Intended for healthcare professionals

Reviews Book

Gender Inequalities in Health

BMJ 2000; 321 doi: (Published 28 October 2000) Cite this as: BMJ 2000;321:1087
  1. Annette MacKay Rossignol, professor of public health.
  1. Oregon State University, USA

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    Eds Ellen Annandale, Kate Hunt

    Open University Press, £15.99, pp 192

    ISBN 0 335 20364 7

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    Gender differences in the opportunity to enjoy good health are related to the biological differences between men and women. Gender inequalities, on the other hand, are related to power and have an ethical component that biology does not. In understanding gender inequalities in health, it is helpful to ask the following questions: Who has power to access the healthcare system and the social, political, and economic arrangements that determine health status? Who has little power? Who is not willing to share power and why? Documenting gender inequalities in health helps in the quantifying of what Popay and Groves call the “health-related indicators of oppression.” Some of these indicators are obvious, such as the percentage of elective abortions of female fetuses in India or sexual and other violence directed towards women and girls. Others are more subtle but damaging none the less, like tiredness, headaches, and chronic pain. In a perfect world, accurate documentation of gender inequalities in health would compel frank discussions about ethical solutions that empower individuals to seek and attain the highest quality of health available to them.

    Gender Inequalities in Health is a series of essays focusing on the methodology and outcomes related to gender disparities in health status and differences in power. It is a highly scholarly work and is not at all devoted to the “male=bad, female=good” view, which is refreshing. While some of the sociological terminology is challenging, the overall product is a state of the art presentation of historical and modern thinking about gender and health. If I were to suggest any improvement, it would be in the area of solutions; that is, the book offers few new ideas about behaviours, programmes, and policies that might reduce gender inequalities in health status.

    Along these lines, and at the risk of alienating feminist women and men everywhere, I want to recount a comment I first heard at the seventh International Women and Health Meeting in Kampala, Uganda, in 1993. I heard the same comment again at the Non-Governmental Organisation Forum on Women in Huairou, China, in 1995. In each setting, women from 40-50 different countries heard the following comment, and agreement with it was nearly total: “Women who gain power become men.” Carpenter refers to this perception by stating that we should not “assume that patriarchal relations will be reproduced by men alone.”

    I find this idea extremely troubling but, given the widespread agreement among women at these meetings, do not doubt its truthfulness, at least in many important situations. Thus, as we strive to understand and solve inequalities in health related to gender, it may be important to remind ourselves that those of us who have attained a comfortable level of power have an ethical obligation to mentor and share power with those people who have not. (See also pp 1034, 1089.)

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