A New Perspective on Health Care Access

By Sara Lake

Imagine a place where women are not formally employed, and spend much of their time performing household chores, farming, and taking care of the family….Where women’s opinions and experiences are often not considered in daily life and public policy issues. Imagine a place where a woman may not get basic health care – such as screenings for breast or cervical cancer -- simply because it costs too much. The place I refer to is the West African nation of Ghana, where I recently visited; however, this also describes the United States.

My experiences have shown me how a lack of health care access affects us, and also how much of our health state is affected by where we live, and how that area’s health system works. My eyes were opened most notably on my recent trip to Ghana. Traveling there provided me with credits toward my degree, and helped me visit someplace that looked entirely different from my home in the U.S. In Ghana, I was able to observe what other nations consider “health.” While I was impressed with the Ghanaians’ holistic approach to medicine, embodied by their focus of healing both body and spirit, I couldn’t help but notice how lifestyle negatively affects health status of the people. In both rural and urban areas, many residents lived in small shacks with only thin clothes to wear and little protection from animals, weather, or intruders. The family’s nutrition was often based on how much a woman could farm, and meals mainly consisted of starch with trace amounts of fruits and vegetables. Grocery markets and pharmacies seemed to be non-existent.

As a result of a variety of social and economic factors, women have difficulty getting preventive and medical care; and their health suffers as a result. A number of women I met had never seen a doctor for gynecological care or cancer screening, and some did not even know where they could find a local health clinic if they needed one. Women’s health can also be affected by a societal practice in which Ghanaian men may have more than one wife, but choose to pay medical costs for just one of them. Fathers may also choose to pay for their sons’ medical costs, but not their daughters’. The life expectancy for a woman in Ghana is 58 years, compared to 80 for a woman in America.¹ The maternal mortality rate for a woman in Ghana? It’s 540 deaths to women for every 100,000 live births. The maternal mortality rate for American women is 14.²

Such startling figures and lower quality of life can be explained by the economic and governmental structure of Ghana, which became independent from Great Britain 50 years ago. As a developing country, employment opportunities are limited for many people. Women in Ghana are more likely than men to be poor due to lack of jobs, training, and/or academic opportunities. Therefore, the cost of medical care is unaffordable for many women, much of the time. In addition, many of the women who I talked with during my stay were unfamiliar with screenings for women’s cancers (such as the Pap test for cervical cancer). This suggested to me that the country’s public health system has not yet formally addressed women’s issues, such as prevention and treatment for common reproductive cancers.

Public health programs are not well-established and the country’s regulatory health agencies lack experienced personnel. Modern technology, like laparoscopes and mammography devices, have been slow to arrive in Ghana and the physicians who are experienced in using these tools are clustered in urban areas many hours away from the majority of rural dwellers.

A friend who was with me on the trip became sick suddenly; luckily, we were in an urban area and found a health facility to treat her. Her insurance covered the costs, so she received the care she needed and was sent home. Unfortunately, the vast majority of Ghanaian women are unable to get this kind of care because they do not live near health providers. Worse, some of my female Ghanaian friends cannot afford treatment in a hospital or health clinic. Despite the issues facing the nation and its people, the women I talked to were optimistic that Ghanaian health services would improve in the future.

Reflecting back on the United States, our situations are different in numerous ways. Unlike Ghana, our nation has the economic power and well-established public health infrastructure available to implement universal health programs and help those who need medical care. We have the necessary tools to improve women’s health, such as financial assistance programs, qualified health professionals, and extensive medical research institutes. It took my trip to Africa -- and examining things through a new lens --before I could see what our country has available for its people and how lucky I am for my health.

Yet, while both of these countries have their own unique circumstances and specific problems, the developing nation and the modernized country share the struggle of health care access. The health care systems in both Ghana and the U.S. need to be adjusted. Women in both countries struggle to get needed medical care, find adequate financial services to support that care, and locate health care providers to address issues specific to women. As an intern for the Women’s Health Voice, I have talked to many women who ask about eligibility for medical assistance and finding facilities to serve women who lack insurance coverage. These concerns are very similar to the issues faced by the women I met in Ghana.

It is unfortunate that women’s living conditions can be detrimental to her health, but it is possible to turn these situations around. The U.S. is a wealthy country with one the most extensive medical systems in existence, great facilities for researching women's health, financial assistance programs, and state-of-the-art research that is both extensive and on-going. We have so far, however, lacked the political will to utilize these resources equitably and support those who need medical help both in the U.S. and internationally.

Understanding the situations and the needs of women abroad can encourage us to learn more about not only other nations’ health care status, but also our own. Ghana and the U.S. are socially and economically very different, but health care access is a problem in both places. Advocating for better access to care here and abroad can increase public awareness of the barriers to health care and build support for policy action to address the health needs of women everywhere.

Sara Lake is a senior at Michigan State University. She will graduate in May with a B.S. in Interdisciplinary Social Science and plans to pursue a graduate degree in public health. She was a NWHN intern during Fall 2007. Sara's interests include eliminating health disparities in underprivileged communities.

REFERENCES:

1. World Health Organization (WHO), World Health Statistics 2007, Geneva: WHO, 2007, pp. 25, 31. “Core Health Statistics” retrieved November 27, 2007 from http://www.who.int/whosis/database/core/core_select_process.cfm.

2. WHO, World Health Statistics 2007. Geneva: WHO, 2007, pp. 24, 30.