Health and Disease Among Women: Biological and Environmental Influences

Eds Roberta B Ness, Lewis H Kuller

Oxford University Press, £45, pp 484

ISBN: 019 5113969

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Rating: ★★

The subject of the book is fascinating. Why are women afflicted by many diseases with greater severity and frequency than men? What are the biological and environmental reasons for these sex differences? Some parts of this book feed the reader's fascination, but, sadly, the greater part dampens it.

The cover blurb states: “Thoroughly referenced and supported by extensive data, this book provides methodological insights that will guide research on women's health in the future,” which is probably true. It is certainly “thoroughly referenced” and makes use of “extensive data.” However, it is also very dense and, in sections, difficult to read and is not ground-breaking as implied in the preface. The book is American, and the literature it draws on is almost exclusively American.

The editors set out to organise research ideas by mediation of disease and claim this to be very unusual in departing from “the more traditional organisation of clinical research and practice along disease-specific lines.” Is this so unusual? Surely it is now commonplace to “believe that the interaction of biologic [sic] influences with behavioural, psychosocial, and lifestyle influences explains a good deal of the observed gender-specific variation in disease frequency between men and women.”

The chapters are grouped into four sections: psychosocial and lifestyle issues, sex steroid hormones, anatomy of the genital tract and immunology, and effects of reproduction and contraception on women's health. The first chapter, “Socioeconomic gradients in health among men and women,” provides a stimulating argument that the very real physiological and psychological differences between men and women are manipulated by different cultures into divergent sets of implications for behaviour, social class, and civil and legal rights, which in turn influence encounters with health risks and their outcomes. The authors conclude that the measures currently used for assessing socioeconomic status may not be appropriate for women.

Other chapters—such as those on breast cancer, osteoporosis, and polycystic ovary syndrome—provide comprehensive overviews of the epidemiology. The chapter on oral contraceptives and hormone replacement therapy ends in a surprising and welcome way: “Menopause is not a disease ... a major goal of future research should be to carefully define the use of hormone therapy as efficacious drugs among selected samples of postmenopausal women.” By contrast, the piece on maternal health effects of pregnancy seems to endorse the all too common medicalisation of a normal life event: “Clinicians need to ... view pregnancy as a potential additional risk factor for health and disease.”

The conclusion of the chapter on sex and depression echoes that of several other chapters and, indeed, the message of the book—that more research is needed. The editors' preface states that their “hope in writing the book is to spark new research that will advance understanding of gender differences in health.” Hopefully, it will do this.