Photo: Women doing aerobics

Despite the need to promote women’s wellness and prevent illness, no state has met the national goals for increasing physical activity, reducing overweight and improving diet, and most are doing poorly, according to a national and state report card.

And, most states fail to ensure women are adequately screened for such common diseases as cervical cancer, colorectal cancer and chlamydia.

The national women’s health survey, however, indicated that every state and the District of Columbia met the national goal for ensuring women age 50 and over have mammograms. At the same time, certain groups of women–the uninsured, older women and some racial and ethnic groups–receive mammograms at less than the national rate.

Overall, the report, called “Making the Grade on Women’s Health: A National and State-by-State Report Card,” shows uneven coverage for prevention and wellness efforts in every state.

This new tool was created by the National Women’s Law Center, the University of Pennsylvania School of Medicine’s FOCUS on Health & Leadership for Women and The Lewin Group, a health policy consulting firm.

Elena N. Cohen, senior counsel at the National Women’s Law Center, said, “This report offers strong evidence that state policy makers are not taking prevention and wellness of women seriously.”

The lag in prevention efforts is particularly disappointing because there is evidence that programs to help ensure women control their weight, eat properly and engage in regular exercise have broad positive health effects, she added.

State and Local Governments Must Promote Women’s Wellness

State and local governments have a responsibility to ensure these goals are being met. “By focusing on governmental action, we’re saying we believe both the federal and state governments have a responsibility to improve women’s health,” Cohen said.

If these nationally accepted guidelines showed women in the nation and in the individual states were healthier, then there wouldn’t be this need to identify and evaluate these indicators, but when the status of women’s health is so poor then there is a special need to have the federal and state government try to help correct the problem, Cohen added.

In assessing the state of prevention for women’s health, the Report Card examined screening rates for cervical cancer, chlamydia, breast cancer, colorectal cancer and osteoporosis. These diseases were selected because early intervention is key to effective treatment, the authors said.

The Report Card found:

  • Twenty-six states and the District of Columbia fell short of the national goal for Pap smears, the primary screening test for cervical cancer. The national goal calls for at least 85 percent of women age 18 and over to have received a Pap smear during the past three years.
  • Twenty-seven states and the District of Columbia do not require private insurers to cover cervical cancer screening.
  • Thirty-one states and the District of Columbia did not meet the national goal for screening for colorectal cancer–the third-leading cancer killer of women. Only two states, Illinois and Missouri, require private insurers to cover colorectal screening.
  • Only three states–Georgia, Maryland and Tennessee–require insurers to cover recommended screening for chlamydia, the most common bacterial sexually transmitted disease.
  • Only five states–Florida, Maryland, North Carolina, Oklahoma and Texas–have required private insurers to cover bone density screening in five categories of women who are prone to osteoporosis because of estrogen deficiencies and other reasons.

Currently, Medicaid and Medicare cover certain screening tests. However, states can help more women by requiring private insurers to cover these vital procedures. Such tests are important because they are often the first step for women to gain access to general health care, the report said.

States Should Require Private Insurers to Cover Screening Tests

On the prevention front, the Report Card looked at indicators that reflect state efforts to encourage such positive health behaviors as exercising, eating right, maintaining a healthy weight, not smoking and drinking alcohol in moderation. Developing these healthful habits can reduce the risk of getting certain diseases and consequences of some diseases.

All 50 states and the District of Columbia received an “F” or failing grade for missing a federal goal of having at least 85 percent of the state’s women engage in leisure-time physical activity. And, only one state, New Jersey, has required students in grades nine through 12 to take four years of physical education in order to graduate. Promoting physical activity in school is crucial to encouraging girls to reap the health benefits of regular exercise and to develop lifelong exercise habits.

Every state also flunked the federal goal for reducing the percentage of overweight persons (ages 20 and over) to 20 percent or less when the goal was applied to women. “This failure has serious implications for women’s health since overweight is associated with a greater risk of such diseases as cardiovascular disease, diabetes and exacerbating existing conditions like arthritis,” the authors said. Arizona was the only state to come within 10 percent of the benchmark.

Poor nutrition is another health problem. Every state flunked the federal goal of having at least 50 percent of its people eating five or more servings of fruits and vegetables a day.

States can adopt outreach programs to women eligible for Food Stamps and a specific program called the Food Stamp Nutrition Education program to teach safe and healthful eating habits. But only nine states–Arizona, Connecticut, Kentucky, Massachusetts, New Hampshire, New York, Tennessee, Vermont and Washington–participate in both programs. Thirty-nine other states have one or the other. Delaware, Maryland and the District of Columbia offer neither.

Melinda Voss has a master’s degree in public health. She was a long-time reporter for The Des Moines Register. She now teaches journalism at the University of Minnesota.