Review

All-American feminism...

Women’s Health - Missing from US Medicine
Sue V Rosser
Indiana University Press, 1994

This book is ambitious. It sets out to tackle the ideological, psychological, economic, epidemiological and cultural aspects of disparities in health care, particularly along gender lines, although giving attention to the way ethnicity and class/poverty might compound inequality.

In her introduction, Rosser highlights key issues. Heart disease, the biggest killer of both sexes in the US, is still seen as a male health issue. Ten times as many women as men die in hospital following angioplasty (particularly if they are black, poor or elderly). Women with kidney failure are between 30 per cent and 50 per cent less likely than men to receive an organ transplant. But research as to why is severely lacking.

The first part sets out the thesis that all science, and clinical science in particular, is biased in favour of men. Male health and illness are seen as the norm, basic research and clinical trials are performed on men, bizarre extrapolations are made to women from animal research, and male scientists choose the topics for research funding and focus. Women are under-diagnosed and under-treated, and although one might argue this is positive, evidence that women’s lives have consequently been lost, particularly due to heart disease and HIV/AIDS, makes Rosser’s case compelling. The overall message is that women’s bodies and minds are treated by clinicians and researchers as less than human and essentially the property of men.

The last section of the book focuses on the situation of women in medicine, education and science. Rosser begins by proposing a feminist analysis and feminist inspired practice in health care. She outlines varieties of feminism (essentialist, radical, lesbian separatist, Marxist etc.), and concludes, somewhat unconvincingly, that most of these approaches are equally valid for male as well as female researchers and practitioners.

Rosser seems convinced that a higher profile for women in the medical profession will do much to change inequalities in health care and professional advancement. This assumes that all women are interested in other women and that women per se are different in their practice from men. With this in mind she dedicates a special chapter to ‘women’s ways of knowing’. This comes dangerously close to portraying women as less able than men to think about and learn scientific facts, and implies that women in particular would benefit from changes in the way that medicine is taught. But both male and female medical students and junior doctors are faced with an education which is unrelated to their needs and those of their patients. This is not a gender issue, and it is risky for women’s careers for it to be seen as one.

While I would not wish to undervalue this book, which is full of facts, figures and information and has its heart in what I consider to be the right place, I am concerned that it takes a simplistic view in many areas. What is unforgivable is what this book shares with others published in the US: it ignores the powerful feminist analysis of women’s health care and women in medicine, based on social science, psychology and clinical practice, which has emerged from Britain over the past 15 years.