Chapter 1 Lecture

Introducing Women’s Health

Why Focus on Women’s Health?

  • Women are different than men
  • Many general health texts relay information from studies based on male standards
  • Besides the physiological concepts, areas such as mental, emotional, and spiritual dimensions of women need to be addressed
  • Women Health issues are also important!!

Emphasis on Health Promotion

  • Health is something to be nurtured in order to prevent illness and disease
  • 3 common types of health actions are:
    • Proactive care: reduction of risks by lifestyle
    • Health care maintenance: continuation process
    • Reactive care: treatment of illness Women’s Health in a Global Society

The greatest emphasis in health promotion is placed on proactive care

Women's Health in a Global Society

  • Women around the world share many common health concerns
  • Women from many countries still experience difficulties with several health issues not experienced in the United States
  • Two important concepts to consider regarding women’s health:
    • Sexism (biased against gender)
    • Misogyny (hatred towards women)

Women’s Health Movement in the United States

  • The formal concept of ‘midwives’ started in Ancient Greece/Rome
  • During the 16th Century, professional schools of midwifery were established in Europe
  • Dr. James Sims (1813-1883) was instrumental for accepting gynecology as a medical specialty
  • Elizabeth Blackwell (1821-1910) was the first woman to receive a medical degree in the United States, founded the New York Infirmary for Women and Children in 1857 and a Women’s College for doctors
  • Dorothea Dix was one of the best-known early nurses, helping to reform institutions for the mentally ill
  • The first training school for nurses was established in 1873
  • Louise McManus (1896-1993) was the first nurse to earn a PhD in the U.S. and developed a “Patients Bill of Rights”
  • The hospice movement was brought to the U.S. by Florence Wald
  • Margaret (Higgins) Sanger (1883-1966) was the American leader in the birth control movement
  • Mary Breckinridge (1881-1965) was the first American to establish midwifery as a profession
  • The late 1960s brought a civil rights movement, sparking issues on women’s health issues (Boston Women’s Health Collective). Books were authored to inform about women’s health, which empowered women to make informed choices about their own bodies (Our Bodies, Ourselves)
  • The first women’s health conference occurred in March (1971) in New York, which challenged traditional treatment of women by the medical profession
  • The National Women’s Health Network was founded in 1975

The Women’s Social Movement

  • The U.S. women’s rights movement was born during the drive for the abolition of slavery (19th Century)
  • The first women’s rights convention was organized in Seneca Falls, New York (July, 1848)
  • Elizabeth Stanton (1815-1902) and Susan B. Anthony (1820-1906) were considered the very first feminists in the U.S. and helped initiate changes in laws for women
  • Liberal feminism is a philosophy that sees the oppression of women as a denial of equal rights, representation, and access to opportunities
  • Betty Friedan was instrumental for the second feminist movement during the 1960-70’s
  • She helped found the National Organization for Women (NOW) and supported the Equal Rights Amendment for women
  • Since then, legislation designed to protect the rights of women and minorities in the United States have been passed

Legislation for Women and Minorities

  • Examples of Legislation made to protect women and minorities:
    • 19th Amendment: (1920) Women can vote
    • Title VII of the Civil Rights Act: (1964) prohibits employment discrimination based on race, color, religion, sex, national origin
    • Equal Pay Act: (1963)
    • Americans with Disabilities Act: (1990)
    • The Family and Medical Leave Act: (1992) authorized 12 weeks of job-protected leave
    • Violence Against Women Act (VAWA): (1994)
    • Title X of the Public Health Service Act: (1970) it is the only federal program dedicated solely to family planning and reproductive health

Sexual Discrimination

  • Sexual discrimination in wages/salaries became illegal in 1963 and sexual discrimination in employment decisions became illegal in 1964.
  • Pregnancy Discrimination Act of 1978 - a woman could no longer be denied employment or filed because of her pregnancy. Health care coverage was also protected.
  • Equal Pay Act (1963)
    • In response to the continuing existence of a gender pay gap, on April 19, 2005, the Paycheck Fairness Act was introduced.
    • The gender wage gap is still significant, but gradual decreases in the gap are occurring over time.
  • Another form of sexual discrimination is the denial of prescription drugs to women for reproductive health concerns (i.e. birth control & emergency contraception).
  • Sexual harassment is unwanted sexual advances, requests for sexual favors, and other verbal/physical conduct of sexual nature that negatively affects the work environment.
    • This term dates back to 1975, after Carmita Wood quit working because the repeated sexual advances of her boss made her physically ill. Lin Farley discovered her case and coined the term “sexual harassment” along with two of her colleagues to describe the phenomenon.

    • Jenson v. Eveleth: made corporate America take real note of sexual harassment in the work-place for the first time and ensured that women should never have to stand alone when faces with a hostile work environment.

  • Additional constructs related to discrimination against women:

    • Homophobia: fear/dislike of a person who is homosexual
    • Heterosexism: a belief/attitude that results in bias/discrimination toward anyone who is not heterosexual
    • Heterosexism is highly prevalent in the U.S.. Countries like Canada and Spain have become social justice role models with equal rights for gays and lesbians.

Disparities in Access to Healthcare

  • According to the National Healthcare Disparities Report 2010

    • Costs of poor health among uninsured people is $65 to $130 billion annually
    • People least likely to have health insurance:
      • Poor
      • Less educated
      • Non-English speakers

  • According to the National Healthcare Disparities Report 2010:

    • One in five Americans lives in a nonmetropolitan area

      • Less likely to seek preventative care
      • Fewer doctors in rural areas

Health Issues for Minority Women

  • 50.8% of the population is female
  • 2010 Census estimates female distribution
    • 79% White
    • 13% Black or African American
    • 4.6% Asian
    • 1% American Indian of Alaska Native
    • 0.18% Native Hawaiian or Pacific Islander

  • Hispanic or Latino Women

    • Lack of access to health care was most prevalent among women who had poor poverty status, less than a high school diploma, or were foreign born.
    • The language barrier may inhibit access to/quality of care and those who immigrate illegally may be hesitant to access health care services.
    • Lack of materials in Spanish explaining the benefits of an active-lifestyle and economic barriers to accessing fitness facilities may contribute to the problem.
    • Puerto Ricans are disproportionately likely to have AIDS.

  • African American Women

    • Morbidity/Mortality rates for women from cancer, HIV/AIDS, pneumonia, and homicide exceed those for whites.
    • More black women live in poverty in the U.S. than any other group of women. Inadequate income leads to inadequate housing, improper nutrition, chronic stress, dangerous jobs, violence and reduced access to medical care.
    • Factors identified as barriers to cancer diagnosis care: poor access to health care services, lack of education and knowledge of cancer prevention/screening, mistrust of the health care system, etc.
    • Stress related to racism has been linked to the high rates of high blood pressure in blacks.
    • The mortality rate for infants is higher among black women than white women.
    • Black women represent 64% of AIDS cases reported among women.

  • Asian Women

    • Asian American women overall exhibit healthful lifestyle behaviors. Health risks that exist vary among subgroups.
    • Smoking is low compared to all American women.
    • Lack of knowledge about cancer for some Asian American subgroups contributes to a failure to get regular screening.
    • Fear of difficulties in communicating, along with shame, guilt, anger, depression, and other responses to certain stigmatized conditions like mental illness and substance abused often deter them from seeking care promptly.

  • Native American Indian and Alaskan Native Women

    • Native Americans are highly suspicious of authority because of their history with the white government.
    • The Indian Health Services (IHS), provides health care through clinics and hospitals to all who belong to a federally recognized tribe and live on or near the reservations. 46% of all American Indians/Alaska Natives have no access to IHS facilities.
    • Racism/discrimination among Native has led to low-esteem and contributed to the incidence of poverty.
      • Poverty and unemployment have fostered a welfare dependence and diets that consist of government commodity foods which are high in fat and calories. 77% of men and 61% of women are reported to be overweight and at risk of diabetes.
    • Lack of a safe water supply or sewage disposal also places them at risk of illness and disease.
    • Family violence is highly problematic and death rates associated with alcoholism are much higher among these women than among women of all races.

  • Native Hawaiian or Other Pacific Islander Women

    • The ORWH reported in 2006 that the health problems of Native Hawaiians reflect their socioeconomic status with nearly 15 percent living well below the poverty level.
    • In one study, Native Hawaiians ranked highest in behavioral risk factors such as being overweight, smoking and excessive use of alcohol, but no in risk factors such as physical inactivity.
    • Many often enter medical treatment at late stages of disease, seeking medical treatment only when self-care and traditional practiced have not brought sufficient relief. This also applies to prenatal care for women.
    • Heart disease and cancer are the major causes of death.

  • Adolescent Females

    • Teenagers of color comprised more than ½ of all adolescents whose families had incomes in the poverty level.
    • Adolescents have low rates of physical contact/medical examinations.
    • According to the ORWH, females are about twice as likely as males to report severe depressive symptoms and to consider/attempt suicide. Young Asian women have the highest depression rates.
    • Adolescents are more likely to participate in behaviors with a high health risk such as: unprotected sexual intercourse, substance use or abuse, and operating a motor vehicle in an unsafe manner.
    • High rates of teen pregnancy are found among young Hispanic and black women.

  • Elderly Women

    • The Women’s Health USA, 2007 reported that employment plays a significant role in the lives of many older Americans.
    • The health of elderly women of color reflects the disadvantages they face because of their gender and their color. These include limited resources available throughout their lives to meet health care needs. This may cause them to have to work longer in their life and may limit their ability to afford health care or medication.
    • Elderly women are likely to be widowed and thus live alone and be heads of households.
    • Medicare is a federal government program that subsidizes health care costs for the elderly, but Medicare does nor cover all of the expenses incurred by the elderly population.
    • Functional disabilities, limitations in activities of daily living, are more frequent in elderly people of color. Arthritis and osteoporosis are common.
    • For all elder women, hearing and vision disabilities associated with age may interfere with a desire or ability to travel to health care facilities.

  • Ethnic, Class, and Gender Bias in Health Research

    • Historically, a majority of health studies have been performed with white, middle-class, young to middle-aged males
    • The National Institutes of Health (NIH) was placed under investigation (1990) for failing to include female subjects in health studies, dictating diagnostic and prescriptive guidelines for men and women
    • Gender and Ethnic Bias is common and present in health research
    • Socio-economics still provides a deterrent for quality health care for the poor as well as geographic differences Women’s Health Research
    • Historically, research for women only focused on diseases affecting fertility and reproduction
    • Other disease research has focused disproportionately on men
    • Women have been excluded from many health studies, regarding women health issues due to:
      • Concerns about pregnancy during the trials
      • Changing hormone levels could skew test results
    • The NIH established the Office of Research on Women’s Health (ORWH) to identify gaps in women’s health research (1990)
    • The ORWH launched the Women’s Health Initiative (1991), long term study that focuses on heart disease, osteoporosis, breast, and colorectal cancer strategies, especially in post-menopausal women

Healthy People 2000: National Health Promotion and Disease Prevention Objectives

  • Three primary goals to improve the public’s health and pay special attention to women were:
    1. Increase the span of healthy life for Americans
    2. Reduce health disparities among Americans
    3. Achieve access to preventive services for all Americans

U.S. Dept. of Health and Human Services, 1990

Healthy People 2010

  • The latest revisions, Healthy People 2010 has two primary goals:
    • Increase the quality and years of healthy life
    • Eliminate health disparities
  • Healthy People 2010 “challenges individuals, communities, and professionals to take specific steps to ensure that good health, as well as long life, are enjoyed by all”
  • See healthypeople.gov Links to an external site. for Healthy People 2012