PROMOTING WOMEN'S HEALTH

Overview: To fulfill President Bush's vision of a healthier America, HHS Secretary Michael Leavitt developed a 500-day plan that reflects his priorities for the Department. Among his six focus areas, he will concentrate on supporting the First Lady's initiatives on helping America's youth and improving the health of women. Improving the health of all U.S. women and girls through research, education, and services is an integral component of the Secretary's plan. The Department's activities and programs focus on women's health throughout the lifespan, from infants to the elderly. (For more information on the Secretary's 500-day plan, visit www.hhs.gov/500DayPlan).

BACKGROUND

Girls and women represent almost 51 percent (or 143 million) of the total U.S. population of 281.4 million Americans.ⁱ More than 29 percent of these females, or 42.1 million, belong to racial and ethnic minority groups. They encompass five major groups: African American/Black, Hispanic/Latino, Asian, American Indian/Alaska Native, and Native Hawaiian/Other Pacific Islander. By 2050, the non-Hispanic White population will decline to about 53 percent, from its current level at 69 percent.

As we age, America becomes increasingly female. Women represent 60 percent of the over-65 population, the fasting growing segment of the U.S. population.ⁱⁱ Women also represent 68 percent of Americans older than 85, a population that grew by 29 percent between 1990 and 2000.ⁱⁱⁱ

Differences in health risks or outcomes can be a function of sex (whether you are male or female). Disparities may also be attributed to race/ethnicity, age, income, education, disability, literacy, and geographic location, among many other factors.

Although women belonging to racial/ethnic populations experience many of the same health problems as White women, as a group, they are in poorer health, they use fewer health services, and they continue to suffer disproportionately from premature death, disease, and disabilities. Many also face tremendous social, economic, cultural, and other barriers to achieving optimal health.

Eliminating, not just reducing, disparities among populations, is one of the nation's health goals. The U.S. Department of Health and Human Services will continue to advance policies and programs that address health and quality of life among all populations of girls and women. In support of the Administration's commitment to women's health, HHS will spend an estimated $8.3 billion on women's health in 2006. In addition, the Department will spend $77.5 billion in Medicare and Medicaid services, which predominantly aid women, for a total of $85.8 billion.^iv

BACKGROUND

Remarkable advances in medicine and health have occurred since the 1900s, when most people in this country did not live beyond their 48^th birthday. Since that time, the life expectancy of both women and men has increased dramatically. In 2003, U.S. women lived on average to the age of 80, while U.S. men lived on average to the age of 75.^v Although this is a 5-year gap in longevity, it has narrowed from 7 years just a decade ago. Men's reduced life expectancy is explained by the dominance of premature death from injury, and secondarily, by heart disease.

Several factors have contributed to longer lifespans:

• advances in medicine, such as the introduction of antibiotics and improved trauma care;
• achievements in public health, such as improved sanitation and better nutrition; and
• the development of a public health infrastructure, which increased women's access to health services, including prenatal care and immunizations.^vi

A 1990 General Accounting Office report found that HHS had made little progress since the mid-1980s in including women and minorities in clinical research trials funded by the U.S. government. Subsequently, the National Institutes of Health (NIH) established the Office of Research on Women's Health (ORWH). The HHS Assistant Secretary for Health then established the Office on Women's Health in the Office of the Secretary. By the mid-1990s, other agencies in HHS had either established offices of women's health or designated a liaison on women's health issues. Today, the HHS OWH coordinates the women's health activities of the agencies through its Coordinating Committee on Women's Health, which was established in 1985.

MORTALITY AND MORBIDITY

Historically, "women's health" has referred only to pregnancy and reproductive health services for women. When women had a lifespan 30 years shorter than today's women, this narrow definition made sense. Today, however, a woman's reproductive years from menarche to menopause comprise less than half of her life expectancy. Consequently, we must consider the health and well-being of women across their entire life span as well as the multidimensional factors that affect their health at each stage of their life.

Women living longer are at increased risk for acquiring one or more chronic (or long-term) conditions, such as heart disease, diabetes, some cancers, osteoporosis, urinary incontinence, and arthritis.^vii These conditions significantly affect an individual's ability to participate independently in some or all the activities of daily life, including eating, bathing, dressing, and walking across a room. The term disability refers to this limitation of activity, whether long term or short term, whether caused by an acute or chronic condition.^viii

As the number of older women is steadily rising, so is the number of women living with a disability. Individuals can acquire a disability through injury, illness, age, genetics, or other causes, or they can be born with a disability.^ix One in five people, or 54 million Americans, live with at least one disability. Almost one-half of them more than 28 million are women.^x Women are more likely than men to be limited in the amount or kind of major activity they can perform.^xi

For both women and men, heart disease and all forms of cancer are the top causes of death. Cerebrovascular diseases, chronic lower respiratory diseases, and Alzheimer's disease round out the top 5 for women. Unintentional injuries, cerebrovascular diseases, and chronic lower respiratory diseases round out the top 5 for men.

HHS ACTIVITIES

A sampling of HHS' principal women's health activities follow.

• The National Women's Health Information Center (NWHIC): This national information clearinghouse on women's health provides reliable, commercial-free information through its website (http://www.womenshealth.gov/) and its information referral center at 1-800-994-9662 (TDD: 1-888-220-5446). A keyword search on the website reveals federal, predominantly HHS, publications and agencies active in that health-related issue.
• GirlsHealth Website: The website (http://www.girlshealth.gov/) promotes healthy, positive behaviors in girls between the ages of 10 and 16. It uses an interactive, user-friendly format to provide information on fitness, nutrition, chronic illness and disability, stress management, relationships with friends and family, peer pressure, suicide, drugs, self-esteem, and other topics. The website also contains a 4Parents & Caregivers section and a 4Educators section.
• The Heart Truth Campaign: This national campaign educates the public, primarily women, about women's risk for heart disease. The Red Dress is the campaign's symbol, reinforcing the message that "heart disease doesn't care what you wear." Mrs. Bush is an official spokesperson for the campaign. A companion Heart Truth education campaign for health care providers is based on the new cardiology prevention guidelines for women developed by the American College of Cardiologists (ACC) and the American Heart Association (AHA). Visit the website at http://www.nhlbi.nih.gov/health/hearttruth/.
• The National Agenda for Public Health Action: The National Public Health Initiative on Diabetes and Women's Health: Developed by HHS and its partners, this national plan addresses the growing health epidemic of diabetes in women. It expands community-based health education programs, promotes risk assessment, supports quality care and self-management for diabetes and its complications, and encourages research into the factors that influence diabetes and women's health.Visit the website at http://www.cdc.gov/diabetes/pubs/action/index.htm.
• Well Integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN): Targeted to low-income, under- or uninsured women between 40 and 64, this program helps these women develop a healthier diet, increase physical activity, and quit using tobacco to prevent, delay and control cardiovascular and other chronic diseases. Operating at the local level in states and tribal organizations, it provides preventive screenings for the risk factors of chronic disease (such as blood pressure and cholesterol testing), lifestyle intervention, and referral services. Visit the website at http://www.cdc.gov/wisewoman.
• National Women's Health Indicators Database: This easy-to-use, web-based resource contains extensive health data on U.S. women and men. National, regional, state, and county data are available by age, race/ethnicity, and gender, all at the same time. Users can make their own tables, graphs, and even maps out of any data in the database. It is available through the website of the National Women's Health Information Center (http://www.womenshealth.gov/statedata/) or directly (http://www.healthstatus2010.com/owh/).
• Federal Portal to Breast Cancer Information: This website (http://www.hhs.gov/breastcancer/) serves as a focal point for the federal government's news and research on breast cancer. Users of the site will find information, links to other resources, and publications on the symptoms, treatment, and diagnosis of the disease; clinical trials and research; statistics; and reference collections.
• Women's Cancers Website: This award-winning federal website provides information about treatment, prevention, genetics, screening, clinical trials, literature, research, and statistics for cancers that occur mainly in women, as well as other cancers. Visit this website of the National Cancer Institute at http://www.cancer.gov/cancertopics/types/womenscancers.
• Family Violence Prevention & Services Program. This federal program, administered by HHS' Administration for Children and Families, funds shelters for battered women and their children, which house more than 300,000 women and children each year. It also funds a network of five domestic violence resource centers, including the National Resource Center on Domestic Violence; the Resource Center on Civil and Criminal Law (Battered Women's Justice Project); Health Resource Center on Domestic Violence; Resource Center on Child Protection and Custody; and the Resource Center for Indian Tribes. The National Domestic Violence Hotline (1-800-799-SAFE) provides victims of family violence with information and emergency assistance. Visit the website at http://www.acf.dhhs.gov/. The Substance Abuse and Mental Health Services Administration's (SAMHSA) National Center on Women, Trauma and Violence was established to develop trauma-informed systems of care to provide mental health services that address the impact of violence and trauma. For that resource, click here: www.mentalhealth.samhsa.gov/cmhs/womenandtrauma/about.asp
• National Women's Health Week: Sponsored by HHS, this national educational effort raises the public's awareness about the manageable steps all women can take to improve their health. Held in May each year in the week surrounding Mother's Day, events focus on the importance of incorporating simple preventive and positive health behaviors into everyday life. HHS, state and local governments, community partners, and public and private organizations promote and plan activities, including preventive health screenings. For more information, visit http://www.womenshealth.gov/whw/.
• Preventive Health Benefits for Women: The Centers for Medicare and Medicaid Services, within HHS, now offers coverage for several preventive benefits for women, including screenings for cardiovascular disease, diabetes, mammography, cervical cancer, and colorectal cancer. It offers immunizations such as influenza and pneumococcal, bone mass measurement, diabetes management, and counseling for smoking cessation. Search the website at http://www.cms.hhs.gov/. New prescription drug coverage under Part D of Medicare will also cover women beneficiaries. (Visit http://www.medicare.gov/ for more information.)
• Health Promotion: The Bright Futures for Women's Health and Wellness Initiative, an ongoing project of HHS' Health Resources and Services Administration (HRSA), recently released a set of tools designed to promote physical activity and healthy eating among adolescent girls and adult women. Accessible online at http://www.hrsa.gov/WomensHealth, the publications include guides, wallet cards and tip sheets on reaching health goals, guidelines for community organizations on organizing health-promotion activities, and materials for primary care providers.
• Women's Health USA 2005, also available at http://www.hrsa.gov/WomensHealth, looks at emerging issues and trends in the women's health, with a focus on racial and ethnic disparities. The publication collects current and historical data on some of the most pressing health challenges facing women, such as teen pregnancy, HIV/AIDS and cancer, and serves as a concise reference for policymakers and program managers.

ⁱU.S. Census Bureau, data for 2002.
ⁱⁱPopulation Resource Center, Older Women and Poverty: A Demographic Profile, March 2005. http://www.prcdc.org/summaries/AgingSeries05/womenandpoverty.html
ⁱⁱⁱPopulation Resource Center, Distinguishing Traits of America's Older Populations, February 2005. http://www.prcdc.org/summaries/index.html#Demographic
^ivU.S. Department of Health and Human Services, FY2006 Moyer Material, Submitted by the Office of the Assistant Secretary for Budget, Technology and Finance. February 7, 2005.
^vCenters for Disease Control and Prevention, National Center for Health Statistics. "Life Expectancy Hits Record High: Gender Gap Narrows," CDC Fact Sheet, February 28, 2005. http://www.cdc.gov/od/oc/media/pressrel/fs050228.htm
^viOffice on Women's Health, U.S. Department of Health and Human Services, A Century of Women's Health: 1900-2000, pp. 1-2, and Weisman, Carol S., Women's Health Care: Activist Traditions and Institutional Change, The Johns Hopkins University Press, 1998, p. 51.
^viiAccess to Disability Data. Funded by the National Institute on Disability and Rehabilitation Research. Chartbook on Women and Disability. As of November 15, 2005. http://www.infouse.com/disabilitydata/womendisability/appendices_glossary.php?print=yes
^viiiAccess to Disability Data.
^ixHHS, The Surgeon General's Call to Action to Action to Improve the Health and Wellness of Persons with Disabilities, Fact Sheet, "What Is Disability? Who Is Affected by Disability?". http://www.surgeongeneral.gov/library/disabilities/calltoaction/factsheetwhatwho.html.
^xU.S. Department of Health and Human Services, Office on Disability, Office on Women's Health. "Breaking Down Barriers to Health Care for Women with Disabilities: A White Paper from a National Summit." December 2004. Washington, DC. http://www.hhs.gov/od/120604meeting.html.
^xiHHS/Office on Women's Health. National Centers of Excellence in Women's Health. Chronic Illness and Disability. September 2001. http://www.womenshealth.gov/COE/pubs/pamphlets/ChronicIllness.pdf

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Note: All HHS press releases, fact sheets and other press materials are available at http://www.hhs.gov/news.

Last Revised: February 22, 2006