Elizabeth Fee and Feminist Public Health

While the term “feminist public health” is rarely used today, Elizabeth Fee’s work reveals the insightful and relevant role of feminism in shaping the field, past and present. Her profiles for Voices From the Past draw attention to the role that women have played in structuring programs for child welfare, establishing services for poor and marginalized groups, challenging racism and inequality, and resisting and redefining health care related to sexuality, reproduction, gender identity, and disability. Such work serves as an important reminder that who we are influences our research and practice, as well as the systems and services we build. In the 1960s and ’70s, feminists reshaped medicine and public health by developing critical analyses as well as alternatives to existing models of care. Many of the innovations of the women’s health movement and lesbian, gay, bisexual, transgender, and queer or questioning (LGBTQ) activism have since been adopted in the mainstream, from midwifery approaches to natural childbirth to the revision of diagnosis and treatment of mental illness.

In 1975, when she was an active member of the second wave of the movement for women’s rights as well as a faculty member at the Johns Hopkins School of Hygiene and Public Health, Fee highlighted the importance of gendered analyses for understanding health and illness, explaining liberal-, radical- and Marxist-feminist critiques of the health care system.¹ By the early 1980s, she was appealing to scientists to take on board the lessons of such critiques to help build a new “feminist science.” This would not mean “the collapse of medical science or the denial of everything that has been achieved by the previous paradigm,” but instead, would offer a “more complete form of knowledge.”² While the evidence continues to mount of the necessity for such a project, her call has yet to be properly addressed. As Cordelia Fine recently asserted, scientists often still see gender as something that should be kept out of science, even though gendered perspectives are deeply embedded in contemporary research.³

Fee’s explicit and unapologetic acknowledgment of the political framework for her research has served as a model for others, myself included, of how to define credibility not by the renunciation of personal perspective but by acknowledging and analyzing its influence. Her insistence that who we are affects which issues we prioritize, our ability to comprehend the circumstances of others, and our willingness to reevaluate complex issues based on changing perspectives on the evidence is vital for identifying and exposing how assumptions continue to distort questions and results.

In her historical work, Fee demonstrated that the social and cultural conceptions that shape our understandings of disease (as well as shaping disease trajectories in individual patients and the spread of epidemics through populations) are sometimes easier to discern when we look at the past. The significance of this approach was dramatically illustrated with the emergence of AIDS, which underscored the limits of a reductionist biomedical framing of epidemiology. Using the example of venereal disease in early 20th century Baltimore, Maryland, she argued that “social and cultural meanings of disease reassert themselves in the interstices of science and prove their power whenever the biomedical sciences fail to completely cure or solve the problem.”⁴ As feminists and queer theorists have illustrated, HIV and AIDS does, in fact, discriminate—infecting some groups at higher rates than others, mapping onto existing patterns of marginalization, reflecting levels of physical and psychological resilience, and shaping access to treatment and support.⁵

With public health researchers, practitioners, and policymakers now grappling with the individualizing trend of personalized medicine, feminist perspectives are ever more relevant for addressing this potential threat to structural analyses of the social and environmental causes of illness. Declining funding for research and services to address inequalities, coupled with the widening gap between rich and poor—in wealth and in health—is undermining the gains made and reintroducing problems previously, successfully, addressed. As Fee has shown, history can serve as a warning system to alert us to the potential consequences of these trends, as evidence to fuel demands for change and as the inspiration for strategies and solutions. The past is an inextricable part of the future of public health, as well as a reminder of the unfinished project to integrate feminist analyses in our research and practice.