The United States has failed to meet most goals for women's health -- largely federal objectives drawn from the U.S. Department of Health and Human Services' Healthy People 2010 agenda -- according to a report released December 13 on the status of women's health by the National Women's Law Center (NWLC) and Oregon Health & Science University (OHSU).
Overall, the nation is so far from meeting the Healthy People and related goals that it receives a general grade of "Unsatisfactory." Of the 26 health indicators that were graded, the country received a "Satisfactory" grade in only three and received a failing grade in half.
Released December 13, the 2010 edition of Making the Grade on Women's Health: A National and State-by-State Report Card, is the fifth in a series of reports since 2000. It grades and ranks each state based on 26 health status benchmarks and also identifies whether states have met 68 health policy goals. NWLC and OHSU developed the report as a resource for advocates, policymakers, and health experts to assess women's health at the federal and state levels. The Report Card provides comprehensive data for researchers to analyze changes in women's health and well-being. This edition of the Report Card includes an analysis of the current status of women's health, a 10-year look back at progress and setbacks, and a comparison to women's health status in 2007, when the Report Card was last published.
10-YEAR LOOK BACK
Less Smoking, More Colorectal Cancer Screening, Lower Heart Disease and Cancer Death Rates; but More Chlamydia, Diabetes, High Blood Pressure and Binge Drinking, Fewer Pap Tests
In the years since the original Report Card was published, the nation has made notable progress on several women's health indicators, including lower death rates from coronary heart disease, stroke, and breast and lung cancer. In addition, fewer women are smoking and more women are being screened for colorectal cancer. Unfortunately, however, there are now greater proportions of women with high blood pressure and who haven't had a recent Pap test. Since 2000, declines in women's health status have been most pronounced in the areas of diabetes, chlamydia and binge drinking.
"The good news is that when the nation rallies around a health problem with federal and state policies and programs as well as public attention, we can achieve real progress," said Judy Waxman, NWLC Vice President for Health and Reproductive Rights. "Unfortunately, we have much more work to do in many areas of women's health."
KEY FINDINGS FROM 2007-2010
Improvements in Cholesterol Screening, but Fewer Women Having Regular Pap Tests and More Reporting Binge Drinking
The most disturbing trends in the past three years (since the Report Card was last published) have been a marked increase in the proportion of women who report binge drinking -- a dangerous form of alcohol abuse that involves having five or more drinks on one occasion -- and a considerable decline in the percentage of women who get a regular Pap smear, the primary test to detect cervical cancer. The nation's grade for binge drinking declined from a "Satisfactory minus" to an "F," and the grade for Pap test rates dropped from an "Unsatisfactory" to an "F."
Cholesterol screening was the only area where women's health improved enough to merit a higher grade when compared with 2007 (moving from an "Unsatisfactory" to a "Satisfactory minus"). Other gains -- including lower proportions of women dying from heart disease, stroke, lung cancer, breast cancer, and during or shortly after pregnancy -- fell far short of the national goals and were not enough to generate better grades on the 2010 Report Card.
In 2010, not one state received an overall "Satisfactory" grade for women's health and just two states received the next highest grade of "Satisfactory minus" -- Vermont and Massachusetts -- a decline from the 2007 edition of the Report Card, when three states received this grade. A majority of states (37) receive an "Unsatisfactory" grade and nearly a quarter of all states (12) receive an overall failing "F" grade. Nine of the 10 states that ranked at the bottom in the original Report Card in 2000 continue to rank at the bottom today; these include Alabama, West Virginia, Oklahoma, Arkansas, Louisiana, and Mississippi. The only state that moved out of the bottom 10 over the course of the decade was Texas, which nonetheless receives an "F" in 2010.
"It is shocking that there is not a single state in this country where women enjoy overall satisfactory health status," said Michelle Berlin, M.D., M.P.H., Vice Chair and Associate Professor of Obstetrics and Gynecology, OHSU School of Medicine; and Associate Director, OHSU Center for Women's Health, a National Center of Excellence in Women's Health.
State Policy Indicators
In addition to health status indicators, the report also assesses 68 health and health-related policies. Of these, only two policy goals were met by all the states: Medicaid coverage for breast and cervical cancer treatment and participation in the Food Stamp Nutrition and Education Program. Only nine states meet a majority (35 or more) of the policy goals, with California (44), New Jersey (43), Massachusetts (40), and New York (39) meeting the most. The four states that meet the fewest policy indicators are Mississippi (10), Idaho (11), South Dakota (11), and Alabama (12).
Though most states have made only piecemeal progress in adopting policies to improve women's health, many of the policy goals examined in the Report Card will be realized with the implementation of the new federal health care law, the Patient Protection and Affordable Care Act. For example, four Medicaid eligibility and enrollment policy goals will be accomplished when new Medicaid eligibility rules take effect in 2014. Several of the Report Card's policy goals for private insurance coverage of preventive services (such as Pap smears, mammograms and osteoporosis screenings) were achieved when a provision of the law that requires all new health plans to cover recommended preventive care with no cost-sharing took effect on Sept. 23 of this year.
"The Affordable Care Act emphasizes access to health care, including the critical preventive services that women need to stay healthy," said Waxman. "There is no doubt that it will make an enormous difference in addressing the problems identified in the 2010 Report Card."
Women need better access to health insurance to get necessary health care.
Access to reproductive health services is insufficient.
Gaps in economic security continue to compromise women's health.
A woman's health varies depending on where she lives.
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