Primary health promotion describes preventive activities aimed at the whole population. Some frameworks also include primordial health promotion, which describes the risk factors present in all of society, such as the incidence of adverse childhood experiences, or the presence of gender-based discrimination.
“Females and medicine are walking this tightrope between being strong and all those traditional male qualities, making decisions, getting on with it and solving problems. Not creating dramas, I guess being a good girl and then also being approachable and nice to the nursing staff.”
“I remember interviewing a GP several years after she had been assaulted by a senior colleague. I asked her what she would say if it happened to someone else. ‘Well its illegal’ she said. I then asked her to reflect on her own experience. She paused and said ‘maybe I should have been more professional, and not smiled as much’ ”
Primary health promotion
Examples from our book:
Although we found people could describe sexual harassment, they found it more difficult to recognise in their own contexts or to respond appropriately, even when they had practiced the skill in a safe setting,
Like many professions with steep hierarchies and masculinised cultures, doctors absorb the expectation that they will tolerate discomforts and manage interpersonal threats by being “strong”. A common phrase was “if you can’t stand the heat, you should get out of the kitchen”.
Women survivors were particularly vulnerable. In order to demonstrate collegiality across disciplines and with senior colleagues, young women doctors described how they presented themselves as ‘nice’, to avoid being seen as domineering or a ‘feminazi’.
There are other vulnerabilities with medicine: long, often residential hours, being moved around different teams so that they are not embedded in a support system, and distant placements.
Medicine is also a field where sexual behaviour and sexual dysfunction is part of the workplace simply because it is part of the job of doctoring. Adverse behaviours, like assault, can occur because a patient lacks capacity, such as when they have dementia, or delerium. In this environment, behavioural expectations can be confusing, and inexperienced doctors need safe support to identify and challenge situations where they feel unsafe.
Primary health promotion targets:
Information sharing
Making sure all workers in medical workplaces are familiar with definitions of sexual harassment and their legal, institutional and professional obligations
Skill development
Improve skills in recognising and responding to sexual harassment
Assessing risk
Analysing the problem of sexual harassment in the organisation
Managing risk
Reduce the risk of sexual harassment by managing work environments
Safe work policies
Ensuring policies are clear and understood
“Policy development seems to be central to providing a safe workplace. However, it should be recognised that sexual assault has been illegal in most jurisdictions for decades, and yet even extreme forms of abuse, such as rape, continue to occur. Policy change is not enough to prevent sexual harms.”
If you are interested in this health promotion stage, you may wish to read the following chapters of our book:
Foreword: The Shame of Sexual Violence Is Not the Victim’s Burden to Carry
2 How to Be a Woman Doctor: Gender, Performance and Sexual Risk
3 The Role of Men
4 A History of Workplace Sexual Harms
5 Medical Workplaces
6 Medical Training
8 Health Promotion Strategies to Reduce Sexual Harassment in the Workplace
Part II: Learning From Interdisciplinary Perspectives
10 Organisational Behaviour: ‘Oops I Did It Again!’ –Understanding Sexual Harm in Medicine and Why It Persists
16 Integrating Interdisciplinary Lenses
Part III: Learning From International Perspectives
Part IV: Looking To The Future
32 Cultural Change from Above and Within: Accountability in Leadership
33 Advocacy from the Ground Up
34 Looking to the Future: The View from Learners and Teachers throughout Medical Training