Handbook of Medical Sociology, Sixth Edition

14. Gender and Health Care

229 widely read books, feminist writers developed a far-reaching critique of the health-care system, attacking the medical profession for excluding women from medicine; overusing and misusing drugs, surgery, and technology; withholding important information from women patients; and trivializing women patients’ concerns (Arms 1975; Corea 1977). Like members of other new social movements that challenged and demystified medicine’s “cultural authority” (Starr 1982), feminists asserted the right to be full and equal participants in medical decisions. The women’s health movement was particularly influential in the social sciences as historians , anthropologists, and sociologists tested and extended feminist ideas. In medical sociology, researchers challenged the prevailing view that professionals are recruited according to strict meritocratic criteria and treat all patients equally (Parsons 1951). Theory and research on gender and health care have also challenged fundamental assumptions of the medical model (Mishler 1981). Researchers have challenged the assumption that definitions of health and illness are unaffected by the social context by showing them to be culturally variable and historically contingent: what is designated an illness varies according to time, place, or social context. Studies revealing gender bias in medical texts have challenged the assumption that medicine is scientifically neutral. The highly sex-segregated nature of the professional division of labor demonstrates that recruitment into medicine continues to have ascriptive elements . At the level of social interaction, medicine’s The health-care system is a deeply gendered social institution, often affecting men and women in dramatically different ways. In the United States and many European countries, health-care occupations are sex segregated: men constitute a majority of physicians, while women are concentrated in occupations that are less prestigious and poorly paid. Because women are more likely than men to seek medical treatment, they are the principal consumers of health care. However, more than three decades of research has demonstrated differences in the kind of health care men and women receive—differences that often place women at a disadvantage. Gender is a significant dimension of social stratification that affects men and women as both providers and recipients of health care. Together with inequalities of race, socioeconomic status, and age, gender shapes both the health-care delivery system and the quality of health care men and women receive. This chapter reviews work on gender and health care, focusing primarily on theory and research in sociology. Origins of Interest in Gender and Health Care Interest in gender and health care developed from the engagement of the social sciences with the second wave of feminism, which flourished in the United States and Western Europe in the 1970s. Feminists made medicine the centerpiece of their analysis, arguing that no institution so clearly epitomized women’s subjugation. In a series of 14 Gender and Health Care Renee R. Anspach, University of Michigan 230 Handbook of Medical Sociology scientific neutrality and its universalism have been challenged by studies showing that men and women patients presenting the same symptoms receive different diagnoses and treatments. These challenges have resulted in a body of theory and research demonstrating that the very acts of defining and treating illness are consummately social and cultural processes. Researchers in gender and health care, then, were at the forefront of the movement to create a sociological perspective on health and medicine. Gender and the Medical Division of Labor:The Persistence of Ascription Gender and Healing: A Brief Historical Overview Both men and women have been healers, although their roles have varied historically. Most historical accounts focus on medieval Europe and the nineteenth-century United States. The Middle Ages laid the foundations for a structure that was to continue in many European countries until the nineteenth century: a largely male stratum, consisting of guilds and dominated by universitytrained physicians; and midwives and folk healers , usually women, who served the rest of the population (Ehrenreich and English 1978). In nineteenth-century America, multiple healing paradigms existed in competition. The predominately male “regulars” served a wealthy clientele in Eastern cities. Regulars were known—and sometimes dreaded—for their harsh treatments, such as bleeding and purging. Women were often rejected by regular medical schools and forced to attend women’s colleges, proprietary colleges, or the schools of the sects that proliferated during the period. In contrast to regulars, sectarians avoided harsh remedies, and most served a rural or working-class clientele (Ehrenreich and English 1978). At the beginning of the twentieth century, the leadership of the regular physicians, influenced by progressivism, began a campaign to make medical education more “scientific,” culminating...