Marcia Greenberger

WASHINGTON (WOMENSENEWS)–One in eight American women lacks health insurance. One-third of American women are overweight. One-half have had an unintended pregnancy. These are the findings of a recent national survey that concluded that the state of American women’s health is critical.

The recession is pushing many women out of the workforce, making them ineligible for health coverage, and the threat of bio-terrorism is draining precious public health resources, so that the short-term prognosis is not good, the report on the survey said.

“The overall results of this report card can only be described as disturbing,” said Marcia Greenberger, co-president of the National Women’s Law Center here and one of the authors of “Making the Grade on Women’s Health,” issued for the second year.

“There are harmful gaps in policy and important areas where our nation is failing to take steps that would significantly improve women’s health,” she told a news conference last week on the report by the National Women’s Law Center, the University of Pennsylvania and the Oregon Health and Science University.

While the study showed that the picture of American women’s health continues to look bleak, it did reveal a glimmer of progress in preventative measures for life-threatening illnesses and access to health insurance.

The report noted the most dramatic inroads involved prevention activities for life-threatening illnesses and access to health insurance. Over the year, the rate of women receiving pap smears jumped 2 percent and the rate of colorectal cancer screenings rose by 3.6 percent. The nation moved from marks of unsatisfactory to satisfactory in these areas, which account for the only grade improvements in the nation’s overall mark since last year. More women also reported receiving mammograms.

Report Cites Little Progress Since Last Year in Nation, States

The report examined women’s health in all 50 states and in the District of Columbia. It listed some advances in public health but found a larger number of systemic shortcomings. Comparing the findings to last year’s, the report also found several setbacks that reduced women’s quality of life, added to the public sector’s medical expenses and caused premature deaths.

Consequently, the nation received an overall grade of unsatisfactory, as did 49 states and the District of Columbia. Only Louisiana received a failing grade because it showed no improvement over last year when eight states and the District of Columbia received Fs.

“I’m terribly disappointed that we’re again unable to give a single state or the nation a grade of satisfactory this year,” said Dr. Michelle Berlin, an associate professor at Oregon Heath and Science University and one of the authors of the report.

“There has been little progress in numerous key areas. Poverty, unhealthy lifestyles, poor mental heath, violence, lack of education and low income continue to interfere with women’s ability to achieve good health in every corner of the nation,” she said.

Regan Ralph, vice president of health and reproductive rights at the National Women’s Law Center, cautioned that the ongoing recession threatened to deprive even more women of access to quality health care in the near future.

“It is particularly disturbing that, with the economy in trouble and the need increasing, very few states improved Medicaid coverage for vulnerable groups of women,” Ralph said. “Only five states and D.C. improved Medicaid coverage for pregnant women and just four improved Medicaid coverage for single parents.”

Critics Say Goals Are Worthy But Standards Are Unrealistic

While the report has had a largely positive reception, some critics charge that it sets unreachable standards and sends an overly negative message. The benchmark to receive a satisfactory grade in the area of health insurance, for example, requires coverage of 100 percent of a state’s residents–considered by many to be a worthy goal but an unrealistic expectation in today’s political climate.

Carol Weisman, a professor of public health at the University of Michigan, said that although she supports the report overall she is concerned that the high standards may be unrealistic.

Universal health coverage is an extremely important objective, Weisman said, but added that it was “an extremely idealistic objective” because of the nation’s reliance on private health insurance.

Weisman had the same criticism of last year’s report, which she aired in the Fall 2001 issue of the Journal of Quality Management in Health Care.

“The benchmarks are essential targets and do not necessarily reflect what is likely to occur based on best practices within the health care delivery system,” she wrote. The targets, she said, are based on idealistic goals rather than actual progress.

Consequently, no state received an overall grade of satisfactory this year, causing some state officials to complain that the report makes it difficult to demonstrate that they are making progress.

But Elena Cohen, senior counsel at the National Women’s Law Center, defended the benchmarks, noting that the standards were adopted from the Healthy People 2010 initiative, a study conducted by the Health and Human Services Department under then President Clinton.

“It is true that there is a high standard,” Cohen said. “But it’s not so much a criticism of the report as it is a reflection of the state of women’s health at this point in time.”

Oregon professor Berlin added that the authors added a new grade–unsatisfactory-plus–to acknowledge significant advances in 10 states. The states that received that grade are Alaska, Colorado, Connecticut, Hawaii, Iowa, Massachusetts, Minnesota, New Hampshire, Utah and Vermont.

Fewer Women Are Taking Steps to Healthy Life; Obesity Increases

The study showed that the number of women taking preventative measures to maintain good health–such as eating properly, exercising regularly and refraining from smoking and binge drinking–decreased over the course of the year. The number of obese women jumped two points to 33.3 percent, while the number of women eating a healthful amount of fruits and vegetables dropped more than one point to 28.6 percent.

The rate of smokers also increased slightly, as did the number of binge drinkers. The decline in preventative health has resulted in a high population of women with poor cardiovascular health, which in turn has made heart disease the leading cause of death among American women, Berlin said. Inadequate research and a failure to understand how the disease affects women contribute to a culture unable to adequately address women’s health needs, she added.

As a result, women are more likely than men to delay seeking care after the onset of heart attacks and to suffer a second heart attack within six years after the first one. Women are also less likely than men to have their heart attack symptoms recognized by health care providers, to receive counseling from physicians on risk factors and to be enrolled in rehabilitative programs after a heart attack, Berlin added.

Other setbacks were registered in the past year: More women reported having high blood pressure and diabetes while fewer women reported having good mental health.

The study also showed stagnant progress in several key areas. About 9.5 percent of women still live in medically underserved areas and nearly one-third of American women have no access to an abortion provider.

The rate of lung cancer, unintended pregnancies, a sexually transmitted disease called chlamydia, and maternal mortality did not improve over the course of the year. Also, the amount of violence against women did not decrease.

Women’s life expectancy also remained fairly constant, as did the number of women living in unhealthy communities where poverty and infant mortality is high and life expectancy and education levels are low.

Southern States Get Lowest Grades, Have Poor Economy, Low Income

While most states received a grade of unsatisfactory, all states were not equal. Regional disparities continue to persist.

The lowest ranked states–Alabama, Arkansas, Louisiana, Mississippi and West Virginia–are all located in the South, the region with the country’s poorest economy. The local political climate and regional demographics, including lower median earnings and education levels, also contributed to the South’s poor showing.

Hawaii ranked as the top state and four states in the Northeast and the Midwest followed. They are Connecticut, Massachusetts, Minnesota and Vermont.

The states that made the biggest improvements since last year are also on the East Coast and in the Midwest. They include the District of Columbia, Iowa, Maryland, New York and Rhode Island.

The states that made the fewest improvements are Georgia, Nevada, North Dakota and Wisconsin.

Disparities concerning race, ethnicity and sexual orientation also persist. African American women, for example, are most likely as a group to be obese. Hispanic women are the least likely to receive mammograms and colorectal cancer screening. Asian Americans are the least likely to have had a Pap smear within the last three years and Native American women have the highest rates of smoking and alcohol use.

Health Insurance Coverage Still Inadequate

The percentage of women without health insurance fell over the course of the year, from 14 percent to 13.2 percent. Four states and the District of Columbia improved in this area–Iowa, Michigan, Pennsylvania and Vermont –rising from a failing grade to an unsatisfactory mark. Two states, Delaware and Nebraska, fell from an unsatisfactory to a failing grade. In addition, lesbians appear to be less likely to have insurance coverage than other women, according to the report.

A large number of American women lack prescription drug coverage, Ralph from the law center said, despite campaign promises by both national parties. This is particularly harmful to women because they account for three-quarters of the nation’s nursing home residents and two-thirds of the nation’s home care consumers.

Even those who do have health insurance often lack the best coverage to meet their needs, Ralph said. The vast majority of states, for example, do not require coverage for hospital stays after childbirth for the period deemed necessary by the woman’s physician.

And 32 states have failed to provide enough patient advocates to ensure that women receive quality long-term care, leaving numbers of women vulnerable to inadequate care, negligence and abuse.

Women also tend to be excluded from medical research studies, meaning that doctors cannot adequately recognize and treat women’s diseases.

While noting policy improvements in health research, Greenberger assailed the Bush administration for failing to improve access to health insurance and the welfare program, which threatens to deprive more women of Medicaid coverage and family support programs.

“We haven’t seen the kind of leadership to provide health care support that is so essential to the country, nor have we seen. . . the kind of leadership that would assuage our concerns,” Greenberger said.

In an Otherwise Bleak Picture, a Few Bright Spots

Still, the authors acknowledged modest legislative progress. Several states have strengthened safety net services, given patients the right to demand external review of managed care decisions and improved coverage for medications for low-income people ineligible for Medicaid.

At the federal level, Congress has adopted the Breast and Cervical Cancer Prevention and Treatment Act of 2000 and improved data collection on women’s health by race, ethnicity and age.

“These are important steps, but they are not nearly enough,” Ralph said, adding that major improvements are still needed in health insurance, mental health, elder care and anti-smoking policies.

Allison Stevens covers politics in Washington, D.C.

For more information:

The National Women’s Law Center:

FOCUS on Health and Leadership for Women:

To read Women’s Enews article about last year’s survey:

“New Study Says U.S. Health Policies Fail Women”:

To read the report:

Oregon Health & Science University: