Major Health Concerns (Magill’s Medical Guide, Sixth Edition)
Women continue to live longer than men. In the United States, the life expectancy of a woman is 79.5 years. Living to an advanced age increases the risk of developing diseases such as stroke, osteoporosis, and rheumatoid arthritis. Many of the health issues that women face are preventable with lifestyle changes.
Heart disease. In the United States, heart disease causes approximately 22 percent of deaths in women. It is the leading cause of death and disability in women over the age of fifty. More than half of women who experience sudden cardiac death did not have symptoms of heart disease. Women generally develop heart disease ten years later in life than do men. Women who survive heart disease have worse long-term outcomes than do men. Approximately 35 percent of women who have had a heart attack will have a second heart attack within six years. Of women with heart disease, 46 percent will become disabled from heart failure and 11 percent will suffer a stroke.
Obesity, high low-density lipoprotein (LDL) cholesterol, high blood pressure (hypertension), inactivity, smoking, and diabetes are known risk factors for the development of heart disease. The percentage of overweight women in the United States continues to increase. In women, being overweight (greater than 20 percent over ideal body weight) is related to an increased risk of heart attack, heart failure, sudden cardiac death, chest pain, and...
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Research (Magill’s Medical Guide, Sixth Edition)
In response to the lack of medical research conducted on women, the National Institutes of Health (NIH) established the Office of Research on Women’s Health in 1990. The following year, the Women’s Health Initiative was launched with the purpose of understanding the main causes of illness, disability, and death in postmenopausal women between the ages of fifty and seventy-nine. The fifteen-year study included 161,808 women from all races and socioeconomic classes.
Prior to the Women’s Health Initiative, long-term hormone therapy was routinely prescribed for postmenopausal women. An estimated six million postmenopausal women in the United States were taking it. These women often had not had menopausal symptoms, such as hot flashes, for years. It was thought that hormone therapy was heart-protective. The Postmenopausal Estrogen/Progestin Interventions (PEPI) Trial was a three-year study that examined the effects of hormone therapy on cardiovascular risk factors. At the end of the study, recommendations were made for hormone therapy as treatment for the prevention of cardiovascular disease in postmenopausal women. A second study, the Heart and Estrogen/Progestin Replacement Study (HERS), was conducted with women with known heart disease. Initial recommendations were that women already on hormone therapy could continue but that women who had heart disease should not begin it in order to prevent further heart problems. After...
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Perspective and Prospects (Magill’s Medical Guide, Sixth Edition)
In Everything You Always Wanted to Know About Sex (1969), American physician David Reuben wrote that menopause was the loss of womanhood and functionality as females. Historically, medical research has generally been conducted with males. If females were included in the studies, then the results were grouped with those of the males. This clustering of results prevented the identification of sex differences. In 1990, the NIH established the Office of Research on Women’s Health in response to the lack of information about women and health. The Women’s Health Initiative, a fifteen-year research study, began in 1991.
In 1993, Congress passed legislation requiring that women be included in all research studies funded by the NIH. Prior to this legislation, women were excluded if they were in their potential childbearing years in order to prevent the risk of drug-related birth defects. The following year, Congress also mandated the establishment of the FDA Office of Women’s Health. The purpose of this office was to require the inclusion of women in studies. Studies have since demonstrated that women experience increased side effects and often more serious consequences from medications as compared to men. The exact mechanisms of these events are unknown.
In 2001, the Institute of Medicine (IOM) published its acknowledgment of the impact of an individual’s sex on disease and treatment. (According to...
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For Further Information: (Magill’s Medical Guide, Sixth Edition)
American Heart Association. “Heart Disease and Stroke Statistics: 2010 Update.” http://www.americanheart .org/statistics. Provides the most recent statistical evidence from data on the incidence of heart disease and stroke by gender and race.
Dibble, Suzanne L., and Patricia A. Robertson. Lesbian Health 101: A Clinician’s Guide. San Francisco: UCSF Nursing Press, 2010. The first comprehensive textbook on lesbian health for clinicians and students. Helpful to general readers as well. Also provides insight into women’s health in general.
Eastwood, Jo-Ann, and Lynn V. Doering. “Gender Differences in Coronary Artery Disease.” Journal of Cardiovascular Nursing 20, no. 5 (September/October, 2005): 340-351. Written for nurses caring for individuals with heart disease.
Gupta, Nelly Edmonson. “What You Should Know About the HPV Vaccine.” Clinical Advisor 9, no. 7 (July, 2006): 46-48. An interview with two physicians about the new HPV vaccine that prevents the major cause of cervical cancer. Written in conversational style that is easy to follow.
Hobson, Katherine. “Hello, His and Her Health Care.” U.S. News and World Report 140, no. 8 (March 6, 2006): 74-76. A short article about the recognition of gender differences in health issues.
Institute of Medicine. Exploring the Biological Contributions to Human Health: Does Sex Matter?...
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Women's Health (Encyclopedia of Medicine)
Women's health is the effect of gender on disease and health that encompasses a broad range of biological and psychosocial issues.
Women's health is the concept that examines gender differences in health and disease states. The average life expectancy has almost doubled for women (79 years for women and 73 years for men), when compared with averages during the turn of the century. Because of the gender gap in lifespan, women comprise approximately two thirds of the population older than 65 and three fourths of the population aged 85 years and older. Currently the fastest growing group in the United States is persons aged 85 years and older. Because of gender life expectancy differences, it is estimated that at the beginning of the twenty-first century, women will outnumber men in the 85 years and older category by 3:1. The reasons for this variance are primarily due to physiological differences among men and women.
During different phases of a women's life cycle there are complex interactions that exist between sex hormones, physiological changes, and emotional issues. Physiological changes occur as early as embryonic development when hormones program structural differences between male and female brains. During reproductive years, sex hormones profoundly influence reproduction and...
(The entire section is 1851 words.)
Women's Health (Encyclopedia of Public Health)
Despite obvious differences between women and meniologically, psychologically, and sociallyhe concept of viewing the totality of women's health as different from men's health arose in Western medicine only in the last two decades of the twentieth century. As recently as the 1980s, students in most Western medical schools were taught that, except for issues related directly to reproductive anatomy and function, women were medically identical to men. According to this belief system, medical research could be carried out on men, and the results could simply be applied to women. As a result, only health care providers who specialized in areas related to reproduction were expected to be knowledgeable about issues particular to women.
In order to understand the modern definition of women's health, it is important to understand the history of how women's health care has been viewed by the medical and medical research establishments. Traditionally, the health of women has been seen as synonymous with maternal or reproductive health. Clearly, the Western medical profession's view of women's health as "maternal health" was concordant with societal mores that valued women mainly for their ability to bear children. However, until well into the twentieth century, the major causes of illness and death in women did, in fact, relate to reproductive issues. Childbirth and sexually transmitted diseases, including cervical cancer, have been the most important health issues for women in all ages and placesxcept in the West and certain other countries in the twentieth century. Prior to 1900, the majority of elderly persons in the United States were men, reflecting the toll that childbearing took on the health of women.
In 1970 the book Our Bodies, Ourselves became a touchstone of the women's health movement. Authored by a group of women participating in a course on health, sexuality, and childbearing, the book emphasizes the importance of women attaining knowledge about their health and being active participants in health care in both an individual and societal sense. Our Bodies, Ourselves also considers the social context of health, including effects of sexism, racism, and financial pressures on the health of women. Throughout the 1970s, major focuses of the women's health movement included reproductive freedom, understanding health in a broader social context, and a critical orientation toward the medical establishment.
In the 1980s, women's health advocates began to argue for a broader definition of women's health and increased participation of women in research studies. A major new focus became changing the medical establishment. The reasons for this change in orientation, particularly toward the participation by women in research studies, were complex. They included, but were not limited to, the growing number of women living beyond their reproductive years and the growing number of women reaching positions of influence within academic medicine.
In 1983 the United States Public Health Service commissioned a task force on women's health. This task force broadly defined women's health issues to include not only reproductive and social issues, but also biological differences between men and women. The modern field of women's health includes the study of illnesses and conditions that are unique to women, more common or serious in women, have distinct causes or manifestations in women, or have different outcomes or treatments in women. Since the 1980s, research on gender differences in health and disease has had important implications for the treatment and prevention of a variety of common serious illnesses, including heart disease, stroke, lung cancer, depression, colon cancer, and dementia. Research in all these areas is ongoing.
Integral to this new expanded view of women's health has been a change in how medical research has been viewed by the public. In the 1970s, the focus of women's health advocates in the United States was on "protecting" women from potential abuses by seeking to avoid their inclusion in medical research studies. It should be noted that women were excluded from medical research during this time because of a variety of factors, and not solely, or even mainly, because of popular advocacy. Medical research was conducted almost exclusively by male physicians, and because most research scientists believed that effects of the reproductive cycle of women might lead to unreliable research results, most supported the belief that research should be conducted on men and then applied to women. Even most medical research on rats during this period was conducted using male rats.
However, by the 1980s, women's health advocates had realized that because women were being excluded from research studies, knowledge about the diagnosis and treatment of a wide variety of common diseases in women lagged far behind knowledge of diseases in men. A major focus of the women's health movement in the 1980s and 1990s was improving knowledge about disease in women by promoting the inclusion of women in research studies, mainly through mandating inclusion of women in federally funded research studies.
A greater understanding of the factors influencing women's health from a biological perspective has been paralleled by a greater understanding of the psychosocial and societal factors that affect women's health status. As an example, research published in the early 1990s showed that because women were more likely than men to require ongoing, rather than episodic, treatment for their health conditions, federally sponsored insurance in the United States (Medicare) actually covered less overall health costs for women than for men. Differences in employment patterns also result in fewer women being medically insured than men, strongly affecting access to health care and health status. Research on domestic violence, which disproportionately victimizes women, underlined the short-and long-term health effects of what had previously been considered either a nonissue or a law enforcement issue.
Some have suggested that the term "women's health" be replaced by the term "gender-based medicine," in part to reflect that medical research that promotes a greater understanding of the effect of gender on health benefits both women and men. However, others believe that the term "women's health" is most accurate, since it incorporates not only biomedical issues, but also the psychosocial and societal factors that ultimately influence the overall health status of women.
The field of women's health seeks to promote an understanding of the biological and psychosocial factor affecting women's health, and to integrate this understanding into public health initiatives, including training of health care providers. Recognition by the medical research establishment of the need to study health and disease in women as well as men has been essential to this new paradigm. Despite the strong influence of biological factors, psychosocial issues still remain the single most important determinant of health status for many women.
JANET P. PREGLER
(SEE ALSO: Domestic Violence; Gender and Health; Maternal and Child Health; Reproduction; Women, Infant, and Children Program [WIC])
The Boston Women's Health Book Collective (1998). Our Bodies, Ourselves for the New Century. New York: Simon and Schuster.
Clancy, C. M., and Massion, C. T. (1992). "American Women's Health Care." Journal of the American Medical Association 269:1918920.
Council on Graduate Medical Education (1995). Fifth Report: Women in Medicine. Washington, DC: U.S. Department of Health and Human Services.
Haseltine, F. P., and Greenberg-Jacobson, B. (1997). Women's Health Research: A Medical and Policy Primer. Washington, DC.: Health Press International.
Healy, B. (1995). A New Prescription for Women's Health. New York: Penguin.
Schroeder, P. (1999). 24 Years of House Work and the Place Is Still a Mess: My Life in Politics. Kansas City, MO: Andrews McMeel Publishing.
Walzer Leavitt, J. (1999). Women and Health in America. Madison, WI: University of Wisconsin Press.