This document summarizes a presentation by Magda Peck on women's health advocacy. It discusses leading causes of death for women in the US including heart disease and cancer. It also provides statistics on health conditions affecting US women such as obesity and smoking rates. The document reviews recommendations from reports on improving women's health research and access to preventive services. It discusses the importance of annual well-woman visits and expanded insurance coverage of women's healthcare under the Affordable Care Act. The presentation emphasizes the role of women in making health decisions and advocating for their own health and the health of others.

1. Leadership in
Action:
Becoming Your
Best Health
Advocate
Magda G. Peck ScD
Founding Dean and Professor
2015 Women Leaders Conference
March 20, 2015

2. Magda G. Peck, ScD
Founding Dean and Professor
Joseph J. Zilber School of Public Health
University of Wisconsin – Milwaukee
mpeck@uwm.edu
414.227.3128 (w) 402.689.9413 (c)
CHALLENGES
CHANGES
CHAMPIONS
…IN 75 MINUTES

3. z
TAKE THE QUIZ!
What are the Top 10
most common Causes of DEATH
For WOMEN in the U.S.?

4. Leading Causes of Death, 2011
WOMEN of All Ages, United States
1. Heart Disease (22.9)
2. Malignant Neoplasm – Cancer (21.8)
3. Cerebrovascular Disease – Stroke (6.1)
4. Chronic Lower Respiratory Disease (6.0)
5. Alzheimer’s Disease (4.7)
6. Unintentional Injuries – Accidents (3.7)
7. Diabetes Mellitus (2.8)
8. Influenza and Pneumonia (2.3)
9. Kidney Disease (1.8)
10.Septicemia (1.5) Source: CDC.gov (2015)
(%) N= 1,236,003

5. Leading Causes of Death, 2011
BLACK WOMEN of All Ages, U.S.
1. Heart Disease (23.4)
2. Malignant Neoplasm – Cancer (22.9)
3. Cerebrovascular Disease – Stroke (6.2)
4. Diabetes Mellitus (4.8)
5. Chronic Lower Respiratory Disease (3.1)
6. Kidney Disease (3.0)
7. Unintentional Injuries – Accidents (2.9)
8. Alzheimer’s Disease (2.7)
9. Septicemia (2.3)
10.Hypertension (2.0) Source: CDC.gov (2015)

6. Leading Causes of Death, 2011
HISPANIC WOMEN of All Ages, U.S.
1. Malignant Neoplasm – Cancer (22.4)
2. Heart Disease (20.5)
3. Cerebrovascular Disease – Stroke (5.9)
4. Diabetes Mellitus (4.9)
5. Unintentional Injuries – Accidents (4.5)
6. Alzheimer’s Disease (3.6)
7. Chronic Lower Respiratory Disease (3.1)
8. Influenza and Pneumonia (2.4)
9. Chronic Liver Disease (2.2)
10.Kidney Disease (2.1)

7. Actual Causes of Death in US
Actual causes of death in the United States, 2000.
JAMA. 2005 Jan 19;293(3):293-4.
1. Tobacco (435,000 deaths; 18.1% of total deaths)
2. Poor diet, physical inactivity
(365,000 deaths; 15.2%)
3. Alcohol consumption (85,000 deaths; 3.5%)
4. Microbial agents (75,000)
5. Toxic agents (55,000)
6. Motor vehicle crashes (43,000)
7. Firearms (29,000)
8. Sexual behaviors (20,000)
9. Illicit use of drugs (17,000)

8. Women’s Health (U.S.)
 Number of U.S. women residents in 2011 :
158.3 million (Health U.S. 2012)
 Percentage of women 18 years and older who
are in fair or poor health: 14.2 (NHIS, 2011)
 Percentage of adult women who are:
 Obese 35.9
 Currently smoke 17.3
 Hypertensive 32.8

9. WISCONSIN Women
 Number of women residents: 2.86 million
 84% white, 7% non-Hispanic black
 US Rankings:
 Heart disease, Cancer, Stroke 20
 Current smoking 29
 Unintentional injury 30
 Suicide 35
 Binge drinking 51

10. Overweight and obesity among adults
NOTE: Overweight but not obese is body mass index (BMI) greater than or equal to 25 but less than 30; grade 1 obesity is BMI greater
than or equal to 30 but less than 35; grade 2 obesity is BMI greater than or equal to 35 but less than 40; grade 3 obesity is BMI greater
than or equal to 40.
SOURCE: CDC/NCHS, Health, United States, 2012, Figure 11. Data from the National Health and Nutrition Examination Survey.

11. Current cigarette smoking
SOURCE: CDC/NCHS, Health, United States, 2012, Figure 8. Data from the National Health Interview Survey and the
National Institutes of Health/National Institute on Drug Abuse, Monitoring the Future Study.

12. WOMEN’S HEALTH CONDITIONS
 specific to women
 are more common or more serious in women
 have distinct causes or manifestations in
women
 have different outcomes or treatments in
women
 have high morbidity or mortality in women
Women’s Health Research:
Progress, Pitfalls, and Progress
Institute of Medicine 2010

13. HONEY, WHAT ARE WE GOING
TO DO ABOUT IT?

14. 1. Is Women’s Health Research Studying the Most
Appropriate and Relevant Determinants of Health?
 Progress has been made in identifying
behavioral determinants of women’s health,
such as smoking, diet, and physical activity.
 Inadequate attention paid to social and
environmental factors; few studies have tested
ways to modify these determinants in women
or examined the effects of social and
community factors in specific groups of women.
Women’s Health Research:
Progress, Pitfalls, and Progress
Institute of Medicine 2010

15. 2. Is Women’s Health Research Focused on the Most
Appropriate and Relevant Conditions and Endpoints?
• Limited advances in depression, HIV/AIDS, and
osteoporosis
• Few advances made in reducing unintended
pregnancy, autoimmune diseases, maternal
morbidity and mortality, alcohol and drug
addiction, lung cancer, gynecological cancers
other than cervical cancer, non-malignant
gynecological disorders, and Alzheimer’s
disease.
Women’s Health Research:
Progress, Pitfalls, and Progress
Institute of Medicine 2010

16. (2010)
2. Is Women’s Health Research Focused on the Most
Appropriate and Relevant Conditions and Endpoints?
 Major progress in reducing mortality for women
from breast cancer, cardiovascular disease, and
cervical cancer.
 Fewer advances in research investigating non-
fatal diseases that result in major morbidity for
women, despite the high value women place on
quality of life as well as longevity.
 The committee recommends that research include
greater attention to assessing quality of life—
for example, functional status or functionality,
mobility, or pain—and promoting wellness.
Women’s Health Research:
Progress, Pitfalls, and Progress
www.iom.edu

17. cc
Women’s Health Amendment
Requires that all private health plans cover –
with no cost sharing requirements for patients –
a newly identified set of women’s preventive
services
 evidence-informed preventive care and
screenings not otherwise addressed by
current recommendations.
Women have longer life expectancies,
a greater burden of chronic diseases and
disability, reproductive and gender specific
conditions …and women often have
different treatment responses than men.

18. Clinical Preventive Services
for Women:
Closing the Gaps
Committee on Preventive Services for Women
Institute of Medicine, National Academy of Sciences
The National Academies Press, 2011
Released July 19, 2011
www.iom.edu

19. IOM Committee – Preventive Services for Women
•Linda Rosenstock, M.D., M.P.H.
(Chair) UCLA School of Public Health
•Alfred O. Berg, M.D., M.P.H.
•University of Washington
•Claire D. Brindis, Dr.P.H.
•University of California, San Francisco
•Angela Diaz, M.D., M.P.H.
•Mount Sinai Medical Center, NY
•Francisco Garcia, M.D., M.P.H.
•University of Arizona
•Kimberly Gregory, M.D., M.P.H.
•Cedars-Sinai Medical Center, Los
Angeles
•Paula A. Johnson, M.D., M.P.H.
•Brigham and Women's Hospital,
Boston
•Anthony Lo Sasso, Ph.D.
•University of Illinois at Chicago
Jeanette H. Magnus, M.D., Ph.D.
Tulane University
Heidi Nelson, M.D., M.P.H., FACP
Oregon Health and Science University
Roberta B. Ness, M.D., M.P.H.
University of Texas School of Public Health
Magda Peck, Sc.D.
University of Nebraska Medical Center
E. Albert Reece, M.D., Ph.D., M.B.A.
University of Maryland (Baltimore)
Alina Salganicoff, Ph.D.
Kaiser Family Foundation
Sally Vernon, Ph.D.
University of Texas School of Public Health
Carol S. Weisman, Ph.D.
Penn State College of Medicine

20. Recommendation 8
At least one well-woman preventive
care visit annually for adult women to obtain the
recommended preventive services, including
preconception and prenatal care. The committee also
recognizes that several visits may be needed to obtain
all necessary recommended preventive services,
depending on a woman’s health status, health needs,
and other risk factors.
Supporting Evidence
Based on federal and state policies (such as included in Medicaid
and Medicare and the State of Massachusetts), clinical
professional guidelines (such as those from the AMA and AAFP,
and private health plan policies (such as Kaiser Permanente).
USPSTF Grade – Not Addressed
Note: well-child visits include adolescent girls under Bright Futures

21. …The inclusion of evidence-based
screenings, counseling and
procedures that address women’s
greater need for services over the
course of a women’s lifetime may
have a profound impact
for individuals
and the nation as a whole.”
THE BOTTOM LINE
(IOM report brief July 2011)

22. ACA POLICY RELATED TO WOMEN
Insurers can no longer charge
women more just because
they’re women.
AND
All plans in the new marketplaces
must cover essential women’s
health care like maternity care.
Source: Enroll America, used with permission, M Herrera Bortz

23. A Health Care System that is Better for Women
• Access to Free preventive services for women
include:
 Well Woman Visits
 All FDA-approved contraception methods and
contraceptive counseling
 Mammograms
 Pap smears
 HIV and other sexually transmitted infection
screening and counseling
 Breastfeeding support, supplies, and counseling
 Domestic violence screening and counseling
• http://www.hrsa.gov/womensguidelines/

24. Thanks to
Enroll America
non-partisan
technical assistance
national, state, local
empowers Americans with
information about their health
coverage options under the
Affordable Care Act (ACA)

25. Over 22 Million Enrolled in Coverage under the ACA
11.4 Million in Marketplace
Coverage for 2015
55% are
Women

26. Women are often the people who others turn to
when making important decisions about health
insurance.
Women make 80% of
Health Care
Decisions
What Enroll America Research Shows

27. Mothers
Sisters
Wives
Girlfriends
Partners
The Power of Women in Health Decisions

28. Too wide, too small, too soon…

30. Complications of
Prematurity,
55.9%
Congenital
Anomalies, 20.3%
SIDS, SUDI,
accidental
suffocation, 15.4%
Homicide, 3.0%
Perinatal
complications,
2.8%
Infections, 1.9%
Other deaths,
0.8%
CAUSE OF INFANT DEATH
2008-2012 CITY OF MILWAUKEE DATA ANALYSIS
= “Unsafe Sleep”

32. Stillbirths Infant deaths
Total N=205 N=318
Average per year 68.3 106
Overall rate 6.5 10.6
White Non-Hispanic rate 3.7 5.2
Black Non-Hispanic rate 9.4 14.4
Hispanic rate 3.6 7.5
2009 – 2011: Stillbirths and Infant Deaths in Milwaukee
2011 data preliminary rate = deaths per 1000 live-births

33. 10 Recommendations to Improve
Preconception Health and Health Care
1. Individual responsibility across the lifespan
2. Consumer awareness
3. Preventive visits
4. Interventions for identified risks
5. Interconception care
6. Pre-pregnancy check ups
7. Coverage for low-income women
8. Public health programs & strategies
9. Research
10. Monitoring improvements
National Preconception Health and Health Care Initiative, October 2010

34. V-Up! for women’s health
Change our Vocabulary
the stock of words used by a
particular group of persons

35. V-Up! for women’s health
Vigorous
(vig-or-ous) adjective
strong, robust, energetic
powerful in action or effect

36. V-Up! for women’s health
Vivacious
(vi-va-cious) adjective
lively, spirited, animated
having tenacity of life

37. V-Up! for women’s health
Vocal (vo-cal) adjective
Inclined to express oneself
in words, insistently

38. V-Up! for women’s health
Veracious
(ve-ra-cious) adjective
Habitually speaking the
truth; honest, truthful

39. V-Up! for women’s health
Valiant
(val-iant) adjective
Courageous, stout-
hearted, worthy, excellent

40. Becoming
Women
of Valor