A Publication of the
Jacobs Institute of Women's Health
Volume 8, Number 4, December 2000
US/UK Health Care: More Similarities than Differences
Addressing Rural Women's Health
On the Agenda
10 Year Anniversary
Ten Greatest Achievements in Women's Health in the 1990s
Call for Papers
New Members
US/UK Health Care: More Similarities than Differences
Despite the differences between the health care systems of the United Kingdom free, universal care funded by the national government - and the United States - privately funded by individuals and employers through insurance companies, with some federal coverage for the elderly and some uninsured remarkable similarities exist between the two systems. Unfortunately, many of the similarities are seen in the persistent shortcomings of both systems when it comes to health care issues that disproportionately affect women.
Although that message pervaded the recent Margaret E. Mahoney Symposium on Quality Health Care for Women in the United States and the United Kingdom, the participants used the opportunity to identify ways the two systems can learn from one another. The Jacobs Institute of Women's Health and The Commonwealth Fund jointly sponsored the conference in Washington, DC, in September.
For example, in both countries, minority women face barriers to good health care. Dame Deirdre Hine, chairman of the U.K. Commission for Health Improvement, noted, "There is some evidence that women from ethnic minorities and lower socioeconomic groups often receive less than their fare share of health care resources," despite universal access to health care. "So the problem of insurance doesn't apply, and yet there is still some evidence that there is poorer access in those groups."
Veena Bahl of the U.K. Department of Health gave a number of examples of poorer health among minorities' such as higher rates of coronary heart disease and diabetes among South Asians. She cited socioeconomic differences, language barriers, longstanding racism and racial discrimination, and lack of cultural sensitivity.
In both countries, lack of patient continuance, for example, with prescription drug regimens, remains a problem. Also in both countries, women sometimes receive different (usually lower) levels of treatment than men for the same condition, domestic violence and teen pregnancy rates continue to pose challenges, and collecting and analyzing data on the quality of health care remains difficult.
Among the more significant differences, Dame Rennie Fritchie of the U.K.'s Pennell Initiative pointed out, is that "British women don't make a fuss," meaning they may be less assertive than U.S. women. The Pennell Initiative surveyed U.K. advice columnists and found women wrote to the so-called "agony aunts" seeking "permission" to consult a doctor, often not wanting to be seen as hysterical, "So there's an assertiveness and a confidence issue," said Dame Rennie.
Cindy Pearson of the U.S. National Women's Health Network supported the comparison, saying, "Probably women in the United States ... are more likely to be assertive in the exam room,...and so they're more likely to be satisfied with the treatment they received."
The United States and the United Kingdom also differ on recommendations for screening intervals, for example, screening for cervical cancer. In the United States, the Centers for Disease Control and Prevention (CDC) recommends women get a Pap test at least every 3 years, although specialty societies such as the American College of Obstetricians and Gynecologists recommend annual screening. U.K. authorities recommend screening every 3-5 years.
Julietta Patnick of the National Health Services Cancer Screening Programmes (U.K.) noted U.K. providers have debated the value of the 3-year versus the 5-year interval. "We have limited resources....It's very difficult to say ... we should screen more often, we should get that last few percent. Maybe we'd actually be better off spending the money getting some of the underserved women in and screening them."
The proceedings of the symposium will be published in Women's Health Issues in early 2001.
Addressing Rural Women's Health
The unique health concerns of women "can be overshadowed by the larger political, economic, educational and health issues in rural communities," according to Joanna Cain, MD, Professor and Chair of the Department of Obstetrics and Gynecology at Penn State College of Medicine. Dr. Cain was among the organizers of a conference in Washington, DC, in August: Bridging Rural Women's Health: Into the New Millennium. The goal was to bring together the various agencies and advocates who support rural women's health to exchange viewpoints and establish priorities.
Various researchers have underscored the need for more attention to rural women's health issues:
" In nonmetropolitan areas, 94% of counties have no abortion provider.1
" Infant mortality is higher in rural communities than urban areas.2
" Elderly women in rural regions are more likely than those in urban regions to use over-the-counter preparations for self treatment because they cannot get to a doctor or cannot afford medical care.3
" Women and children suffer almost twice as many farm-related injuries as men, 75% of which are severe, permanent, or fatal.3
The Centers for Disease Control and Prevention, the U.S. Public Health Service Office on Women's Health, Penn State College of Medicine, and Penn State College of Health and Human Development supported the conference. The proceedings will be published in the January/February 2001 issue of Women's Health Issues. To order a copy, please visit jiwh.org or call 202-863-4990.
References
1. Henshaw SK, Van Vort J. Abortion services in the United States, 1991 and 1992. Fam Plann Perspect 1994;26:100-106, 112
2. Chabot MJ, Garfinkel J, Pratt MW. Urbanization and differentials in white and nonwhite infant mortality. Pediatrics 1975;56:777-781
3. Bushy A. Health issues of women in rural environments: an overview. J Am Med Wom Assoc 1998;53:53-56.
HHS Blueprint for Action on Breastfeeding, from the Department of Health and Human Services Office on Women's Health and the Office of the Surgeon General, offers action steps for the health care system, families, the community, researchers, and the workplace to better focus attention on the importance of breastfeeding. The full text can be obtained from the web site of the National Women's Health Information Center at www.4woman.gov or by calling 1-800-994WOMAN.
American College of Obstetricians and Gynecologists Survey of State Laws on HIV & Pregnant Women, 1999-2000, summarizes each state's legal requirements regarding HIV testing, informed consent, and pre- and posttest counseling of pregnant women and newborns. Single copies are available on request at no charge. Call Megan McReynolds at 202-863-2594 or e-mail .
In Their Own Words: The Uninsured Talk About Living Without Health Insurance, from the Kaiser Family Foundation's Commission on Medicaid and the Uninsured, describes the experiences of families without health insurance. For a free copy, visit www.kff.org or call 1-800-656-4533.
2000-2001 NABCO Breast Cancer Resource List, from the National Alliance of Breast Cancer Organizations, includes nearly 700 support groups and other resources. Go to www.nabco.org to view the contents or send $5 to NABCO, 9 East 37th Street, 10th Floor, New York, NY 10016 for the complete list.
Living Longer, Staying Well: Promoting Good Health for Older Women, an issue brief from The Commonwealth Fund, describes the gaps and disparities in access and preventive services and suggests steps for improving older women's health. Download or order a copy at www.cmwf.org or call 1-888-777-2744 (publication no. 412).
Dear Friends:
What a wonderful and busy 10th anniversary year this has been for the Jacobs Institute of Women's Health! We successfully launched three new publications, had our biggest annual awards luncheon ever, and hosted our first international women's health meeting. Amid all this activity, we took time to reflect on what we and others have accomplished in women's health over the past 10 years and to establish goals for the future.
Our list of the 10 greatest achievements in women's health in the 1990s is included in this newsletter. Suggestions for the list were garnered from members, visitors to our Internet site, and the Jacobs Institute board. These are not our accomplishments alone but reflect the progress that has occurred through the determined efforts of many in the health care professions, government agencies, research institutions, and advocacy organizations.
Our 10 goals for the next 10 years are intended to serve as mile markers as we chart future achievements in women's health. I would like to take this opportunity to tell you what the Jacobs Institute is doing to help achieve these goals.
Expand health insurance coverage to all women, and improve health insurance benefits for services that women need.
The Jacobs Institute has worked with managed care companies and with employers to highlight ways in which they can better tailor health benefits for women. Our reports Women's Health and Managed Care: Opportunities for Action and Value Purchasing: Investing in Women's Health contain specific recommendations for improving health care benefits and health care systems to provide a more female-friendly fit. Upcoming issues of Women's Health Issues will provide analyses of the gaps in women's insurance coverage and benefits, as will the Women's Health Data Book, Third Edition, scheduled for release in 2001.
Reduce the disparities in women's health outcomes across socioeconomic levels and ethnic groups.
Participants at our international meeting comparing the quality of women's health care in the United States and the United Kingdom demonstrated convincingly that insurance coverage alone does not solve the problem of disparities (see story on page 1). Improving outreach and cultural competence are no doubt part of the solution. In 2001, we will focus our third annual womens health meeting with The Commonwealth Fund on successful strategies for reducing disparities in health outcomes.
Enhance communication between women and their health care providers.
We have two initiatives aimed at achieving this goal. Our publication Guidelines for Counseling Women on the Management of Menopause is designed to improve the quality of counseling that women receive about menopause and has been distributed to more than 190,000 primary care providers and to health plans. We are also working with the National Partnership for Women and Families and CIGNA HealthCare to produce a guide for women on understanding and using managed health to obtain the various benefits to which they are entitled.
Increase research and attention to the issues of aging women.
This years Jacobs Institute Ortho-McNeil Scholar, Dr. Kelli Koltyn, will investigate the association between physical activity, physical functioning, and quality of life among older women living in nursing homes. We also published a special issue of Women's Health Issues (volume 10, issue 2) on improving Medicare coverage for older women.
Improve the quality of care for women.
This is a central theme of much of the Jacobs Institute's work. This year, we examined the differences between men's and women's satisfaction with their health care by analyzing responses to CAHPS, the Consumer Assessment of Health Plans questionnaire administered by the National Committee for Quality Assurance. One of our breakfast seminars focused on the state of quality measurement in managed care; another focused on consumer barriers to receiving state-of-the-art medicines. In 2001, we launch the Women's Heart Initiative, building on the work of a steering committee convened this year by the Jacobs Institute, the Agency for Healthcare Research and Quality, and the National Institutes of Health's Office of Womens Health. Our project will help focus health care resources on helping women live longer, heart-healthy lives.
Other goals for the next 10 years:
" Ensuring women's reproductive rights
" Reducing the rates of unintended pregnancy and sexually transmitted disease
" Furthering the development of gender-specific medical education curricula
" Addressing the needs of women as care givers
" Developing useful applications for genetic information while safeguarding women's privacy
Over time, we hope to develop initiatives to further these goals. We will also give support and recognition to others working toward them. Our world is too complicated and the challenges too great for any one individual or organization to single-handedly achieve these ambitious ends. But by working together and supporting and celebrating our accomplishments, we will advance the health of all women.
On behalf of the board and staff of the Jacobs Institute of Women's Health, I want to express our deepest thanks to all who helped the Jacobs Institute reach its 10-year anniversary. In particular, we thank those who contributed financially this year (see the annual donor list below). We recommit our efforts over the next 10 years to the pursuit of excellence in women's health.
Sincerely,
Martha C. Romans,
Executive Director
Ten Greatest Achievements in Women's Health in the 1990s
In honor of our 10th anniversary, we asked our members and visitors to our web site to select the 10 most important advancements in women's health over the past decade. Here are the results:
1. Increased research on women's health and policies requiring that women be included in clinical studies
2. Recognition of heart disease as a women's health issue and the inclusion of women in studies of heart disease
3. Greater awareness of domestic violence as a women's health issue
4. Increased attention to the health concerns of midlife women, including the prevention and treatment of osteoporosis, and increased involvement of women in their health care decision-making
5. Decline in teen pregnancy rates
6. Availability of FDA-approved emergency contraception
7. Improvements in breast cancer screening
8. Increased awareness of depression as a women's health issue
9. Increased number of women health professionals and an increase in the number of health care organizations and programs focused on women
10. Advances in the treatment of infertility.
Articles submitted to Women's Health Issues are peer-reviewed by a multidisciplinary editorial board of experts in women's health. Women's Health Issues is distributed to subscribers and online via ScienceDirect and ContentsDirect. All submissions are eligible for the $1,000 Charles E. Gibbs Leadership Award.
Welcome to the following new members of the Jacobs Institute, who joined between August 19 and November 22, 2000. For more information on membership, call the Jacobs Institute at 202-863-4990 or click here.
Cynthia Aninao
James O. Armitage, MD
Sonia Baku
John J. Barton, MD
Patricia Benner
Louis Burgher, MD, PhD
Canadian College of Naturopathic Medicine
Deb Cathcart
CIGNA
William Paul Dillon, MD, FACOG
Ellen R. Fischbeim, MD
Jorge Gandia, MD
Joan Gibson-Howell, RDH, MS Ed
Rachel Benson Gold
Elizabeth Goodman, MD
Lisa M. Hollier, MD
Mary Ann Huslig
Ellen Hutchins ScD, MSW
Illinois Masonic Medical Center
Anita Kablinger, MD
Amal J. Khory, PhD, MPH
Donna Kubesh
Dana Lee, JD
June Mary Makdisi
Jenifer Markowitz
Kathryn T. McLearn, PhD
Carole Meyers, MD
Kristin Lewis Norfleet
Georgia B. Padonu, RN, DrPH
Herbert Peterson, MD
Kathleen Reape, MD
Kathryn L. Reed, MD
Karen Rezai, MPH
Carol Dawson Rose, RN, MS
Thomas C. Rowland, Jr., MD
W. Allen Schaffer, MD
Judith Bunnell Sellers, DMSc, FNP
Diana Shaw
Sharleen H. Simpson
Karen G. Swenson, MD
Erin E. Tracy, MD, MPH
Rita Van Fleet, RN
Janis Wagner, RN
Carol Wood