Gender inequalities in health

When I first picked up this book I thought it would start by documenting the extent of gender inequalities in health—how much longer than men women live, what they die from, what illnesses men and women are more likely to endure, and the like. However, this book offers a different, and much deeper, analysis of gender inequalities in health than that. It opens with a broad discussion of the changing social environment within which gender is constructed and researched. The book has been compiled as a response to the ‘oversimplified established wisdom’ about gender and health—that women get sicker and men die quicker—offering a ‘critical retrospective’ of gender inequalities and social theory over the past three decades. Each of the chapters addresses particular aspects of the variety of ways that issues of gender and health have been approached, and often oversimplified. They combine, to varying degrees, discussion of theoretical perspectives with empirical work. While the main focus is upon Britain, there is also some attention paid to other industrialized countries, and in particular to the USA and Eastern Europe. The first couple of chapters set the scene by covering such issues as changing participation in employment and the work environment, education, families and households, domestic work and the division of labour. For example, in Chapter One Annandale and Hunt discuss the blurring of the distinction between the home and working environment and the possible ramifications of that. Their documentation of the changing environment is interwoven with reflections on the shifting research agenda, referring to examples such as the contested relevance of the Registrar General's classification of occupation for indicating women's socio-economic status and the changing meaning of marital status categories. This presents a solid foundation for the rest of the book, although a few graphs of some of the trends described in the text might help the reader take in some of the statistical information. In Chapter Two Carpenter takes further this critical investigation into the theoretical frameworks which have guided thinking and research in this area, extending the debate more extensively into the realms of sociology and social theory with the aim of spurring greater theoretical reflexivity. He advocates a ‘critical realist’ approach that strikes a balance between structure and process and achieves a two-way communication between theory and empirical research. Chapter Three by Popay and Groves explores the potential for exploring the life narratives (personal stories) of both men and women. It is subsequent chapters which may spark particular interest for epidemiologists, as they contain greater reference to quantitative empirical evidence. In Chapter Four Graham addresses socio-economic change and inequalities in men and women's health in the UK with her trademark competence and clarity. She outlines trends using national data sets and the British birth cohort studies, documenting the ‘long shadows of disadvantage’ that lead to the accumulation of material, psychosocial and behavioural risk factors. Epidemiologists will also be familiar with the life course perspective taken in Chapter Five by Arber and Cooper. Here the interaction of both age and cohort influences are considered using the British General Household Survey, so that gender inequalities in health are recognized as very different in form and meaning for different age groups. Two further chapters look at trends in mortality. Waldron considers trends in gender differences in mortality over time, by causes and in terms of sex mortality ratios, using US data for 1950–1990. Chenet looks at gender and socio-economic inequalities in mortality in the very different context of Central and Eastern Europe where the emphasis is on testing hypotheses more than on theoretical deliberation. Unfortunately the editors have decided against a concluding chapter which might have related some of the more empirical content that appears later in the book with the theoretical debate that is outlined at the beginning. One solution might be for the reader to revisit the introductory chapter when they come to the end of the book. If you are looking for ‘quick facts’ about gender inequalities in health this book is not the best place to start looking. But if you are looking for sound and informative description and discussion about where research into gender inequalities in health has been, where it's at and where it is and should be heading, then this is a most commendable book to consult. It is well-informed, clearly written, and constructively provocative.