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Women in prison with alcohol problems: why gender-responsive policies matter.

Article Excerpt
Interest in health inequalities has grown in recent years. The World Health Organization (WHO) defines them as variations in health status between social categories that are unnecessary, avoidable, and unfair. The extent of a society's commitment to justice determines the extent to which available knowledge is transformed into actions and population policies to achieve this.

The biological, sexual, cultural and social differences between men and women have implications for which health problems affect them and how, and therefore for their health and social intervention needs. Sex, in the biological sense, plays a key role because of differences in the effects of treatments, the results of diagnostic tests and the manifestation of clinical signs and symptoms in men and women. Sex, in connection with differences in the reproductive act, produces distinguishing features between men and women and specific needs. Gender is a concept that incorporates the social factors associated with men's and women's different patterns of socialization, which in turn have to do with family roles, work expectations, types of occupation and social culture, which also affect the process of health and illness.

The invisibility of these ways of producing inequality perpetuates a chain of situations that ends up producing different patterns of what men and women die of and how they die. From a public health perspective the interest in gender inequalities arises because this difference in health status is due to the epidemiological fact that gender (male and female) is a health determinant, whereas sex is regarded as a confusing factor. Whether or not this knowledge will be transformed into intervention has to do with the action of health policies, their potential capacity to modify the factors involved in the different degrees of vulnerability of men and women, and their capacity to organize health resources to deal with illness (Peiro, Ramon, Alvarez-Daret, Colomer et al. 2004).

In addition to gender inequalities, there are also social and economic inequalities that give rise to marginalized groups.

On the subject of marginality, Cortes (2002) says:

"It is a concept located within the theory of modernization according to which "underdeveloped" societies are characterized by the coexistence of a traditional and a modern segment, the former constituting the main obstacle to achieving self-sustained economic and social growth. In its most abstract form, the notion of "marginal" refers to zones that have not yet been penetrated by the norms, values or ways of being of modern man. (11)"

Cortes (2002) continues, arguing that marginalization refers to persons in urban zones who display the following characteristics:

* They live in shanty towns or dilapidated areas within the city.

* They lack the capacity to act, and simply people the area, merely existing. This involves lack of participation in social decisions; these groups lack integration and are unable to overcome their circumstances on their own.

* Marginalized persons have low standards of living, housing, health, educational attainment and culture.

* They earn subsistence wages and have unstable jobs.

* They lack political organizations to represent them.

If these characteristics are applied to women who abuse psychoactive substances, it is easy to understand that marginalization is a result of the interplay among personal problems (alcohol abuse, use of illicit drugs, and mental health problems), structural problems related to the lack of decent housing (such as the need to remodel existing housing, living in rented accommodation, etc.), financial shortages that lead to unemployment and a high risk of being outside the scope of social welfare institutions. One such marginalized group is women in prison.

Female offenders represent a growing percentage of correctional populations worldwide. In the United States more than one million women are currently under criminal justice supervision (Bloom, Owen & Covington 2003). In Mexico City...