Abstract
Kuhlmann and Annandale’s The Palgrave Handbook of Gender and Healthcare represents a tremendous resource for health practitioners, independent researchers, policy-makers, and academics alike. The exploration of the embedded nature of sex and gender within global healthcare delivery systems makes it not only a topic that is long overdue in terms of understanding gender complexities, but a necessity that can no longer be ignored if we are truly interested in solving health inequities on a global scale. Even so, the authors make the case that despite the importance of gender, being male or female should never be seen as being synonymous with a particular health problem or outcome. In this context, neither gender nor biological sex can ultimately be seen as static in any given society.
According to Dr Daniel Amen in his book Making a Good Brain Great (2006), the biology of our brains can be effectively changed by decreasing ANTS (Automatic Negative Thoughts), eating foods that promote higher brain functioning, avoidance of foods/substances which decrease brain performance and activity, and engagement in more socially meaningful relationships. This ability to reinvent a healthier version of our past selves suggests that behavioral changes can be made and health gains can be attained if significant strides are made. As such, in health policy we may do a disservice to presuppose that there is a one-to-one relationship between social/biological categories and health outcomes, lest they be taken as a given. Taking to such assumptions may yield precarious research findings such as over-reporting or under-estimation of various health outcomes based on social categories.
The Palgrave Handbook consists of 27 chapters covering in detail critical topics such as healthcare policy, social patterning, equity and access to healthcare, healthcare organization and delivery, and gender-sensitive healthcare among health practitioners. The authors seek to move beyond simplistic notions of gender differences in health outcomes to explore how social context, health delivery systems, and individuals shape health in complex ways at the macro-, meso-, and micro-levels. By doing so, the authors attempt to further understand and document both why and how health problems occur to begin with. This is a particularly useful mechanism when prevention is a priority, which could potentially allow for key policy interventions in healthcare services and delivery.
Essential topic-relevant terminology used throughout the Handbook includes the following terms: equity, equality, gender-sensitivity, mainstreaming, and gendered. Furthermore, the taken-for-granted conceptual and operational definitions of these terms are discussed in further detail in order to demystify current debates on gender and health that have consumed academic and policy circles alike. The object here is to move past ideological and theoretical arguments to focus on truly transforming the way gender and health are envisioned. Although intellectual debate and pontification are not without their merit, the purpose of the book is greater – to provide a practical, empirically based handbook for persons from varying professional and academic levels.
The authors draw upon a critical feminist approach to frame their analyses on gender and healthcare. Such an approach is useful to look at gender more broadly to encompass the social meanings and attitudes associated with being male or female in any given society. For example, if men are more prone to being risk-takers and socially perceived to be better able to ‘hold their liquor’, then certain risky health behaviors such as higher alcoholic consumption may be more apparent, especially if they have access to financial resources which allow them to engage in such behaviors over and above women (Payne and Doyal, 2010).
Although Kuhlmann and Annandale argue that health inequality has subversive effects for both men and women, it is women who may suffer more severely in this regard. Contributing authors Payne and Doyal state that, ‘Though men may be damaged by the social construction of masculinities they are rarely harmed in any direct way by gender inequalities themselves’ (p. 27). Although it is known that there is a clear structural advantage for men across most societies due to severe patriarchy, this advantage may come at a price. Research has shown that there are greater health declines for all in societies with higher levels of economic inequality between the richest and poorest segments of society as compared to their counterparts (Daniels et al., 2000). Besides sheer wealth and income, studies have shown that residential segregation may be linked to excess mortality in a national sample of US adults (Collins and Williams, 1999). Furthermore, it is extremely plausible that the intersection of race, class, and gender (Collins, 2000) may cause health advantages for White women over Black men and Black women (Weitz, 2010). For example, in the United States key indicators of life chances such as life expectancy at birth and at age 65, and infant mortality rates are exceedingly influenced by race (National Center for Health Statistics, 2008; MacDorman and Mathews, 2008).
The Handbook further addresses several timely and critical issues of either national or international significance including HIV/AIDS and gender research with a focus on South Africa, old age care in Japan and Sweden, women’s health centers, implications of female representation in the medical profession, and an examination of the connection between maternal and child health with a focus on India. Moreover, India represents a health paradox of sorts in that despite the enormous gains made in the health sector over the past few decades, approximately 1 million persons suffer from excess mortality. This seemingly alarming statistic includes a large portion of women and children. Perhaps, as cited previously, the severe inequality between various sections of the citizenry is a major factor. However, it is made clear in the Handbook that several other central issues emerge for further consideration including cultural perceptions of females, gendered health perceptions, the social and historical milieu, socioeconomic conditions, and the availability of reproductive technologies. The invited contributor Tulsi Patel (2010) does an impressive job in explaining that depending on the health outcome, income is not always the best measure to utilize to understand the health status of women.
Likewise, there are several key premises which emerge from the Handbook that have not already been discussed. Medical sociologists may find the following to be of particular importance to their field, although these points may very well resonate with other fields. They include but are not limited to: (1) the need for perspectives, programs, and future planning to focus on equality in order to yield greater gender equity; (2) the importance of gender-sensitive health indicators understood within a gendered framework; (3) the necessity for the examination of health inequities for women at local, national, and global levels in order to expand political and cultural awareness of health problems and potential solutions; (4) the vital role of health policy-makers in shaping current and future population health; and lastly, (5) the failure of individual blaming approaches (from mental health to HIV/AIDS) to truly eradicate gendered health disparities.
Given the nature of the topic and its enormity, the Handbook provides a condensed version of national (United Kingdom) and international studies, paradigm shifts, and taken-for-granted assumptions within the gender and health arenas. It in no way seeks to represent a definitive answer to the multitude of problems regarding the complex relationship between gender and health. Rather, Kuhlmann and Annandale seek to explain the ways in which power (the ability to get someone to do a desired outcome willingly or unwillingly) is severely linked to the health outcomes of millions if not billions on a global scale. Here we find that most gender inequities lead to ignoring gender differences and perhaps on a greater level some form of organizational and institutional bias. The current handbook would definitely serve as an advantageous resource for academics and policy-makers alike and is coherent enough to be assigned as a main textbook in a health policy course, or could equally be used to develop a critical research agenda on gender differences and access to care as there are a plethora of suggestions for future research.