The Palgrave Handbook of Gender and Healthcare

Kuhlman, E. and Annandale, E. ( eds ) The Palgrave Handbook of Gender and Healthcare . Houndsmills, Basingstoke : Palgrave Macmillan 2010 £50 (hbk ) xxii + 482 pp. ISBN 978-0-230-23031-6 This collection opens with the bold claim that it appears at ‘an optimum time to draw state-of-the-art thinking on gender and healthcare together into one compilation’. The ascendancy of neoliberalism, the election of many conservative governments, and the global financial crisis (with consequent pressures on public funding) might militate against susceptibility to a gender perspective. On the other hand, as the editors point out in their introductory essay, gender mainstreaming is enjoying wide currency internationally, and recent advocacy and research into men’s health has broadened the focus. The editors have assembled 27 chapters into five broad parts: Gender in healthcare and policy; The social patterning of health by gender; Equity and access to healthcare; Gendering the organisation and delivery of health care; and The professions as ‘catalyst’ of gender sensitive healthcare. The contributors are mainly women (and a few men) from the UK, USA, and Western Europe, plus several from southern Africa, Mexico, India, Taiwan, and Australia. Most of the authors are international experts in the topic represented here, and many have taken the opportunity to reprise their previous work. There has long been a need for more contextualised perspectives on gender and health, making this collection welcome indeed. It follows the recent trend toward international approaches, incorporating chapters with detailed information on Germany, Finland, Sweden, Australia, Taiwan, Canada, the USA, and broader regional information on sub-Saharan Africa, Latin America and Europe. In addition, a few authors had the unenviable task of trying to make generic statements (e.g. the chapter by Lin and and L’Orange on indicators, or the one by Hunt and colleagues on help seeking.) The effort to devise such all-encompassing accounts seems fundamentally contradictory to the call for contextual specificity, yet the chapters discussing international and national approaches to gender mainstreaming make clear that both are needed. Writing this review from my home in the Antipodes, I was pleased to see that four of the contributors are from Australia, and their chapters included Australian information. However, Anderson’s chapter (on women’s health centres in Canada) describes remarkable achievements in that country, but does not mention the parallel history of women’s health policy and women’s health centres in Australia, a comparative perspective that would have lent additional depth to the analysis. Similar comments could be made about other chapters. It may seem parochial to complain that more international notice has not been taken of Australian action and research, but for more than a decade (early 1980s to late 1990s), Australia punched well above its weight on women’s health, and its story should be included in a comprehensive picture. I suspect this book will be of most use to policymakers and programme planners who have to implement gender mainstreaming. Researchers who are already familiar with the field will find useful supplements and top-ups here, but will probably have read many of the contributors in original and more extensive publications. Teachers and researchers who are new to gender and health will find it useful for familiarising themselves and scoping the issues. The book is a resource to be consulted, rather than an integrated and coherent statement. At times, I wished that contributors had been able to take more account of one another’s texts, several of which effectively pose direct or implicit challenges to one another within a very few pages. For example, the argument in Chapter 14 might have been clarified if the author had read Chapter 15 while preparing her own text. The editors were intent on bringing ‘politics and power more firmly to the heart of the analysis’, but those concepts are absent from many chapters. Nor, alas, have the authors resolved such ubiquitous problems as conceptual muddiness surrounding the sex/gender distinction; contradictory consequences of key processes (such as medicalisation, or even something as apparently innocuous as reporting gender disaggregated data); or the propensity to gloss ‘gender’ as women. For me, one highlight of the book is Standing’s chapter on health sector reforms in low and middle income nations, in which complex issues are unpacked and vividly illustrated by specific case studies on how two ‘generations’ of healthcare reform played out in different contexts. Indeed, short boxed case studies in several chapters bring abstract generalisations to life in ways that render their human significance immediately accessible. Andersen’s account on women’s health centres in Canada was inspiring, but I longed for the ‘backstory’ on what led to the establishment and funding of the Women’s Health Bureau. Werde’s notion of ‘hegemonic femininity’ in nursing is one I will use in future. And the editors’ concluding chapter is a valuable summary of the state of play, reviewing the persistent complexities, conceptual difficulties and political obstacles facing those seeking to incorporate gender into health research, planning and policy. Perhaps it is too much to hope that they would have dispelled the ‘unresolved gender troubles’ they identified in their opening essay.

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