On April 25, the Senate Health, Education, Labor, and Pensions Subcommittee on Public Health held a hearing to examine women’s health issues. The subcommittee heard testimony from a number of experts on the unmet needs in women’s health.
Dr. Eve Slater of the Department of Health and Human Services (HHS) detailed the agency’s efforts to improve women’s health. She said that in 2002, HHS will spend nearly $70 billion on women’s health. While noting that “women are not only living longer, they are living more healthy and productive lives in their later years,” Dr. Slater said, “There is still much work to be done.”
Specifically, she told the subcommittee that cardiovascular disease and its manifestations such as heart attack and stroke are the leading cause of death for American women. Additionally, she noted that “diabetes linked to obesity has reached epidemic proportions in this country,” adding that diabetes “is the fifth leading cause of death among women.”
Dr. Slater also highlighted a number of HHS women’s health activities, including activities on cardiovascular disease, diabetes, obesity, domestic violence, and maternal oral health. She discussed the importance of the Public Health Service’s Office on Women’s Health in implementing these activities, saying that the office is “refining its performance goals to focus on activities that will result in measurable reductions in the rate of preventable diseases in women over the next five years.” The office will first focus on cardiovascular diseases, cancer, diabetes, and HIV/AIDS because “they represent the leading causes of morbidity and mortality in women…, disparities exist between men and women for these diseases—either in treatment, incidence, or prevalence—and finally, they are all preventable.”
Dr. James Marks of the Centers for Disease Control and Prevention (CDC) agreed that prevention is the key to improving women’s health. “As this committee knows, the burden placed on our society by chronic diseases is enormous,” he said. Noting that prevention research “identifies the risk factors for disease, designs and tests interventions to prevent them, and develops and evaluates systems to deliver the interventions to the populations who need them,” Dr. Marks said that the CDC’s prevention research activities consist of 26 academic research centers and a $15 million extramural prevention research activity, which will fund 30 new projects in FY2002.
Adding that the prevention research has to be translated in order to realize results, Dr. Marks gave several examples. In 2001, the CDC held a National Safe Motherhood Summit, which established several goals, including: reducing the rates of maternal mortality and complications; eliminating disparities in maternal health outcomes; collecting good data on the frequency of these complications and good research to find out why these problems occur; and utilizing these research findings and moving to evidence-based prevention interventions.
Despite CDC’s efforts to monitor safe motherhood through its Pregnancy Mortality Surveillance System, Dr. Marks noted several challenges with addressing the above mentioned goals. Most notably, “neither complications nor disparities among American women can be fully addressed due to inadequate data sources.” He continued, “There is no standardized method to define conditions that are considered pregnancy-related illness. Even pregnancy-related deaths, events that generate vital records, are undercounted and sometimes improperly classified.”
Another example—the National Breast and Cervical Cancer Early Detection Program (NBCCEDP)—Dr. Marks deemed “one of CDC’s most successful prevention interventions.” He said that through September 2000, “more than 3.0 million screening tests have been provided to over 1.8 million women….Almost half of these screenings were to minority women, who have traditionally had less access to these services.”
Continuing the discussion of federal agency efforts, Dr. Carolyn Mazure of the Women’s Health Research Coalition testified in support of a bill (S. 946) that would codify the offices of women’s health at the Agency for Healthcare Research and Quality, the CDC, the Food and Drug Administration, the Health Resources and Services Administration, and the Office of the Secretary. Currently, only the offices at the National Institutes of Health and the Substance Abuse and Mental Health Services Administration are established by statute. The bill is sponsored by Sens. Olympia Snowe (R-ME) and Barbara Mikulski (D-MD).
“These offices provide a base of operations that focus the energy and galvanize the interest within each agency regarding the health of women,” she said, adding, “Of equal importance, each of these offices is in an ideal position to supply specialized information on women and their health needs.”
Speaking to the importance of improving safe motherhood, Dr. Thomas Gelhous of the American College of Obstetricians and Gynecologists said, “Each year in the United States, 30% of pregnant women have pregnancy-related complications, before, during, or after delivery that often lead to long-term health problems.” Additionally, “over half of pregnancy-related deaths could be prevented through improved health care access, improved quality of care, and changes in maternal health and lifestyle habits,” he said.
Dr. Gelhous called for increased funding for research on safe motherhood, including research into the effects of drugs on pregnant women. “There is very little information available to help doctors know what the best dose of a particular medicine is for pregnant women and how that medication may affect the developing fetus,” he said.
Marlene Jezierski, a nurse who is a violence prevention educator at Allina Hospitals and Clinics in Minnesota, discussed the importance of educating health care professionals on how to screen for domestic violence. Stating that “domestic violence is a health care issue,” Ms. Jezierski made four recommendations:
Dr. Alice Ammerman of the University of North Carolina at Chapel Hill told the subcommittee about her state’s success with implementing the CDC’s WISEWOMAN program, which provides heart disease, obesity, and diabetes screening for women enrolled through the NBCCEDP. In addition to screening, the program provides these women with information about ways in which they can make nutritional, lifestyle, and behavioral changes that can improve their health.
First funded in 1995, the North Carolina program initially focused on dietary changes, but then expanded the program to include physical activity, smoking cessation, and osteoporosis and diabetes prevention. Dr. Ammerman said that the WISEWOMAN funding “has allowed us to build capacity in local health departments to provide substantially improved health promotion interventions and to link with existing complementary public health resources in the community.”