Editorial

WOMEN AND THE CONTROL OF HEALTH

Health is not only a question of curing diseases or preventing them. The right to health means not only the right to be free from disease but also physical, emotional and mental well-being. Our definition of health is that it has to do with all aspects of our lives, from the kind of food we eat to the kind of house we live in and the kind of work we do. Health cannot be separated from the political, economic and cultural systems of our societies. It cannot be isolated from our roles as women within these societies.

Whether we live in an industrialized country or the Third World, health care and health services are all too often confined to the area of medicine. Predominantly curative, sophisticated and expensive, health services are centered around institutions, with knowledge and control of medicine in the hands of an elite medical establishment. Even when the aim is prevention of disease, the underlying political and economic causes of ill health are largely ignored.

A multi-million dollar hospital is largely irrelevant to a country where the ill health of the people has more to do with lack of sanitation and enough food, than with complex diseases needing surgery. Yet a hospital in Pakistan, for example, cost 43.5 million rupees when total expenditure for the Rural Health Program at the time amounted to only 16.5 million rupees. In the USA or Europe, the emphasis put on drugs and medicines far outweighs the importance given to good balanced diet. Tranquilizers and anti-depressants are prescribed to people whose real problems are unemployment or lack of child care facilities. Research has made possible complex heart and brain surgery, while malnutrition and poverty are far from eradicated and many women still give birth in inhuman circumstances.

Depending on our country, some of us have a degree of control over where we live, what we do and what we eat. Most of us have very little control over the health care system, very little say in the decisions as to what kind of health care is available to us. And as women we are particularly affected by the health care systems or the lack of them. We have only to think of a few examples :

• as potential mothers we face the problem of having children or not, of contraception and abortion;
• as mothers we are mainly responsible for the health of our children and families, feeding them, caring for them when they are sick;
• as workers both in outside production and in the home as mothers we are over-worked, overtired, subject to poor working conditions with all that this means for our health;
• as consumers for the family, we become the particular target of the pharmaceutical industry, through their publicity for medicine and "health" products;-
• as objects of desire we are bombarded by the chemical industry to buy beauty products, to fight old age, to undergo plastic surgery for beauty purposes;
• as women confronted and confined to all these roles, we are treated as mad for not adjusting to them, psychoanalyzed by men and given drugs as a solution;
• as women we are subjected to laws and systems of health made by men, which are not geared to our needs or those of our families, and which restrict our self-determination;
• the lack of safe and effective contraception for instance or laws requiring our husbands' consent for abortion.

Because of the concentration of health care in the area of medicine and because of the control of medicine by specific political forces, we have chosen in this first ISIS Bulletin on Women and Health to examine the impact of this on women's lives. This impact is enormous. It is not our capacity to have children which is the only health issue of concern to women, but it is certainly a central one. This is why we also have such a large section in this bulletin devoted to reproduction. 

Our analysis shows that women have lost control over their own health and reproduction. We know, though, that they are beginning to take back that control. The women's self-help movement in North America, Western Europe, Australia and New Zealand gives testimony to that. Women in other parts of the world are organizing in different ways. This will be the focus of ISIS Bulletin No. 8 - Women and Health Part 2.

Jane Cottingham
Marilee Karl