1 History and Current Issues in Women’s Health

Chapter Objectives:

  • Outline events that had, or continue to have, a significant impact on women’s health
  • Explore topics that impact your own personal health
  • Discuss current issues regarding health care for women in the US
  • Explore how health care options for women in the US compare to healthcare options in other countries
  • Explore factors that impact a woman’s access to quality and affordable health care
  • Identify criteria for finding valid and reliable health information on the Internet

Women’s Health History

I’m interested in women’s health because I am a woman. I would be a darn fool to not be on my own side. ~Maya Angelou

Communities and countries and ultimately the world are only as strong at the health of their women. – Michelle Obama

Development of Women’s Health Care in the US

purple and white textile with i m a big print

If you had to pick just one, what event, discovery, development or invention do you feel has had the greatest impact on women’s health? Ideas such as birth control or women’s right to vote, Roe vs Wade or even Title IX may quickly come to mind. What about safe birthing practices or the women’s health movement of the 1970’s?  Consider that women from minority groups are now better represented in the health care field? In reading the following articles about the history of health care in the US, reflect on how our choices today may be different if not for these developments.

Article: History of Women’s Health Movement in the 20th Century

Understanding Personal Health History

Considering how significant events in our collective health history impact resources and accessibility is the first step. Next, we need to explore how current health accessibility, education, and regulations impact our personal wellness and health choices today. As you begin to ask yourself about choices you make for your health now and information you will need for future health choices, it is important to explore criteria for defining health and wellness as well as understanding how to  seek valid and reliable sources of health information.

Broad Perspectives of Health

The most widely used of the broader definitions of health if from the World Health Organization (WHO), which defines health “a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity”. This classic definition is important, as it identifies the vital components of health. Well-being includes the presence of positive emotions and moods, the absence of negative emotions, satisfaction with life, fulfillment and positive functioning. In simple terms, well-being can be described as judging life positively and feeling good. Well-being is associated with numerous health, job, family, and economically related benefits. For example, higher levels of well-being are associated with decreased risk of disease, illness, and injury; better immune functioning; speedier recovery; and increased longevity. Individuals with high levels of well-being are more productive at work and are more likely to contribute to their communities. Many practitioners have expanded their focus to include wellness at the positive end of the health continuum. Wellness is being in good physical and mental health. Because mental health and physical health are linked, problems in one area can impact the other. At the same time, improving your physical health can also benefit your mental health, and vice versa. It is important to make healthy choices for both your physical and mental well-being. Remember that wellness is not just the absence of illness or stress. One can still strive for wellness even while experiencing these challenges in life. To more fully understand the meaning of health, it is important to understand each of its individual components of wellness.

The Six Dimensions of Wellness

Think of each dimension as a continuum that can include more healthful or less healthful behaviors. Goals can be set to move each individual marker towards better balance rather then expecting perfection in all areas.

Physical

Body functioning; recognizing the need for physical activity, healthy foods, and adequate sleep. Avoiding unhealthy habits.

Social

Developing a sense of connection, belonging, and sustained support system. Having positive relationships

Intellectual

Recognizing creative abilities and finding ways to expand knowledge and skills. Being open-minded.

Emotional

Coping effectively with life and expressing emotions in an appropriate manner.

Spiritual

Having a sense of purpose and meaning in life; establishing peace, harmony, and balance in our lives.

Environmental

Occupying pleasant, healthy, and safe environments that support wellbeing. Positively impacting the quality of our surroundings (including protecting and preserving nature).

 

Learning about the Six Dimensions of Wellness can help a person choose how to make healthful choices a part of everyday life. Wellness strategies are practical ways to start developing healthy habits that can have a positive impact on physical and mental health.

Determinants of Health

The range of personal, social, economic, and environmental factors that influence health status are known as determinants of health. What makes some people healthy and others unhealthy? We may know what actions promote health but for various reasons may not have access to the tools necessary to make long term, positive changes. How can we create a society in which everyone has a chance to live a long, healthy life?

Determinants of health are factors that contribute to a person’s current state of health. These factors may be biological, socioeconomic, psychosocial, behavioral, or social in nature. Scientists generally recognize five determinants of health of a population:

Policymaking

Policies at the local, state, and federal level affect individual and population health. Increasing taxes on tobacco sales, for example, can improve population health by reducing the number of people using tobacco products.

Some policies affect entire populations over extended periods of time while simultaneously helping to change individual behavior. For example, the 1966 Highway Safety Act and the National Traffic and Motor Vehicle Safety Act authorized the Federal Government to set and regulate standards for motor vehicles and highways. This led to an increase in safety standards for cars, including seat belts, which in turn reduced rates of injuries and deaths from motor vehicle accidents.

Does all policy contribute positively to health for all? We will be exploring this question more in future chapters.

Social Factors

Social determinants of health reflect the social factors and physical conditions of the environment in which people are born, live, learn, play, work, and age. Also known as social and physical determinants of health, they impact a wide range of health, functioning, and quality-of-life outcomes.  Examples of social determinants include:

  • Availability of resources to meet daily needs, such as educational and job opportunities, living wages, or healthful foods
  • Social norms and attitudes, such as discrimination
  • Exposure to crime, violence, and social disorder, such as the presence of trash
  • Social support and social interactions
  • Exposure to mass media and emerging technologies, such as the Internet or cell phones
  • Socioeconomic conditions, such as concentrated poverty
  • Quality schools
  • Transportation options
  • Public safety
  • Residential segregation

Examples of physical determinants include:

  • Natural environment, such as plants, weather, or climate change
  • Built environment, such as buildings or transportation
  • Worksites, schools, and recreational settings
  • Housing, homes, and neighborhoods
  • Exposure to toxic substances and other physical hazards
  • Physical barriers, especially for people with disabilities
  • Aesthetic elements, such as good lighting, trees, or benches

Poor health outcomes are often made worse by the interaction between individuals and their social and physical environment.  For example, millions of people in the United States live in places that have unhealthy levels of ozone or other air pollutants. In counties where ozone pollution is high, there is often a higher prevalence of asthma in both adults and children compared with state and national averages. Poor air quality can worsen asthma symptoms, especially in children.

Health Services

Both access to health services and the quality of health services can impact health. Healthy People 2020 directly addresses access to health services as a topic area and incorporates quality of health services throughout a number of topic areas.

Lack of access, or limited access, to health services greatly impacts an individual’s health status. For example, when individuals do not have health insurance, they are less likely to participate in preventive care and are more likely to delay medical treatment.

Barriers to accessing health services include:

  • Lack of availability
  • High cost
  • Lack of insurance coverage
  • Limited language access

These barriers to accessing health services lead to:

  • Unmet health needs
  • Delays in receiving appropriate care
  • Inability to get preventive services
  • Hospitalizations that could have been prevented
Individual Behavior

Individual behavior also plays a role in health outcomes. For example, if an individual quits smoking, his or her risk of developing heart disease is greatly reduced. Many public health and health care interventions focus on changing individual behaviors such as substance abuse, diet, and physical activity. Positive changes in individual behavior can reduce the rates of chronic disease in this country.

Examples of individual behavior determinants of health include:

  • Diet
  • Physical activity
  • Alcohol, smoking, vaping, and other drug use
  • Hand washing
Biology and Genetics

Some biological and genetic factors affect specific populations more than others. For example, older adults are biologically prone to being in poorer health then adolescents due to the physical and cognitive effects of aging.

Sickle cell disease is a common example of a genetic determinant of health.  Sickle cell is a condition that people inherit when both parents carry the gene for sickle cell. The gene is most common in people with ancestors from West African countries, Mediterranean countries, South or Central American countries, Caribbean islands, India, and Saudi Arabia.

Examples of biological and genetic social determinants of health include:

  • Age
  • Sex
  • HIV status
  • Inherited conditions, such as sickle-cell anemia, hemophilia, and cystic fibrosis
  • Carrying the BRCA1 or BRCA2 gene, which increases risk for breast and ovarian cancer
  • Family history of heart disease

Health Disparities

Although the term disparities is often interpreted to mean racial or ethnic disparities, many dimensions of disparity exist in the United States, particularly in health. If a health outcome is seen to a greater or lesser extent between populations, there is disparity. Race or ethnicity, sex, sexual identity, age, disability, socioeconomic status, and geographic location all contribute to an individual’s ability to achieve good health. It is important to recognize the impact that social determinants have on health outcomes of specific populations. Healthy People strives to improve the health of all groups.

To better understand the context of disparities, it is important to understand more about the U.S. population. In 2008, the U.S. population was estimated at 304 million people.

  • In 2008, approximately 33%, or more than 100 million people, identified themselves as belonging to a racial or ethnic minority population.
  • In 2008, 51%, or 154 million people, were women.
  • In 2008, approximately 12%, or 36 million people not living in nursing homes or other residential care facilities, had a disability.
  • In 2008, an estimated 70.5 million people lived in rural areas (23% of the population), while roughly 233.5 million people lived in urban areas (77%).
  • In 2018, an estimated 4% of the U.S. population ages 18 to 44 identified themselves as lesbian, gay, bisexual, or transgender.

Healthy People 2020 defines health equity as the “attainment of the highest level of health for all people”. Achieving health equity requires valuing everyone equally with focused and ongoing societal efforts to address avoidable inequalities, historical and contemporary injustices, and the elimination of health and health care disparities.”

Health disparities adversely affect groups of people who have systematically experienced greater obstacles to health based on their racial or ethnic group; religion; socioeconomic status; gender; age; mental health; cognitive, sensory, or physical disability; sexual orientation or gender identity; geographic location; or other characteristics historically linked to discrimination or exclusion.”

Over the years, efforts to eliminate disparities and achieve health equity have focused primarily on diseases or illnesses and on health care services. However, the absence of disease does not automatically equate to good health. Powerful, complex relationships exist between health and biology, genetics, and individual behavior, and between health and health services, socioeconomic status, the physical environment, discrimination, racism, literacy levels, and legislative policies. These factors, which influence an individual or population’s health, are known as determinants of health.

For all Americans, other influences on health include the availability of and access to:

  • High-quality education (including quality health education)
  • Nutritious food
  • Decent and safe housing
  • Affordable, reliable public transportation
  • Culturally sensitive health care providers
  • Health insurance
  • Clean water and non-polluted air

Risk Factors and Levels of Disease Prevention

Part of learning how to take charge of one’s health requires understanding risk factors for different diseases. Risk factors are things in life that increase your chances of getting a certain disease. Some risk factors are beyond your control. A person may be born with them or have exposure with no fault assigned.

Some risk factors that you have little or no control over include:

  • Family history of a disease
  • Sex
  • Ancestry

Some controllable risk factors include:

  • What you eat
  • How much physical activity you get
  • Whether you use tobacco or vape
  • How much alcohol you drink
  • Whether you misuse drugs
bowl of vegetable salads

In fact, it has been estimated that almost 35 percent of all U.S. early deaths in 2000 could have been avoided by changing just three behaviors:

  • Stopping smoking
  • Eating a healthy diet (for example, eating more fruits and vegetables and less red meat)
  • Getting more physical activity

A person can have one risk factor for a disease or  many. The more risk factors a person has, the more likely they will get the disease. For example, if people eat healthy, exercise on a regular basis, and control blood pressure, their chances of getting heart disease are less than those of diabetics, smokers, and sedentary people. To lower your risks, take small steps toward engaging in a healthy lifestyle, and you’ll see big rewards.

People with a family health history of chronic disease may have the most to gain from making lifestyle changes. You can’t change your genes, but you can change behaviors that affect your health, such as smoking, inactivity, and poor eating habits. In many cases, making these changes can reduce your risk of disease even if the disease runs in your family. Another change you can make is to have screening tests, such as mammograms and colorectal cancer screening. These screening tests help detect disease early. People who have a family health history of a chronic disease may benefit the most from screening tests that look for risk factors or early signs of disease. Finding disease early, before symptoms appear, can mean better health in the long run.

Levels of Disease Prevention

Prevention includes a wide range of activities — known as “interventions” — aimed at reducing risks or threats to health. You may have heard researchers and health experts talk about three categories of prevention: primary, secondary and tertiary. What do they mean by these terms?

Primary prevention aims to prevent disease or injury before it ever occurs. This is done by preventing exposures to hazards that cause disease or injury, altering unhealthy or unsafe behaviors that can lead to disease or injury, and increasing resistance to disease or injury should exposure occur. Examples include:

  • Legislation and enforcement to ban or control the use of hazardous products (e.g. asbestos) or to mandate safe and healthy practices (e.g. use of seatbelts and bike helmets)
  • Education about healthy and safe habits (e.g. eating well, exercising regularly, not smoking)
  • Immunization against infectious diseases.

Secondary prevention aims to reduce the impact of a disease or injury that has already occurred. This is done by detecting and treating disease or injury as soon as possible to halt or slow its progress, encouraging personal strategies to prevent re-injury or recurrence, and implementing programs to return people to their original health and function to prevent long-term problems.

Examples include:

  • Regular exams and screening tests to detect disease in its earliest stages (e.g. mammograms to detect breast cancer)
  • Daily, low-dose aspirins and/or diet and exercise programs to prevent further heart attacks or strokes
  • Suitably modified work so injured or ill workers can return safely to their jobs.

Tertiary prevention aims to soften the impact of an ongoing illness or injury that has lasting effects. This is done by helping people manage long-term, often-complex health problems and injuries (e.g. chronic diseases, permanent impairments) in order to improve as much as possible their ability to function, their quality of life and their life expectancy. Examples include:

  • Cardiac or stroke rehabilitation programs, chronic disease management programs (e.g. for diabetes, arthritis, depression, etc.)
  • Support groups that allow members to share strategies for living well
  • Vocational rehabilitation programs to retrain workers for new jobs when they have recovered as much as possible.

Current Issues in Women’s Health

Understanding health history, factors that influence wellness and behaviors that improve personal wellness  all contribute to a persons current state of health. Now, lets look at current issues or policy in our society that impact a person’s access to health care or influence health care choices.

Podcast: How the US Fails Women When it Comes to Health

Valid and Reliable Health Resources

How can you learn more about your own personal health history, disparities, risk factors and possible impact on your life now?  As you begin to seek information to improve your own wellness, it is important to understand where to find reliable health information. As you know, anyone can create a a web page and post any information they choose for public perusal. Some of this information, subtly or not so subtly, may have an ulterior motive in selling products, influencing your actions or even your vote. So, when looking for information to care for your own health, how do you discern useful and accurate information from the rest? In other words, who are you willing to trust with your health?

Article: How To Find Reliable Health Information on the Internet

Interactive Tool: Trust It or Trash It

Check for Understanding

  1. Reflecting on the reading, what event, development or discovery do you feel has had the greatest impact on women’s health?
  2. What current issues in women’s health are of particular interest to you and why?
  3. What are the dimensions of wellness and how might these factors influence each other?
  4. What are the determinants of health and give examples of how these determinist may impact your personal health.
  5. What is a risk factor an what is the difference between uncontrollable and controllable risk factors?
  6. What are the three levels of disease prevention?
  7. How does US health care compare to that of other developed countries? Name one area the US is doing well and one area we are failing.
  8. What factors might impact a woman’s access to quality, affordable health care?
  9. When researching health information online, what are at least 4 things you should know about the article to judge validity and reliability?

 

License

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Women's Health by Dawn Markell is licensed under a Creative Commons Attribution 4.0 International License, except where otherwise noted.

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