Review

A gender for health

WOMEN AND HEALTH SERVICES
Lesley Doyal (ed)
Open University Press, 1998

This book provides a welcome overview of the ways women are trying to address women’s health issues. It is comprehensive and deals with a wide range of perspectives and approaches.

Hilary Graham considers the use of epidemiologically assessed evidence on risk in the UK health strategy and the different way in which women who are experiencing the sharp end of inequality see risk. In the book as a whole I would have welcomed more reflection on how gender issues should be targeted in relation to economic policies.

Issues which have emerged in the past decade include older women, smoking and coronary heart disease. Authors paint a picture of the high level of women’s morbidity with various references to the importance of musculo-skeletal problems, but there is no chapter specifically on this or on disability. To what extent is the agenda set by women academics and is this important? There is a chapter on women as workers, about Hoxton Health Collective, but the sections on women-centred hospital services in gynaecology and breast conditions made me want to know more about how nurses feel about their changing roles.

There is a tension between women-centred approaches and ‘evidence-based’ priorities which was insufficiently addressed – as was the development of gender approaches and men’s health, which I think has been at the expense of women’s health. The paradox of lower female mortality rates despite greater social and economic disadvantage also needed revisiting.

Despite these reservations, I warmly recommend the book. It provides a mass of information about the progress health services have made and examples of current women-centred approaches. It has useful information on how women’s health needs are not being met and ways to improve the situation, and is an inspiring and energising read.