Health in the Global Community/Women’s health

Chapter 17

Women’s Health

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Women’s Health

“… essential to the development of health care for women are the concepts of health promotion, disease and accident prevention, education for self-care and responsibility, health risk identification and coordination for illness care when needed.”

– Preamble to a New Paradigm for Women’s Health,

Choi (1985)

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

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Major Indicators of Health

Mortality rates

Cardiovascular disease (CVD) continues to be the number one overall killer of women.

Cancer rates are increasing because of lifestyle choices, environmental carcinogens, and increase in life expectancy.

Diabetes mellitus causes the premature death of many women and is a risk factor for CVD.

Gaps exist in the availability and quality of reproductive health care services globally.

Life expectancy for Americans is at an all-time high.

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

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From http://ndep.nih.gov/partners-community-organization/campaigns/SmallStepsBigRewards.aspx

From http://www.nhlbi.nih.gov/educational/hearttruth/

Major Indicators of Health (Cont.)

Morbidity rates

More women than men are hospitalized each year in the United States.

Women are more likely than men to be disabled from chronic conditions.

Women are more likely than men to have surgery; many surgeries relate to reproductive health.

The most frequently occurring interruption in women’s mental health relates to depression.

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

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Social Factors Affecting Women’s Health

Health care access

Education and work

Employment and wages

Working women and home life

Family configuration and marital status

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

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Health Promotion Strategies for Women

Collaboration and an interdisciplinary approach are necessary to meet the health care needs of women.

Women should receive services that promote health and detect disease at an early stage.

Many women seek information that will allow them to be in control of their own health.

Women desire to become more knowledgeable about their own health.

Health promotion for low-income, underserved women may differ from that for middle-class women.

Knowledge deficits about one’s own health prevail among women regardless of socioeconomic or educational level.

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

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Common Acute Illnesses in Women

Urinary tract infection and dysuria

Diseases of the reproductive tract

Vaginitis, vulvovaginitis, pelvic inflammatory disease (PID), and toxic shock syndrome (TSS)

Chronic diseases

Coronary vascular disease (CVD) and metabolic syndrome, hypertension, diabetes, arthritis, osteoporosis, and cancer (breast, lung, gynecological)

Mental disorders and stress

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

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Reproductive Health Concerns

Nutrition

Includes total life nutritional experience

Dysmenorrhea

Family planning

Includes fertility control and infertility

Need multiple safe options designed to meet the individual needs of all women

STIs, HIV, and AIDS

Women need age-appropriate STI prevention, education, and counseling.

Worldwide, AIDS is a leading cause of death among young women.

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

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Other Issues in Women’s Health

Unintentional injury or accidents

Domestic violence is the single largest cause of injury to women between the ages of 15 and 44 in the United States.

Disabilities resulting from acute and chronic conditions

Women have fewer disabilities than men because they tend to report their symptoms earlier and receive necessary treatment.

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

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Major Legislation Affecting Women’s Health Services

Public Health Service Act (1982)

Provides biomedical and health services research, information dissemination, resource development, technical assistance, and service delivery.

Includes the Family Planning Public Service Act

Title VII of the Civil Rights Act of 1964

Prevents discrimination based on sex, race, color, religion, or national origin

Amended to also include pregnancy and childbirth

Sexual harassment is violation of Civil Rights Act

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

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Major Legislation Affecting Women’s Health Services (Cont.)

Social Security Act

Provides monthly retirement and disability benefits to workers and survivor benefits to families

Occupational Safety and Health Act (OSHA)

Enacted in 1970

Ensures safe and healthful working conditions

Family and Medical Leave Act (FMLA)

Enacted in 1993

Provides 12 weeks of unpaid leave each year for family and medical reasons

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

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Health and Social Services to Promote the Health of Women

Affordable Care Act (ACA) of 2010

Protection from being denied coverage by insurance companies

Protection from being charged more for health care services because of their gender

Preventive care without copays including:

Well-women visits with screening and counseling for gestational diabetes, HPV, STIs, HIV, contraception, and domestic violence

Breastfeeding counseling support and supplies

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

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Health and Social Services to Promote the Health of Women (Cont.)

Medicaid (1965)

A federal- and state-funded health insurance program for the poor

Expanded under ACA to persons under 65 with an income below 133% of poverty level

Largest source of funding for people with limited income, regardless of age eligibility

Five broad coverage groups:

Children, pregnant women, adults in families with dependent children, individuals with disabilities, individuals 65 years or older

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

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Health and Social Services to Promote the Health of Women (Cont.)

Women’s health services

Provide primary health care needs, as well as reproductive and maternity care services including:

Eating disorders

All forms of abuse

Disease prevention, including smoking cessation

Health promotion focusing on nutrition, exercise, and stress management

The National Women’s Health Network is a strong advocate for women’s concerns.

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

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Other Community Voluntary Services

Women’s organizations

Promote voluntary involvement with community; many others have made women’s health a major item on their agenda.

Networking

Help women advance careers, improve lifestyles, and increase income and success.

Crisis hotline services

Provide counseling to battered women, battering parents, rape victims, those considering suicide, and those with multiple needs.

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

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Levels of Prevention

Primary prevention

Recognize risk for disease and target health care behaviors to reduce risk

Never smoking, following a nutritious diet, safe sex practice, avoiding drugs, limiting alcohol consumption, and staying physically active

Secondary prevention

Routine screening for cervical cancer, STIs, breast self-exams, and mammograms

Tertiary prevention

Education and resource utilization

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

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Roles of the Community Health Nurse

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

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Direct care

Educator

Counselor

Researcher

Research in Women’s Health

Research efforts to include women in studies have grown; not based only on male subjects

NIH Office of Research on Women’s Health (ORWH) established in 1990

Many topics examined based on special task force recommendations

Research on financing and delivery of health services for women

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

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Office of Research on Women’s Health

Overarching themes for research:

Developmental, psychological, spiritual, and physiological factors effect on lifespan

Female determinants’ (such as genetics and gender expectations) effect on health

Health disparities and diversity

Diseases and conditions affecting women

Career development and advancement of women in the sciences

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

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“Women are at the center of the health of the United States; therefore, if better models are developed for improving the health of women, the health of the entire nation will benefit.”

– Nies and McEwen (2015)

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

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