Health Care101


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  • Health Care101

    1. 1. Health Care 101: Women's Health Paula A. Johnson, MD, MPH Executive Director, Connors Center for Women’s Health and Gender Biology Chief, Division of Women’s Health Brigham and Women’s Hospital
    2. 2. Women’s Health: What is it? <ul><li>Health issues specific to women </li></ul><ul><li>Health problems more common among women </li></ul><ul><li>Health problems experienced differently by women </li></ul><ul><li>Different social contexts of women </li></ul>
    3. 3. <ul><li>Leading causes of death among U.S. women </li></ul><ul><li>Heart disease </li></ul><ul><li>Lung cancer </li></ul><ul><li>Breast cancer </li></ul><ul><li>Chronic Conditions among U.S. women </li></ul><ul><li>High blood pressure (25%) </li></ul><ul><li>Arthritis (22%) </li></ul><ul><li>Osteoporosis (20%) </li></ul><ul><li>Diabetes (6%) </li></ul><ul><li>Source: Making the Grade on Women’s Health, National Women ‘s Law Center, 2001 </li></ul>Women’s Health Facts
    4. 4. Health Issues Specific to Women <ul><li>Diseases of the reproductive tract (endometriosis, fibroids) </li></ul><ul><li>Pregnancy (health prior to pregnancy, prenatal care, labor and delivery, postpartum) </li></ul><ul><li>Female-specific cancers (breast, cervical, uterine) </li></ul><ul><li>Sexual health (family planning, protection against sexually transmitted diseases, abortion) </li></ul><ul><li>Menopause (hormone replacement therapy) </li></ul>
    5. 5. Health Issues Specific to Women-Examples <ul><li>Health of women prior to pregnancy </li></ul><ul><li>Tomorrow’s older women </li></ul><ul><li>Vulnerable population who can fall through the cracks given focus on pregnancy and children </li></ul><ul><li>No clear measures </li></ul><ul><li>Disparities in low birth weight is indicator of disparities in health prior to becoming pregnant </li></ul>
    6. 6. Health Issues Specific to Women-Examples <ul><li>Breast Cancer </li></ul><ul><li>Leading cause of death for American women ages 34 to 54; second leading cause of cancer death for all American women </li></ul><ul><li>Massachusetts is among the top 3 states for the highest incidence of breast cancer, and the top 10 states for the highest mortality (American Cancer Society) </li></ul><ul><li>Mammography remains the standard for routine screening and early diagnosis (significant progress in MA) </li></ul><ul><li>New technologies for diagnosis and treatment are emerging </li></ul>
    7. 7.       Source: NCHS public use data file. Rates are age-adjusted to the 2000 US standard million population by 5-year age groups. Regression lines are calculated using the Joinpoint Regression Program.
    8. 8. Health Issues Specific to Women-Examples <ul><li>Breast Cancer -- Issues </li></ul><ul><li>Potential relationship between environment and increased incidence </li></ul><ul><li>MassHealth Breast and Cervical Treatment Program expected to be implemented in 1/04 </li></ul><ul><li>Crisis in mammography: </li></ul><ul><ul><li>long waiting times </li></ul></ul><ul><ul><li>relatively low reimbursement </li></ul></ul><ul><ul><li>litigation directed at radiologists </li></ul></ul><ul><ul><li>difficulty in recruitment of breast imaging faculty to academic medical centers </li></ul></ul>
    9. 9. Health Problems More Common Among Women Than Men <ul><li>Autoimmune diseases (multiple sclerosis, lupus, fibromyalgia, etc.) </li></ul><ul><li>Arthritis </li></ul><ul><li>Osteoporosis </li></ul><ul><li>Urinary incontinence </li></ul><ul><li>Depression </li></ul><ul><li>Alzheimer’s disease </li></ul><ul><li>Domestic violence </li></ul>
    10. 10. Health Problems More Common Among Women Than Men- Examples <ul><li>Autoimmune Diseases/Lupus </li></ul><ul><li>Immune system attacks healthy cells in the body; can effect the joints, skin, kidneys, brain, heart, lungs and blood </li></ul><ul><li>9 out of 10 people who have lupus are women </li></ul><ul><li>Lupus is 3 times more common in black women than in white women </li></ul><ul><li>Afflicts almost 2 million Americans; death rates are on the rise </li></ul><ul><li>Onset usually occurs between the ages of 15 and 40; a leading cause of kidney disease , stroke and premature cardiovascular disease in women of childbearing age </li></ul>
    11. 11. Health Problems More Common Among Women Than Men- Examples <ul><li>Autoimmune Diseases/Lupus -- Issues </li></ul><ul><li>Biologic basis of disease and female/racial predominance not understood-- may involve the action of estrogens on immune system </li></ul><ul><li>Possible link between environmental toxins and increased incidence of disease </li></ul><ul><li>Early diagnosis is critical and often not achieved </li></ul>
    12. 12. Health Problems More Common Among Women Than Men- Examples <ul><li>Depression </li></ul><ul><li>Women experience depression at about twice the rate of men </li></ul><ul><li>Most frequently occurs in women aged 25 to 44 </li></ul><ul><li>Suspected contributing factors in women include: </li></ul><ul><ul><li>biological differences (reproductive, hormonal, genetic) </li></ul></ul><ul><ul><li>psychosocial factors (stress from work/family responsibilities and societal roles/expectations; increased rates of poverty and sexual abuse; chronic illness) </li></ul></ul><ul><li>Women attempt suicide twice as often as men; men are more likely than women to die by suicide </li></ul>
    13. 13. Health Problems More Common Among Women Than Men- Examples <ul><li>Depression (continued) </li></ul><ul><li>Equal rates of depression pre-adolescence, but precipitous increase in depression in girls ages 11-13 with girls twice as likely to experience a major depressive episode by age 15 </li></ul><ul><li>Research shows a strong relationship between eating disorders (anorexia and bulimia nervosa) and depression in women (90-95% of cases of anorexia occur in young females) </li></ul><ul><li>Second leading cause for hospitalization of younger women in 2000 </li></ul>
    14. 14. Health Problems More Common Among Women Than Men- Examples <ul><li>Depression -- Issues </li></ul><ul><li>Depression in women is misdiagnosed approximately 30 to 50% of the time. </li></ul><ul><li>Less than 50% of women who experience clinical depression will ever seek care. </li></ul><ul><li>Link between depression and other illnesses (heart disease, obesity) and economic well-being </li></ul>
    15. 15. Health Problems More Common Among Women Than Men- Examples <ul><li>Domestic Violence </li></ul><ul><li>One out of twenty women aged 18-59 report experiencing physical violence, fear, or control by an intimate partner in the past year </li></ul><ul><li>One in five female high school students report being physically or sexually abused by a dating partner, potentially leading to health risk behaviors (substance abuse, eating disorders, risky sexual behavior, suicide) </li></ul><ul><li>37% of all women who sought emergency room treatment for violence-related injuries were injured by a current or former spouse, boyfriend, or girlfriend </li></ul><ul><li>Each year, medical expenses from domestic violence total at least $3 to $5 billion </li></ul>
    16. 16. Health Problems Experienced Differently by Women <ul><li>Heart disease </li></ul><ul><li>Lung cancer </li></ul><ul><li>Diabetes </li></ul>
    17. 17. Health Problems Experienced Differently by Women - Examples <ul><li>Heart Disease </li></ul><ul><li>Heart disease is the leading killer of women in the U.S. </li></ul><ul><li>Women have their first heart attack on average 10 years later than men, but are more likely to die from their first one </li></ul><ul><li>Women experience different symptoms than men </li></ul><ul><li>Some risk factors have different prevalence and different impact in women, for example-- diabetes and obesity </li></ul><ul><li>Women tend to be underdiagnosed and undertreated (both medications and procedures) </li></ul><ul><li>Underlying physiology is probably different in women </li></ul>
    18. 18. Ratio of IHD Mortality for Blacks vs. Whites, United States 1996 National Center for Health Statistics: Vital Statistics of the United States, 1996. Age (yrs) Ratio of Death Rates for Blacks : Whites
    19. 19. Health Problems Experienced Differently by Women - Examples <ul><li>Heart Disease -- Issues </li></ul><ul><li>Origins of sex-based differences </li></ul><ul><li>Earlier identification and treatment of risk factors-- especially those that impact women (diabetes, obesity) </li></ul><ul><li>Improve awareness among women who are still not aware of their risk </li></ul><ul><li>Ensure ability of those with few resources to adopt healthy eating behaviors </li></ul><ul><li>Develop strategies directed towards women for rehabilitation and make rehabilitation more available to women </li></ul>
    20. 20. Health Problems Experienced Differently by Women - Examples <ul><li>Lung Cancer </li></ul><ul><li>Second leading cause of death of women in the U.S. </li></ul><ul><li>Leading cause of death from cancer in women </li></ul><ul><li>Women smokers may be more susceptible to lung cancer than male smokers </li></ul><ul><li>Type of lung cancer differs </li></ul><ul><ul><li>adenocarcinoma more common in women and nonsmokers </li></ul></ul><ul><ul><li>more women nonsmokers have lung cancer then men </li></ul></ul><ul><ul><li>differences not explained by smoking patterns </li></ul></ul>
    21. 21. Health Problems Experienced Differently by Women - Examples <ul><li>Lung Cancer (continued) </li></ul><ul><li>Increased risk of smoking-related deaths and smoking-related morbidities (heart attack, stroke, hip fractures, and decreased fertility) </li></ul><ul><li>High risk populations with gender-specific increase in lung cancer: </li></ul><ul><ul><li>long-term or heavy smokers </li></ul></ul><ul><ul><li>poverty and Medicaid recipients </li></ul></ul><ul><ul><li>late menopause or estrogen replacement in smokers </li></ul></ul><ul><ul><li>breast cancer survivors </li></ul></ul>
    22. 22. Lung Cancer Death Rates per 100,000 women, 1930-1990 From:   Baldini: Chest, Volume 112(4) Supplement 4.October 1997.229S-234S
    23. 23. Health Problems Experienced Differently by Women - Examples <ul><li>Lung Cancer -- Issues </li></ul><ul><li>Origins of sex-based differences </li></ul><ul><li>Improve awareness of risk among women and health care providers </li></ul><ul><li>Maintenance of smoke free environments </li></ul><ul><li>Gender-specific strategies in smoking cessation </li></ul><ul><li>Improved coverage of smoking cessation (programs and pharmaceuticals) </li></ul>
    24. 24. Health Problems Experienced Differently by Women - Examples <ul><li>Diabetes </li></ul><ul><li>Half of people with diabetes are women (8.1 million); prevalence is 2-4 times higher among black, Hispanic, American Indian and Asian Pacific Islander women than white women </li></ul><ul><li>From 1990 to 1998, diabetes rates increased 70% among women ages 30-39 </li></ul><ul><li>For those with diabetes: </li></ul><ul><ul><li>risk of heart disease is greater for women than men </li></ul></ul><ul><ul><li>women have lower survival rates and poorer quality of life following a heart attack than men </li></ul></ul><ul><ul><li>women are at greater risk of blindness than men </li></ul></ul>
    25. 25. Health Problems Experienced Differently by Women - Examples <ul><li>Diabetes (continued) </li></ul><ul><li>Pregnant women with diabetes are at greater risk for complications such as preeclampsia, Cesarian section, and infections </li></ul><ul><li>Children exposed to diabetes in-utero have a greater likelihood of becoming obese during childhood and adolescence and of developing Type 2 diabetes </li></ul>
    26. 26. Health Problems Experienced Differently by Women - Examples <ul><li>Diabetes -- Issues </li></ul><ul><li>Promote early diagnosis and reward improved control of diabetes </li></ul><ul><li>Improve education that diabetes is to a large part preventable </li></ul><ul><li>Enhance prevention, especially in the young </li></ul><ul><ul><li>Improved physical education programs in schools </li></ul></ul><ul><ul><li>Healthy eating in schools and at home </li></ul></ul><ul><ul><li>Target those at risk </li></ul></ul>
    27. 27. Why do these differences exist? <ul><li>Incomplete understanding of how biologic differences between women and men relate to disease and health </li></ul><ul><ul><li>Lack of women participating in clinical trials and analysis of health studies by gender </li></ul></ul><ul><li>Potential provider and healthcare system biases (i.e. lower provider referrals for women to services compared with than men and programs that do not address women’s needs) </li></ul>
    28. 28. Why do these differences exist? <ul><li>Lack of integrated and comprehensive models of care for women </li></ul><ul><li>Disparities in access to care (more women than men rely on Medicaid and Medicare for their health coverage) </li></ul><ul><li>Societal factors </li></ul><ul><ul><li>Poverty, transportation, child care, stress, competing priorities (i.e. care-taking of children, parents, others) </li></ul></ul>
    29. 29. Why do these differences exist? <ul><li>Insufficient reimbursement & funding for obstetrics, mammography, preventive and comprehensive services for women </li></ul><ul><li>Financial pressures including funding and reimbursement may affect women disproportionately (decreased profitability of obstetrics for hospitals, mammography, etc.) </li></ul>
    30. 30. Women’s Health Report Card: 2001 <ul><li>Developed by the National Women’s Law Center </li></ul><ul><li>33 health status indicators </li></ul><ul><li>32 policy indicators </li></ul><ul><li>4 categories addressed: </li></ul><ul><ul><li>Access to health care services </li></ul></ul><ul><ul><li>Wellness and prevention </li></ul></ul><ul><ul><li>Diseases and causes of death </li></ul></ul><ul><ul><li>Living in a healthy community </li></ul></ul>
    31. 31. Women’s Health Report Card: 2001 <ul><li>Massachusetts ranks second best in nation </li></ul><ul><li>BUT </li></ul><ul><li>Overall grade was U+ (unsatisfactory plus) </li></ul><ul><ul><li>(Received a grade of Satisfactory on 12 of 33 indicators) </li></ul></ul>
    32. 32. Women’s Health in Massachusetts <ul><li>Patterns in use of preventive services and health practices vary by race, income, education, and age (BRFSS 2000-2001). </li></ul>
    33. 33. Innovations in Women’s Health <ul><li>Science </li></ul><ul><ul><li>Understanding the sex differences in the biology of disease </li></ul></ul><ul><ul><li>Need to develop the cross-disciplinary structures to make advances in science </li></ul></ul><ul><ul><li>Role of environment in potentiating disease in women </li></ul></ul><ul><ul><li>Role of stress in mental and physical health </li></ul></ul>
    34. 34. Innovations in Women’s Health <ul><li>Technology </li></ul><ul><ul><li>Video-assisted surgery through small incisions (thoracics and cardiac) </li></ul></ul><ul><ul><li>Radiology -- MRI assisted surgery for breast cancer </li></ul></ul><ul><ul><li>Focused ultrasound to treat uterine fibroids as alternative to hysterectomy </li></ul></ul><ul><ul><li>Testing to improve risk stratification-- Ca125, hs-CRP </li></ul></ul>
    35. 35. Innovations in Women’s Health <ul><li>Delivery of Care </li></ul><ul><ul><li>Provide comprehensive, integrated care for women </li></ul></ul><ul><ul><li>Provide care that reflects the specific needs of women across the lifespan </li></ul></ul><ul><ul><li>Ensure care is accessible and reflects the cultural needs of the patient </li></ul></ul><ul><ul><li>Address the care of women more proactively, with a focus on prevention </li></ul></ul><ul><ul><li>Measure outcomes for women </li></ul></ul>
    36. 36. Innovations in Women’s Health <ul><li>Policy/Advocacy </li></ul><ul><li>Health and economic policy will be critical to continued innovation </li></ul><ul><li>Increasing awareness and support of issues affecting the health of women </li></ul><ul><li>Focusing on comprehensive care for women at all stages of life </li></ul><ul><li>Create synergy between women’s health and addressing health disparities </li></ul>
    37. 37. What else needs to be done? <ul><li>Increase the number of women participating in health related research </li></ul><ul><li>Increase funding for women’s health research and reward interdisciplinary research </li></ul><ul><li>Create policy that enhances comprehensive care of women of all ages </li></ul><ul><li>Promote adequate reimbursement for obstetric, mammography and preventive services </li></ul><ul><li>Evaluate provider practices and understanding of critical women’s health issues </li></ul><ul><li>Reduce disparities in access to care and outcomes </li></ul>
    38. 38. Contact Information <ul><li>Paula A. Johnson, MD, MPH </li></ul><ul><li>Executive Director, Connors Center for Women’s Health and Gender Biology </li></ul><ul><li>Chief, Division of Women’s Health </li></ul><ul><li>Brigham and Women’s Hospital </li></ul><ul><li>75 Francis Street, Boston, MA 02115 </li></ul><ul><li>Phone: (617) 732-8985 </li></ul><ul><li>Rachel A. Wilson, MPH </li></ul><ul><li>Director of Women’s Health Policy and Advocacy </li></ul><ul><li>Phone: (617) 525-7512; Email: </li></ul>