(WOMENSENEWS)–So many American women hover at or close to the poverty level that their health and well-being is seriously undermined, and states are doing little about it.

A comprehensive national study, "Making the Grade on Women’s Health: A National and State-by-State Report Card," found that more than 13 percent of the nation’s women live in poverty–about 18 million. And, in many states, nearly a quarter of women live in households below the federal poverty level (defined as $17,050 for a family of four in the 48 contiguous states).

The study is a joint project 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.

Without an adequate income, a woman cannot afford health care services, health insurance, safe housing, nutritious food and other basic necessities that promote and protect her health and well-being, the authors said.

Checking another economic indicator, the report noted that in 1998–the latest year for which figures are available–women on average earned only 72.3 percent of what men earned. The authors assessed each state against a benchmark that women should earn 100 percent of what men earn. No state was within 10 percent of that goal. As a result, every state, the District of Columbia and the nation as a whole received an "F" or failing grade.

Gender-Based Wage Gap Persists Nationwide

The wage gap was the smallest in the District of Columbia, where women earn 87.5 percent of what their male counterparts earn. The gap was largest in Alabama and Oklahoma, where women earn less than 66 percent of what men earn.

To improve women’s economic security, the report suggested states could take five key steps:

  • allowing families receiving federal income assistance, known as welfare or Temporary Assistance to Needy Families, to keep some of the child support payments made on their behalf;
  • improving collection rates of child support;
  • providing state-supported income assistance akin to the federal Supplemental Security Income to the elderly, blind and individuals with disabilities;
  • keeping taxes low for currently poor families; and
  • enacting a minimum wage that allows a family to reach the poverty level.

Currently, the federally mandated minimum wage of $5.15 an hour amounts to $10,712 a year–far below what many consider to be a living wage. The Report Card set a benchmark of $6.39 an hour, which would allow a family of three supported by a year-round, full-time, minimum wage earner to reach the poverty level. Only two states, Oregon and Washington, have set $6.39 as their minimum wage. All other states are below that level or have no mandated minimum wage.

Such economic indicators may help explain why the United States ranks 19th among nations, with an average life expectancy for women of 78.9 years. Japanese women have the highest life expectancy of 82.9 years. Though no state met Japan’s level, all states fell within 10 percent of that standard, the Report Card found. The range was from 76.9 years in Louisiana to 81.3 years in Hawaii.

Infant mortality is another key indicator of a population’s health, the authors said. To date, 18 states have met the Healthy People 2000 goal of no more than seven infant deaths per 1,000 live births and 12 states were within 10 percent of that benchmark. The other 20 states and the District of Columbia received an "F" for falling more than 10 percent below that standard.

Health Affected by Education, Bias, Wages, Environment

"These are commonly accepted measures of the health of our community and nation and what we found is very disappointing," said Sharon Levin, senior counsel for the National Women’s Law Center.

Besides assessing the level of women’s economic security, the report examined how education, discrimination, gun control and the environment affect women’s health. The results in these areas were not particularly encouraging.

On the education front, only four states–Alaska, Utah, Washington and Wyoming–had 90 percent or more of women graduate from high school. The 35 states that were within 10 percent of that goal received a "U" for unsatisfactory. And, 11 states received an "F" for failing to come within 10 percent of the benchmark. The nation as a whole received a "U."

"There are still a lot of women in this country who don’t complete high school," Levin noted. "This is a basic step for being able to take care of yourself in this society. If you can’t take care of yourself, you can’t take care of your health."

Since discrimination can harm women’s health by creating barriers to health care services and insurance, the Report Card examined whether states have comprehensive laws that prohibit employment discrimination based on sexual orientation and genetic information.

Only eight states–California, Connecticut, Nevada, New Hampshire, New Jersey, Rhode Island, Vermont and Wisconsin–had outlawed both kinds of discrimination.

Common Sense Gun Control Would Reduce Women’s Deaths, Injuries

The authors said effective gun control laws were another way to reduce the number of deaths and serious injuries to women. Specifically, states should enact "common sense measures," which would require licensing and waiting periods, require safe storage and prohibit concealed handguns, the authors said. No state has adopted all three restrictions, but the District of Columbia has banned handguns.

Nine states–California, Connecticut, Hawaii, Illinois, Iowa, Massachusetts, Minnesota, Missouri and New Jersey–had adopted a strong combination of many of these restrictions, while 18 states have weaker or fewer strictures on guns.

Because exposure to toxins contributes to illness, disability and death, the Report Card assessed the states’ monitoring efforts for six health conditions: lead poisoning, mercury poisoning, pesticide poisoning, carbon monoxide poisoning, acute chemical poisoning and asthma.

The Report Card found that no state monitors all six conditions and only four states–Mississippi, Missouri, New Mexico and Wisconsin–check for five of those conditions.

Improving public transportation would also aid women’s health by making it easier for women to reach their health care providers and jobs and reducing toxic pollution caused by cars, the Report Card said. Yet, the state average annual per capita spending for public transportation ranged from about $675 per urban resident in New Jersey to less than $2 per urban resident in Mississippi.

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.