Young Feminists -- A Community-Based Approach to Improving Health

By Sara Lake

Community-based health interventions, although not well recognized, have helped women access care when and if they need it. For example, some medical facilities and local health departments have programs to provide opportunities for low-income and/or uninsured women. As an AmeriCorps Volunteer in Service to America (VISTA), I worked at a non-profit medical clinic in southwestern Michigan, where I was able to help provide those services to women in need. This past year, I served as a community health worker, a health educator, and community outreach coordinator. Each day, it was my mission to connect women to local health care resources and empower them to take control of their health.

One program I worked on in Michigan is the Breast and Cervical Cancer Control Program (BCCCP). It is funded by the Centers for Disease Control and Prevention (CDC), and includes a special project entitled the Well-Integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN). Women who are low-income, uninsured, or under-insured can come into the clinic for a comprehensive health screening that includes tests for diabetes, hypertension, obesity, and other common chronic conditions which tend to go untreated among this population. If a woman chooses, she can also work with a lifestyle counselor (myself at one time!) to set goals and work to modify health behaviors that put her at risk for these and other conditions. This mainly involves working with her on efforts to improve nutrition, expand physical activity, and quit smoking. At the same visit, women receive a pelvic exam and Pap test, as well as a referral for a mammogram – all for free or at a reduced cost.

Many of the women I saw at the clinic were very grateful for the opportunity to have this important medical visit. Some women were diagnosed with high blood glucose levels, a symptom of diabetes, and received thorough instructions and materials on preventing the disease. Some women were identified as being obese, and therefore at risk for other health problems such as diabetes, and given assistance in how to lose weight. One of the past year’s 160 WISEWOMAN patients was diagnosed with breast cancer; thankfully, her treatment was covered by the program. Had she not come in for those free cancer screenings, I can only imagine what her situation would be today – poorer health and greater susceptibility to illness.

The program also helped me connect women with other, non-medical services that support health and wellness. For example, many of the WISEWOMAN patients I counseled did not exercise, either due to an unsupportive living environment (e.g., unsafe neighborhoods, a lack of sidewalks, bad weather) or for financial reasons (e.g., they could not afford a gym membership). I encouraged women to start exercising through the clinic’s AmeriCorps-driven community walking program. This is outside the clinic’s typical medical services, but fits with their mission to promote positive well-being and health. Directing these women to the walking program not only increased their opportunities to exercise, but also fostered a sense of camaraderie and, possibly, stress relief every evening they attended. Nursing students also came to the walking program and provided free blood pressure tests and health education each night, to address any additional health care concerns or questions women have.

Another program that was recently implemented at the clinic is the Nutritional Options for Wellness (NOW). Through this program, WISEWOMAN patients with abnormally high blood glucose levels, diabetes, or hypertension can be referred to a nurse specialist. The nurse specialist provides education about chronic disease and nutrition issues that low-income people often face, which can lead to negative health outcomes (like cardiovascular disease and diabetes). If the woman meets the program’s income requirements, partnering food pantries will provide her with a tailored “food prescription” through which they supply healthy food products that can help prevent illness and are congruent to the woman’s unique health needs.

These are just a few examples of interventions that provide services and preventive care to women at the local level. Programs like these are very relevant at this time, when approximately 10.2 million women in the United States are uninsured.¹ According to the Kaiser Family Foundation, 14% of women reported that they “delayed or went without needed health care because they could not afford associated costs.”² As we have all been learning as the health care debate unfolds, even women who have insurance may not be covered to receive certain services and can even be denied health coverage for a “pre-existing condition,” such as pregnancy!³

Health care reform, if passed, will have a tremendous effect on our nation’s, and hopefully, women’s health. One proposed component of the health care reform bills currently being considered in Congress that would enhance women’s health is a greater emphasis on preventive care, which has the potential to provide funds to help women gain access to routine, high-quality well-woman health care visits and to cancer screenings. If the bill includes universal care for all women, it would level the playing field for low-income and uninsured women who often cannot get these services. This population is especially vulnerable to disease; if they cannot access health services, they may not know they are ill or may not be able to get treatment. Additionally, the bill will allow patients to receive these important services without co-pays – which hamper low-income individuals’ access to care. Women who are uninsured and/or living in pov-erty often compromise their health care by forgoing doctor’s visits and routine screenings in order to pay for rent, utilities, groceries, and children’s expenses. This is especially true for women who are unemployed or whose work does not provide health benefits.

I realize that these community-based activities and programs cannot replace affordable health care or health insurance, and that we need to keep fighting to make sure that everyone in the U.S. is covered and can access health services they need. But, these programs do serve as a supplement to improve health and well-being. While government action on improving women’s health is pending, small changes in local areas, particularly in low-income ones, can make a real difference in people’s lives. Activists like you can make a difference at the community level.

Here are a few options to help women in your community:

• Start a support group or a low-cost health club – team up with community health workers to stress the importance of disease prevention and wellness promotion.
• Generate interest in local farmers’ markets and community gardens in various neighborhoods – not just affluent ones – for equal access to healthy food.
• Contact state and federal leaders, urging them to sustain programs like BCCCP that provide services and screenings for uninsured women.
• Support your local community health clinics and their efforts.

Sara Lake, a past NWHN intern, is currently a graduate student at the University of Illinois at Chicago, pursuing a degree in public health. Her career interests include focusing on women’s health and health disparities.

References

1. The Henry J. Kaiser Family Foundation (KFF). The Uninsured: A Primer. Menlo Park, CA: KFF, 2009. Retrieved October 24, 2009 from http://www.kff.org/uninsured/upload/7451-05_Data_Tables.pdf.

2. The Henry J. Kaiser Family Foundation (KFF). The Uninsured: A Primer. Menlo Park, CA: KFF, 2009. Retrieved October 24, 2009 from http://www.kff.org/uninsured/upload/7451-05_Data_Tables.pdf.

3. The Henry J. Kaiser Family Foundation (KFF). Health Reform: Implications for Women’s Access to Coverage and Care. Menlo Park, CA: KFF, 2009. Retrieved 10/24/09 from http://www.kff.org/womenshealth/7987.cfm.