Rep. Capps stressed that while screening is available to test for many conditions, patients must have access to a health care professional in order to secure screening, so making sure that access to care is available to newly insured patients across the country remains a critical goal. Knowing about diseases and risk factors provides individuals with the opportunity to notice a problem early and to take action. She emphasized that health care providers require education to spot unique warning signs and women need support because they all too often put their families and jobs ahead of their own health.

Rep. Capps said that additional research is needed to examine how disease is manifested in women and to ensure that treatments work in women. The Congresswoman concluded by saying that with this new holistic approach to health care, we are on track to reverse the trend of declining mortality in women. However, we still have a lot more work to do.

Speakers
Cindy Hall introduced Susan Dentzer, senior policy adviser to RWJF. One of the nation’s most respected thought leaders on health care, Ms. Dentzer is a health care expert featured on the PBS NewsHour. From 2008 to 2013, she served as editor-in-chief of Health Affairs, the nation’s leading peer reviewed health policy journal.

Susan Dentzer of Robert Wood Johnson Foundation

Ms. Dentzer opened by saying that Americans are at a distinct disadvantage relative to their peers in other high-income countries when it comes to life expectancy and mortality. A study released by the Institute of Medicine (IOM) in January 2013, US Health in International Perspective: Shorter Lives, Poorer Health, reported that Americans on average have shorter lives than their peers in other high-income countries. This study also demonstrated that Americans have a longstanding pattern of poorer health than their peers that is strikingly consistent and pervasive over the life course from birth to old age.

To delve more deeply into mortality trends for women and men in the US, Ms. Dentzer highlighted findings from a county-based study published in 2013 and conducted by David A. Kindig and Erika R. Cheng, Even As Mortality Fell in Most US Counties, Female Mortality Nonetheless Rose in 42.8 Percent of Counties from 1992-2006 (Health Affairs, March 2013). This study — the first to examine the socioeconomic and behavioral correlates of mortality change at the county level in recent years — compares trends in male and female mortality rates in 3,140 counties from 1992-96 and from 2002-06. The authors' analysis shows that female mortality rates increased in 42.8 percent of counties during this period, while male mortality rates declined in most counties and increased in only 3.4 percent of counties. The counties with high mortality rates were located in parts of the country commonly thought of as the "stroke belt" — such as Appalachia, Florida, and the Gulf Coast — as well as areas in the northern Midwest, Northern California, and the Northwest. This study found that counties with lower mortality rates had higher educational levels and lower smoking rates while those with higher mortality rates were characterized by high obesity rates.

Ms. Dentzer underscored that declining mortality for women represents a stunning reversal from the marked improvements in life expectancy that occurred over the 20th century. This trend among women is in all likelihood the result of a  'toxic stew' of many factors that include: toxic stress (fallout from adverse childhood events such as sexual abuse);  socioeconomic stressors (low-wage jobs, poor economic growth, etc.);  high rates of smoking and obesity;  poor diet and lack of exercise;  chronic illnesses (diabetes, hypertension, and heart disease);  injuries, such as falls or car accidents;  and prescription drug abuse and overdoses. Ms. Dentzer concluded with several recommendations: 1) more research to fully understand the causes and drivers of increased mortality rates among women, 2) development and testing of new interventions, 3) use of existing and proven interventions (e.g., prevention of obesity and diabetes, and reduction in prescription drug abuse), 4) coordination of health care providers and the public health system, and 5) employment of population health approaches and a stronger focus on the upstream determinants of health (e.g., low incomes) in order to build a Culture of Health.

Ms. Dentzer then introduced the two panelists: Dr. Nora D. Volkow (director of the National Institute of Drug Abuse [NIDA], National Institutes of Health) is one of the nation’s leading experts on substance abuse pertaining to prescription drugs, illegal drugs, alcohol, etc. Deborah Chapman Bryant, DNP, RN (director of Partnerships for HealthCare Quality Research at Medical University of South Carolina (MUSC) and director, Outreach and Community Relations for the Hollings Cancer Center, MUSC), is a former recipient of a fellowship in nursing from RWJF.

Nora D. Volkow
Dr. Volkow thanked RWJF for the opportunity to talk about the role of substance abuse in increasing mortality among women. She noted that the reason people take drugs (e.g., cocaine, opiates, marijuana, nicotine, and alcohol) is that all of these drugs raise dopamine levels, which creates pleasurable sensations in the mind and body. Whether someone takes drugs and becomes addicted stems from the characteristics of the drug, one's own biology, and the social structure. Dr. Volkow explained that females respond differently to drug intoxication than males do. Hormone levels at menarche and menopause can increase a drug's reinforcing effects, its concentration in the brain, and its toxic effects. At the same time, women's higher levels of estrogen during some periods of their lives can provide a protective effect in relation to drugs. Dr. Volkow said that, on average, rates of drug use are higher in men than women, a pattern that has been seen for a long time. The social structure plays a role in substance abuse patterns exposing boys and men to environments where drugs are accessible.

Dr. Nora Volkow, director of the National Institute of Drug Abuse

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