Are Women Getting The Health Care They Need?
by Betty Soldz
To respond to that question, a recent national report "Making The Grade on Women's Health: A National and State by State Report Card" * would lead us to believe they are not.
In order to meet the health care needs of women, there needs to be a comprehensive understanding of several interrelated issues:
- financial access to healthcare services
- the understanding by providers and employers of the different needs of men and women
- an understanding of the quality and outcomes of health services provided to women
Some of the obstacles that preclude good healthcare for women are:
- lack of health insurance
- women's caregiving responsibilities
- lack of flexible work schedules
- limited transportation
- lack of sufficient programs to educate women on health issues
- lack of enough research on women's health issues.
Many women lack health insurance from employers and, because of their low wages, can not afford to purchase insurance. The best way to protect all women would be for us to have a Universal Health System covering all citizens.
Without respite assistance caregivers may not be able to leave the person they are caring for during the limited office hours some physicians now keep Only a good system of respite care will solve the problem of women caregivers finding time to care for their own health. Improving access for routine appointments with flexible office hours would be helpful for both working women and caregivers. Although more employers now understand the need for flexible work schedules, many do not understand this need and how it affects the healthcare of women.
Medical offices convenient to transportation are imperative for the elder woman or any woman who does not drive. Lastly, more programs to educate women on health problems and preventive care are needed. The following is one example of inadequacy in education on women's health: While twenty percent of women nationally are affected by osteoporosis only 26 states have state funded education programs to address this. Teaching women to control chronic conditions such as high blood pressure can help reduce the risk of heart disease and stroke. Understanding the need to consider having a mammogram can save one's life.
Historically, not enough medical research has been done on women. We now know that there are many health conditions that are different for women and men. One example is heart disease, a condition which is harder to diagnose in women. Although the National Institutes of Health published guidelines for research on women's health in 1994**, much of the health research still being done does not focus specifically on women. Women should be equally represented in clinical trials for new health care products. Then we need to reach out to alert women to their unique health care risks.
There was one longitudinal study of aging which began in 1958 (Baltimore Longitudinal Study on Aging*** ) which demonstrates the significance research can have on women's health. The findings, according to the National Institute on Aging, suggest ways to delay, reduce, or even reverse increasing vulnerability to disease and frailty with age. This study was the first to report that estrogen replacement therapy may protect against Alzheimer's disease and memory decline associated with cognitive aging. There is also evidence that estrogen replacement therapy has a beneficial effect on learning in postmenopausal women. In the area of disease, it was found that women over the age of 55 may have no immunity to tetanus which may mean that immunization guidelines need to be revised. More research of this kind needs to be done.
We know that women are not receiving good health care when only 25 percent of women over the age of 50 are screened for colon cancer and only nine percent of women 65 and older, under Medicare, had a bone density test in the last two years to detect osteoporosis. Also, many insurers do not cover a baseline bone density test for women under 65 even though we now know that such a baseline test is prudent in order to be able to measure bone loss as we age.
As women's longevity increases, it is imperative to also increase the quality of life. Now that the national election is over we should work to hold our politicians accountable to creating programs and policies that will improve women's health care. Some issues to be addressed are: Universal Health Coverage, preventive health screenings, mental health parity which would provide coverage of mental disorders on the same basis as physical disorders, Medicare coverage for prescription drugs, education to promote good health, more research on women's diseases and respite care for caregivers. Only when we address all of these issues will women get the health care they need.
*(Making the Grade on Women's Health was developed jointly by the National Women's Law Center, FOCUS on Health & Leadership for Women at the Center for Clinical Epidemiology and Biostatistiics at the University of Pennsylvania School of Medicine and the Lewin Group, August 2000)
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