In 1900, women and men had no difference in life expectancy. Women began to outlive men only after World War II. While the reasons for this gap are not entirely clear, it presents a fascinating and recent issue. A baby girl born today into a first-world country can expect to live six years longer than a boy born in the same country. A baby girl born in a third- or fourth-world country may live at least three to four years longer than a boy, even if she is born in the most austere circumstances. At the beginning of the twentieth century, a woman had no direct control over the environment around her. She depended on affiliations with powerful males or her family for financial and social stability. Similarly, the physician had very little direct power to intervene in the course of illness. He--and it was inevitably a he--was essentially a sophisticated observer, who could observe and predict the course of illness. He was armed with little more than laudanum, whiskey and leeches, and he did very little to change the actual course of disease. Physicians were revered as omnipotent seers of the future. For better or worse, physicians have since lived with the legacy of prophecy and the aura of mystery born in that period.
World War II brought about three important changes. In the first place, men were away long enough and in great enough numbers that women had access to opportunities they otherwise would never have had. For the first time, not only did we have firewomen, policewomen and "Rosie the Riveter," but in academic medical programs women were admitted to chief residencies, functioned as interim heads of departments and began to join training programs in orthopedics and surgery. After the war, many women were literally sent back to pediatrics, gynecology and internal medicine. A few stalwarts refused to go.
In general, at the end of the war women had gotten a taste of what it meant to own their own money, to not have to deal with intermediaries--the men to whom they were attached--for control over their environment. They also had a taste of intellectual growth. They were not going to give up these things easily. In fact, it was inevitable that a resurgence of feminism would result from the experience of women in World War II. wer of the physician had increased exponentially. Penicillin was introduced and utilized for the first time during World War II. Our understanding of the physiology of shock improved during the war, as did the sophistication of our views about anesthesia and surgical procedures. We even learned that viruses were transmitted in serum, when we found that we were causing hepatitis in the soldiers we transfused to treat shock. The physician emerged for the first time in all of history with an ability to really effectively intervene in spectacular ways and to change the whole epidemiology of disease.
The post-World War II era also saw the creation of managed health care. In 1950, William Shannon published his famous concept of the National Institutes of Health (NIH). The first version of managed care also came out of World War II; in an effort to attract the best workers during the war's wage freeze, the Kaiser shipbuilding corporation offered a health-care plan to its employees. This experiment first taught employers that the better the benefits, the better the employees.
These three enormously powerful changes--the birth of feminism, increased physician skills and the beginnings of managed care--all emerged as the direct result of a piece of history, World War II.
