Despite obvious differences between women and men—biologically, psychologically, and socially—the concept of viewing the totality of women's health as different from men's health arose in Western medicine only in the last two decades of the twentieth century. As recently as the 1980s, students in most Western medical schools were taught that, except for issues related directly to reproductive anatomy and function, women were medically identical to men. According to this belief system, medical research could be carried out on men, and the results could simply be applied to women. As a result, only health care providers who specialized in areas related to reproduction were expected to be knowledgeable about issues particular to women.
In order to understand the modern definition of women's health, it is important to understand the history of how women's health care has been viewed by the medical and medical research establishments. Traditionally, the health of women has been seen as synonymous with maternal or reproductive health. Clearly, the Western medical profession's view of women's health as "maternal health" was concordant with societal mores that valued women mainly for their ability to bear children. However, until well into the twentieth century, the major causes of illness and death in women did, in fact, relate to reproductive issues. Childbirth and sexually transmitted diseases, including cervical cancer, have been the most important health issues for women in all ages and places—except in the West and certain other countries in the twentieth century. Prior to 1900, the majority of elderly persons in the United States were men, reflecting the toll that childbearing took on the health of women.
In 1970 the book Our Bodies, Ourselves became a touchstone of the women's health movement. Authored by a group of women participating in a course on health, sexuality, and childbearing, the book emphasizes the importance of women attaining knowledge about their health and being active participants in health care in both an individual and societal sense. Our Bodies, Ourselves also considers the social context of health, including effects of sexism, racism, and financial pressures on the health of women. Throughout the 1970s, major focuses of the women's health movement included reproductive freedom, understanding health in a broader social context, and a critical orientation toward the medical establishment.
In the 1980s, women's health advocates began to argue for a broader definition of women's health and increased participation of women in research studies. A major new focus became changing the medical establishment. The reasons for this change in orientation, particularly toward the participation by women in research studies, were complex. They included, but were not limited to, the growing number of women living beyond their reproductive years and the growing number of women reaching positions of influence within academic medicine.
In 1983 the United States Public Health Service commissioned a task force on women's health. This task force broadly defined women's health issues to include not only reproductive and social issues, but also biological differences between men and women. The modern field of women's health includes the study of illnesses and conditions that are unique to women, more common or serious in women, have distinct causes or manifestations in women, or have different outcomes or treatments in women. Since the 1980s, research on gender differences in health and disease has had important implications for the treatment and prevention of a variety of common serious illnesses, including heart disease, stroke, lung cancer, depression, colon cancer, and dementia. Research in all these areas is ongoing.
Integral to this new expanded view of women's health has been a change in how medical research has been viewed by the public. In the 1970s, the focus of women's health advocates in the United States was on "protecting" women from potential abuses by seeking to avoid their inclusion in medical research studies. It should be noted that women were excluded from medical research during this time because of a variety of factors, and not solely, or even mainly, because of popular advocacy. Medical research was conducted almost exclusively by male physicians, and because most research scientists believed that effects of the reproductive cycle of women might lead to unreliable research results, most supported the belief that research should be conducted on men and then applied to women. Even most medical research on rats during this period was conducted using male rats.
However, by the 1980s, women's health advocates had realized that because women were being excluded from research studies, knowledge about the diagnosis and treatment of a wide variety of common diseases in women lagged far behind knowledge of diseases in men. A major focus of the women's health movement in the 1980s and 1990s was improving knowledge about disease in women by promoting the inclusion of women in research studies, mainly through mandating inclusion of women in federally funded research studies.
A greater understanding of the factors influencing women's health from a biological perspective has been paralleled by a greater understanding of the psychosocial and societal factors that affect women's health status. As an example, research published in the early 1990s showed that because women were more likely than men to require ongoing, rather than episodic, treatment for their health conditions, federally sponsored insurance in the United States (Medicare) actually covered less overall health costs for women than for men. Differences in employment patterns also result in fewer women being medically insured than men, strongly affecting access to health care and health status. Research on domestic violence, which disproportionately victimizes women, underlined the short-and long-term health effects of what had previously been considered either a nonissue or a law enforcement issue.
Some have suggested that the term "women's health" be replaced by the term "gender-based medicine," in part to reflect that medical research that promotes a greater understanding of the effect of gender on health benefits both women and men. However, others believe that the term "women's health" is most accurate, since it incorporates not only biomedical issues, but also the psychosocial and societal factors that ultimately influence the overall health status of women.
The field of women's health seeks to promote an understanding of the biological and psychosocial factor affecting women's health, and to integrate this understanding into public health initiatives, including training of health care providers. Recognition by the medical research establishment of the need to study health and disease in women as well as men has been essential to this new paradigm. Despite the strong influence of biological factors, psychosocial issues still remain the single most important determinant of health status for many women.
JANET P. PREGLER