Diverse Women, Diverse Health Care Needs--NWHN's Panel on Women & Health Care<
By Rebecca Kirsh
The American Public Health Association (APHA) meeting is held every year in Washington, and provides an unequaled opportunity for public health professionals and activists to network with their peers, learn from one another, and share strategies for improving the health of the American public.
At last year’s meeting, held in November, the National Women’s Health Network hosted an informative panel discussion entitled: “Access to Care: Diverse Needs of Diverse Women.” Panel members stressed the need for universal health care; the problem of unequal access to health care for women, especially women of color; and the reforms needed to change the system. Moderator Cynthia Pearson, NWHN’s Executive Director, summed up the theme by noting, “Health care can’t be one size fits all—it must reflect the fact that diverse women have diverse needs.”
Panelists included Martha Livingston, Ph.D., associate professor of public health at State University of New York at Old Westbury and member of Physicians for a National Health Program; Toni Bond, NWHN board member and President/CEO of African American Women Evolving, Inc.; Adriane Fugh-Berman, M.D., former chair of NWHN’s board of directors and professor at Georgetown University’s graduate program in Complementary and Alternative Medicine; and Lisalyn Jacobs, J.D., NWHN board member and vice-president of Legal Momentum. These speakers discussed various aspects of diversity in health care promotion before an audience of approximately 30 participants.
Americans Lack Access to Health Care Services & Information
The United States spends fully 15% of its Gross Domestic Product (GDP) on health care, more than any other industrialized country. While other developed nations spend between 8—10% of their GDP on health care, they manage to cover their entire population, unlike the U.S. Dr. Livingston noted that one-quarter of Americans have gone without health insurance at some point over the last two years, which usually means they also go without timely preventive care and medical treatment. The result is that thousands of Americans suffer, become disabled, and die from conditions that are treatable and preventable.
Toni Bond noted that even women who have health insurance and can access care may find services to be inappropriate. Women of color, in particular, report that they sometimes feel their health care providers are dismissive, disrespectful and disinterested: factors which make seeking medical care unpleasant and often avoided. The panelists discussed the need for meaningful health care reform that makes affordable and high-quality services available to all Americans, regardless of gender or income.
Ms. Bond described a survey conducted by African American Women Evolving (AAWE) among 300 African American women aged 18-62 who lived in Chicago. Between 2000 and 2001, AAWE surveyed these women about their views on, and experiences with, various reproductive health issues. The organization found that 72% of the women believe abortion should be an option. The study also found that most of the women use only one contraceptive method which, depending on their circumstances, may mean they are not protecting themselves against sexually transmitted diseases (STDs) through dual contraceptive use.
In addition, the study found that 50% of the women douche frequently, a medically unnecessary practice that can increase a woman’s risk of contracting STDs. In response, AAWE launched the “Healthy Vagina Project” to educate women about the negative health effects of douching and advocate greater publicity for this information, such as on douching product’s labels.
Integrating Complementary and Alternative Medicines into the Culture of Medicine
True access to appropriate and quality services involves the opportunity to choose the form of care that best meets a patient’s needs. NWHN believes that women should have the right to access effective therapies from both Western and alternative models, based on what the woman herself feels best suits her needs, beliefs, and culture.
Adriane Fugh-Berman. M.D. reported that some women prefer Complementary and Alternative Medicine (CAM) to Western models of intervention. Dr. Fugh-Berman described CAM as a group of medical and health care systems, practices, and products that are not presently considered part of conventional Western medicine as practiced by physicians. CAM therapies includes acupuncture, aromatherapy, chiropractic, homeopathy, massage, therapeutic touch, etc.1
Although CAM therapies are often dismissed as unscientific, there is a surprising amount of evidence from reputable studies indicating that certain therapies are effective for certain conditions. Biofeedback, for example, is effective at relieving migraine headaches. Widely used outside of the U.S., CAM is not an integral part of the U.S. system and is usually not covered by insurance. For this and other reasons, CAM is often inaccessible to those who lack insurance or whose coverage excludes alternative treatments.
Dr. Fugh-Berman noted that, while research is essential to discover effective treatments, it is only part of the equation in encouraging CAM. Even when physicians and consumers know that particular CAM therapies are useful, they may not choose to recommend or practice them. Dr. Fugh-Berman called for a paradigmatic shift in conventional medicine to integrate effective CAM modalities into treatment, education, and coverage. Yet, so long as the medical system remains profit-driven—and physicians unduly influenced by pharmaceutical companies—this is unlikely to occur.
Health Care for Immigrant Women – Restrictions & Barriers
Lisalyn Jacobs, J.D. described the difficulties immigrant women face in accessing the U.S. health care system. Barriers include a lack of accommodation for cultural and language differences, cultural barriers to seeking care, and legislative restrictions that prevent some immigrants from entering the health care system. For example, battered women who came to the U.S. after 1996 must currently wait five years before qualifying for federal programs such as health insurance, food stamps, welfare, and disability services. And, Congress recently considered language requiring federally funded emergency rooms to question patients’ immigration status and report their findings to the authorities.
Ms. Jacobs commented that restrictions on accessing care and deportation threats are intended to have a chilling effect on immigrants’ health care behavior. But, everyone suffers under such a situation. Individuals remain sick and untreated, and their conditions worsen. Delays in getting timely care lead to increased Emergency Room use, which drives up costs for health care providers, the government, and individuals. These problems are compounded for immigrant women who are victims of family violence; these women are forced to remain in danger because they are excluded from medical and social services that could help them (and their children) find safety.
The U.S. health care system is deeply flawed. It does not provide adequate and appropriate coverage to all, and it often fails to recognize and value diversity among patients and potential therapies. To create equal access to appropriate and high-quality care for all, the panelists called for the system to become more open, responsive and inclusive, and strive to fully meet the needs of all Americans.
To learn more about the organizations represented at the panel, see the links below:
- Physicians for a National Health Program: www.pnhp.org
- African American Women Evolving, Inc: www.aaweonline.org
- Georgetown University’s Complementary and Alternative Medicine program: www.georgetown.edu/departments/physiology/cam/
- Legal Momentum: www.legalmomentum.org
Rebecca Kirsh graduated from the University of Toronto in June 2004, majoring in Sociology, Health Studies and Women’s Studies. She hopes to pursue a graduate degree in public health, with a concentration in women’s health. Rebecca was a 2004 fall intern at NWHN and is continuing her internship into the winter term.