Women's Access to Health Insurance Services
Lack of health insurance is a major barrier to women receiving needed health care services. But even women with health insurance face barriers to getting the health care they need. The status indicators in this section examine the percentage of women who lack health insurance, those who live in communities without enough primary care providers, and women’s access to prenatal care and abortion services-two essential services for women that are also indicative of women’s access to general health care services.
Without health insurance, most women cannot obtain the health care they need. As noted in the national report card, nearly one in five women ages 18-64 is uninsured in the U.S. Although the lack of health insurance is a significant problem for both men and women, women face special challenges. Women are generally poorer than men, and nationwide earn just 78 cents for every dollar men earn.1 Women also use the health care system more, in part due to their reproductive health needs.2
Because they are poorer (on average) and use more care, women spend a greater share of their income on their health needs. They are more likely than men to struggle with medical debt and to report cost-related problems accessing health care. Women without coverage are especially likely to struggle to afford the care they need.3 In 2007, nearly half of uninsured women reported problems with medical bills, including being unable to pay for food, heat or rent, using up all of their savings, taking out a mortgage or a loan against their home, or taking on credit card debt.4
People living in a “medically underserved area” reside in an area with reduced access to primary care physicians.1 For some, access is reduced due to residence in a remote location, while for others it is due to the disproportionately low number of primary care physicians in a non-remote area. One in five Americans have inadequate or no access to a primary care physician.2 The lack of accessible health care services is particularly acute for poor and low-income people, who do not have the financial resources to travel to find health care and may not be accepted by physicians due to low reimbursement rates in Medicaid (the health insurance program for low-income people).3
Women who receive prenatal care beginning in their first trimester of pregnancy (i.e., within the first 12 weeks) tend to stay healthier and have healthier babies.1 Early initiation of prenatal care helps improve maternal and newborn health by connecting women with high-risk pregnancies to obstetrical and neonatal care.2 Certain vulnerable populations—including young women,3 poor women, women with lower education levels,4 and women in certain racial and ethnic groups5—are less likely to receive adequate prenatal care. It is particularly important to reach out to these underserved groups, who may otherwise go without beneficial prenatal services.
The absence of health care providers trained and available to provide abortion services can endanger women’s lives and health. For instance, abortion provider shortages may delay access to abortion procedures, which are safer the earlier in pregnancy they are performed.1 Across the country, 87% of U.S. counties had no abortion provider in 2005, and as noted in the national report card, 35% of women live in these underserved counties.2,3 Poor access to abortion services is a particular concern in rural communities. In 2005, 97% of non-metropolitan counties had no abortion provider.4
Addressing Wellness and Prevention
Seven out of 10 U.S. deaths each year are due to chronic diseases. Heart disease, cancer and stroke alone account for more than half of all annual deaths, yet preventive screenings and reducing risk factors can dramatically reduce the burden of these diseases. Focusing on wellness and prevention is essential to saving lives and reducing health care costs. This section includes status indicators on key medical screening tests for women and personal behaviors that can influence health.
The status indicators in this section examine screening for cervical cancer, breast cancer, colorectal cancer and cholesterol levels. These tests, which are designed to be provided when women are free of symptoms, were selected because they screen for diseases that can be treated effectively with early interventions.
Papanicolaou (Pap) smears remain the primary screening tool to help identify and prevent cervical cancer. Nevertheless, many women do not receive regular Pap smears,1 especially older women, uninsured women and women in key minority groups.2 When cervical cancer is identified early it is highly treatable and associated with long survival and good quality of life, but 6 out of 10 cervical cancer cases occur in women who have never been screened or who have not received a Pap test in the past five years. Regular Pap smears are essential to women’s health and when widely adopted, assist to reduce mortality and morbidity rates associated with cervical cancer.3
Breast cancer is the second most common cancer among American women.1 Mammography is the single most effective method of early detection and can identify breast cancer several years before the appearance of physical symptoms. Early detection of breast cancer greatly increases treatment options, the chances for successful treatment, and survival.2 Thus, it is critical that women have access to mammography services. Although the overall number of women who get mammograms is relatively high (and above the Healthy People benchmark) many women—particularly those who are uninsured, low income, or members of certain racial and ethnic minority groups—do not get mammograms at the same rate.3
Colorectal cancer is the third leading cause of cancer-related deaths among women, after lung and breast cancer.1 Colorectal cancer is most common in people age 50 and older and the risk increases with age.2 Regular screening examinations, including colonoscopy and sigmoidoscopy,3 can reduce a woman’s risk for developing colorectal cancer and can assist in the detection and treatment of colorectal cancer in its early stages. Therefore, this screening procedure is recommended for women age 50 and older.4 Despite this recommendation, screening for colorectal cancer lags far behind screening for both breast and cervical cancers.5 Screening rates are particularly low among individuals who lack health insurance, are without regular access to a healthcare provider or are members of certain racial and ethnic minority groups.6,7
High cholesterol is a major risk factor for heart disease, the leading cause of death among U.S. women.1 Certain behaviors such as, eating a diet low in saturated fat and cholesterol, increasing physical activity, and maintaining a healthy weight can prevent or lower high cholesterol.2 Therefore, the National Heart, Lung and Blood Institute recommends that all adults over the age of 20 undergo a cholesterol screening every 5 years to help identify high cholesterol levels and prompt action to prevent or lower their risk of heart disease.3
Certain behaviors play an important role in promoting health and preventing disease. Being physically active, not smoking, controlling alcohol intake, maintaining a healthy weight, eating a healthful diet, and visiting a dentist annually can improve or maintain a woman’s general health and well-being and can reduce both the risks and consequences of certain diseases. This section includes status indicators examining these health-promoting behaviors.
Research shows that moderate physical activity can substantially reduce the risk of developing or dying from heart disease, diabetes, colon cancer, and high blood pressure, and may also protect against lower back pain (a leading cause of acquired disability) and some forms of cancer (for example, breast cancer).1 The Centers for Disease Control (CDC) recommends that adults engage in 30 or more minutes of physical activity at least five days a week.2
Obesity has reached epidemic proportions in the United States, with the majority of the population being overweight or obese.1 Poor diet and physical inactivity contribute to the rising rates of people who are overweight or obese,2 and these conditions are the third leading cause of preventable death in the United States after tobacco use and hypertension.3 This epidemic has serious implications for women’s health, since being overweight or obese is associated with a greater risk of developing a variety of serious medical conditions including cardiovascular disease, high blood pressure, diabetes, respiratory problems, some types of cancer, and arthritis.4
The Dietary Guidelines for Americans recommend eating a healthful diet consisting of at least five servings of a variety of fruits and vegetables daily.1 These foods help lower the risk of many chronic conditions and diseases. Conversely, poor nutrition increases both the prevalence and the severity of many conditions (including obesity, high blood pressure, osteoporosis and arthritis) and illnesses (including cardiovascular disease, diabetes and certain cancers).2,3
Smoking is the leading cause of preventable death in the United States and is the primary risk factor for lung cancer, the leading cause of cancer deaths among U.S. women.1 In the United States almost 80% of lung cancer deaths in women are due to smoking.2 Both men and women who smoke face increased risks for other diseases as well (e.g., other cancers, chronic lung disease, heart disease, and stroke), and women experience unique smoking risks related to pregnancy, oral contraceptive use, menstrual function, and cervical cancer.3
Excessive alcohol use is dangerous to a woman’s health. Long-term heavy drinking increases the risks for high blood pressure, stroke and other cardiovascular diseases as well as certain forms of cancer and liver disorders.1 While chronic alcohol use is a known health problem, binge drinking (five or more drinks on at least one occasion) is also a hazardous form of alcohol abuse. Besides being associated with the aforementioned health problems, binge drinking also increases the risk of unintentional/intentional injuries and sexually transmitted diseases/infections.2
Leading health experts stress that oral health is integral to general health and well-being. Poor oral health and untreated oral conditions can result in irreversible dental decay, and also put women at risk for conditions such as heart disease.1 Annual dental visits are an important aspect of maintaining good oral health. Dental check-ups can detect early signs of oral health problems and can prompt the use of treatments that reverse these problems or prevent further damage from occurring.2
This section of the Report Card includes status indicators for five major areas affecting women’s health: key causes of death, chronic conditions, reproductive health, mental health, and violence against women.
Key Causes of Death
The status indicators in this section examine the death rates for some of the leading causes of death among women.
Coronary heart disease is the leading cause of death for women in the United States—it killed more than one in every four women who died in 2006.1 Although this condition is often considered a “man’s” illness, more women than men die of heart disease each year.2
Stroke is the third leading cause of death in the United States and the leading cause of serious, long-term acquired disability. In 2006, the prevalence of stroke in U.S. women was 3.2% (approximately 3.9 million women). Women account for over 60 percent of U.S. stroke deaths and each year, about 55,000 more women than men have a stroke.1
Lung cancer is the leading cause of cancer death among women in the United States and the third most common cause of death overall for women. The chance that a woman will develop lung cancer in her lifetime is about 1 in 16. For cigarette smokers however, the risk is much higher.1
Breast cancer is the most common type of non-skin cancer in the United States, and the second leading cause of cancer death for women.1 In 2010, an estimated 39,840 women will die from breast cancer.2
The status indicators in this section reflect some of the leading chronic health conditions that affect women and their quality of life.
High blood pressure is a major risk factor for heart disease, stroke and heart failure.1 Yet many people with high blood pressure are unaware that they have it.2 Regular screening and adoption of the healthy behaviors reflected by the Women’s Health Report Card prevention indicators (including exercise, consuming sufficient fruits and vegetables, and not smoking) are key to reducing the proportion of women with high blood pressure.3
In 2007, approximately 23.6 million Americans had diabetes, a condition associated with several life threatening co-morbidities and complications such as heart disease, stroke, hypertension, kidney disease, nervous system disease, blindness and lower-limb amputations.1 Diabetes can be both prevented and controlled. People with pre-diabetes who lose weight and increase their physical activity can prevent or delay type-2 diabetes, and those already diagnosed with diabetes can reduce the occurrence of complications through a variety of preventive care practices.2
Diabetes continues to be most common among certain racial and ethnic minority groups, and the disease also has unique implications for women. The disease can affect both mothers and their unborn children and can cause difficulties during pregnancy.3 Women who develop diabetes in pregnancy (“gestational diabetes”) are more likely to develop type-2 diabetes later in life. The development of heart disease among diabetic women is also of particular concern. Women with type 2 diabetes are 27% more likely than men to develop cardiovascular problems.4
Although the majority of new HIV infections and AIDS cases occur among men, the impact of the disease on women has grown significantly since the beginning of the HIV/AIDS epidemic. In 1995, women represented only 8% of AIDS diagnoses but by the year 2007 they represented 27% of all AIDS diagnoses.1 Women of color, particularly Black women, are disproportionately affected by HIV/AIDS—in 2007 Black women accounted for nearly two-thirds of new AIDS diagnoses among women.2 Research suggests that women with HIV/AIDS face increased barriers to care and disparities in access relative to their male counterparts.3 Women also experience unique interactions between the virus and their reproductive health system. HIV is transmitted more efficiently from men to women during sexual intercourse, and women with HIV are at an increased risk of contracting a variety of reproductive conditions, including human papillomavirus and cervical cancer.4
Arthritis is a prevalent chronic health condition and the leading cause of acquired disability in the United States. Women are disproportionately affected by arthritis—in 2006, 24 % of women reported arthritis compared to 18 % of men.1
Of the 10 million Americans estimated to have osteoporosis, eight million are women.1 Osteoporosis can cause many health problems, particularly for older women. It is a major risk factor for hip fracture, a health problem that often has serious consequences.2
Reproductive health is a critical component of women’s health and well-being. The status indicators in this section examine maternal mortality, women diagnosed with Chlamydia, and unintended pregnancies. These indicators were selected because they reflect a range of reproductive health services.
Chlamydia is the most common bacterial sexually transmitted disease/infection in the United States and is most prevalent among sexually active adolescents, young adults, and certain minority groups. Chlamydia is particularly dangerous because it is often asymptomatic in women and can only be identified through screening methods. Untreated Chlamydia infections can lead to pelvic inflammatory disease (PID), which is a major cause of infertility, ectopic pregnancy and chronic pelvic pain.1
Maternal mortality is a key indicator of health worldwide and reflects the ability of women to secure maternal and other health care services. The maternal mortality ratio in the United States is 12.1 deaths per 100,000 live births. The lifetime risk of maternal death is greater in the U.S. than in 40 other countries, including almost all other industrialized nations.1 There are also marked disparities in maternal mortality in the U.S., as Black women face a disproportionately high risk of dying from pregnancy-related conditions when compared to white women.2
Almost half of all pregnancies in the United States are unintended, meaning that they are either unwanted (i.e., pregnancy occurs when no children, or no more children, are desired) or mistimed (i.e., pregnancy occurs earlier than desired). Unintended pregnancy rates vary greatly by age, income level and race. The burden of unintended pregnancy falls most heavily on women aged 18-24, low income women, and certain minority groups.1
Mental disorders are a major cause of disability, on par with heart disease and cancer. Compared to men, women are nearly twice as likely to report unmet mental health care needs, and have higher rates of diagnosis for certain mental health conditions, including depression, anxiety-related disorders, and eating disorders. The status indicator below addresses this important women’s health issue.
Leading health experts agree that mental and physical health have a marked impact on each other and cannot be viewed separately.1 Because good mental health is difficult to define (even though specific mental conditions may be identifiable), this indicator reflects women’s own sense of mental well-being by tracking reporting of the average number of days during the past 30 days that their mental health was “not good.”
Violence Against Women
Stopping violence against women is critical to ensuring women’s health and well-being. The status indicator below addresses this important issue.
Violence impacts women’s physical and mental health. Young women, low-income women and certain minority groups are disproportionately affected by violence and rape.1
Living in a Healthy Community
The Report Card defines women’s health holistically to emphasize that it is affected by the broader social context and communities in which women live. Thus, the Report Card defines women’s well-being as occurring when a woman’s mental, physical, social, economic, political, educational, and environmental quality of life allows her to pursue her full potential. The status indicators in this section address many of these factors.
Life expectancy is a key indicator of health status worldwide. Both physical and mental disabilities influence life expectancy and while women in the United States generally have a longer life expectancy than men, women’s life expectancy in a large number of countries (including Australia, Canada, Greece, Japan, and Singapore) surpasses that of women in the U.S.1
Because illness affects all aspects of women’s lives, including their ability to work, to care for their families, and to participate in their communities, measuring limitations on usual activities is a good indicator of women’s own perceptions of their overall health and quality of life.
Infant mortality (i.e., infant deaths that occur within the first year of life) is a key indicator of health worldwide, reflecting the health not only of infants but of the entire population. Infant mortality is also an indicator of pregnant women’s access to high quality primary care.1 The U.S. infant mortality rate is higher than those in most other developed countries, and the gap between the U.S. infant mortality rate and the rates for the countries with the lowest infant mortality appears to be widening.2
Economic Security and Education
A woman’s inability to afford health care services, health insurance, safe housing, nutritious food, and other basic necessities seriously compromises her health and well-being. Educational attainment improves a woman’s health and well-being, both by opening the door to greater economic security, and by providing the literacy skills necessary to navigate the health care system. The Report Card considers three critical measures of women’s economic security and educational attainment: the number of women living in poverty, the wage gap between men and women, and the percentage of women graduating from high school.
Women are far more likely than men to live in poverty.1 As indicated in the national report card, 13.4% of U.S. women live below the federal poverty threshold. In general, populations with the highest poverty rates are also those that report poor health status. Those who have the fewest resources in the United States also report worse health outcomes, regardless of whether the measure is mortality, the prevalence of acute or chronic diseases, or untreated mental health problems.2
The wage gap (the difference between men’s wages and women’s wages) is an important indicator of women’s economic security because it reflects a major economic hurdle that endangers women’s health and well-being. The wage gap cannot be dismissed as the result of “women’s choices” in career and family matters. In fact, recent authoritative studies show that even when all relevant career and family attributes are taken into account, there is still a significant, unexplained gap in men’s and women’s earnings. Even when women make the same career choices as men and work the same hours, they still earn less.1
Women without a high school degree have lower earnings, more difficulty securing health care, and are more likely to engage in substance abuse, experience unintended pregnancy, or suffer adverse health consequences.1 In addition, women who complete high school have higher average “health literacy” (i.e., the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions) than those who have not completed high school.2