern Arizona. In I. Dyck I., N. D. Lewis, & S. McIafferty (Eds.), Geographies of women’s health (pp. 143–158). London: Routledge.
Pratt, G. (2000). Feminist geographies. In R. J. Johnston, G. Pratt, & M. Watts (Eds.), The dictionary of human geography, 4th ed. (pp. 259–262). Oxford: Blackwell.
Public Health Alliance for LGBTTIQ Equity (PHA). (2002). Policy resolution on ethical research and evidence-based practice for lesbians and gay men. Ontario Public Health Association, Toronto, Canada. Retrieved 6 June, 2003, http://www.opha.on.ca/ppres/2002-01_res.pdf.
Purkey, W. W., & Novak, J. M. (1996). Inviting school success: A self-concept approach to teaching, learning, and democratic practice, 3rd ed. Belmont: Wadsworth Press.
Raphael, D., & Bryant, T. (2002). The limitations of population health as a model for a new public health. Health Promotion International, 17(2), 189–199.
Reinharz, S. (1992). Feminist methods in social research. New York: Oxford University Press.
Rose, G. (1993). Feminism & geography: The limits of geographic knowledge. Minneapolis: University of Minnesota Press.
Rosenberg, M. (2003). Taking account of people in geographies of health and health care 10th International Symposium in Medical Geography. July, 2003, Manchester, England.
Ryan, B., Brotman, S., & Rowe, B. (2000). Access to care: Exploring the health and well-being of gay, lesbian, bisexual and two-spirit people in Canada. Montreal: McGill Center for Applied Family Studies.
Sandelowski, M. (2002). Visible humans, vanishing bodies and virtual nursing: Complications of life, presence, place and identity. Advances in Nursing Science, 24, 58–70.
Stevens, P. E. (1992). Lesbian health care research: A review of the literature from 1970–1990. Health Care for Women International, 13, 91–120.
Stevens, P. E., & Hall, J. (1992). Applying critical theories to nursing in communities. Public Health Nursing, 9(1), 2–9.
Taghavi, H. (1999). LGBT health care access project final research report: An overview and analysis of community consultations. Vancouver: LGBT Health Association.
Taylor, S., Rizvi, F., Lingard, B., & Henry, M. (1997). Educational policy and the politics of change. New York: Routledge.
Toronto Charter for a Healthy Canada. (2003). Strengthening the social determinants of health. Toronto: Author.
Tripathi, S. (2001). Differing access to social networks: Rural and urban women in India with reproductive tract infections and sexually transmitted diseases. In I. Dyck, N. D. Lewis, & S. McIafferty (Eds.), Geographies of women’s health (pp. 159–176). London: Routledge.
Valentine, G. (1993). (Hetero)sexing space: Lesbian perceptions and experiences of everyday spaces. Environment and Planning D: Society and Space, 11, 395–413.
Van der Meide, W. (2001). The intersection of sexual orientation and race: considering the experiences of lesbian, gay, bisexual, transgendered (“GLBT”) people of color & two-spirited people. Ottawa: EGALE Canada.
Vickers, J. (1997). Reinventing political science: A feminist approach. Halifax: Fernwood Publishing.
Wainwright, E. M. (2003). Constant medical supervision: Locating reproductive bodies in Victorian and Edwardian Dundee. Health and Place, 9, 163–174.
Wiles, J. (2003). Daily geographies of caregivers: Mobility, routine and scale. Social Science and Medicine, 55, 141–154.
Williams, A. (Ed). (1999). Therapeutic landscapes: The dynamic between place and wellness. Lanham: University Press of America.
Williams, A. (2002). Changing geographies of care: Employing the concept of therapeutic landscapes as a framework in examining home space. Social Science and Medicine, 55, 141–154.
World Health Organization, Health & Welfare, Canada, & The Canadian Public Health Association (CPHA). (1986). Ottawa Charter for Health Promotion. Ottawa.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
MacDonnell, J.A., Andrews, G.J. Placing sexuality in health policies: feminist geographies and public health nursing. GeoJournal 65, 349–364 (2006). https://doi.org/10.1007/s10708-006-0028-7
Issue Date:
DOI: https://doi.org/10.1007/s10708-006-0028-7