Putting a Female Face on the Need for a Culture of Health

Jul 25, 2014, 11:29 AM, Posted by Susan Dentzer

A doctor examines a patient.  An image appears on a computer monitor.

Statistics are “human beings with the tears washed away,” an old saying goes. Sadly, the tears behind one set of statistics, showing that women’s life expectancy has been falling in just under half of U.S. counties, have rarely garnered much notice.

How to put a face on this story, to help mobilize corrective action?

Progress toward that end was made last week, when the Robert Wood Johnson Foundation teamed up with Women’s Policy, Inc, a nonprofit, nonpartisan organization that seeks to inform policy-making on women’s issues, to sponsor a briefing on that subject on Capitol Hill. About 75 people, including several female members of Congress, gathered in the Rayburn House Office Building to learn what is driving the widespread trend of poorer female health. (Watch the webcast by clicking here).

They also learned the names of some of those seemingly faceless human beings behind the statistics—names like Melissa, Mary and Maria.

Those were pseudonyms (out of respect for privacy) for real patients encountered by Debbie Chatman Bryant, a 2012 recipient of RWJF’s Community Health Leaders Award and a current RWJF Executive Nurse Fellow.  Bryant, a doctor of nursing practice at the Medical University of South Carolina, directs a program that sends a mobile van into racially diverse and medically underserved communities to conduct mammography and other cancer screening.

  • Melissa, a 35-year-old African American woman expecting her fifth child, was screened through Bryant’s program and diagnosed with advanced breast cancer. Despite treatment, she died not long after giving birth.
  • Mary, 51, is homeless, has a history of mental illness, and still cares for her adult son, who suffers from bipolar disorder. Her breast cancer was discovered and treated successfully, and she continues in recovery.
  • Maria, 46, works as a machine operator, doesn’t have health insurance and, as Bryant said, “let too many years slip by between mammograms.” When her breast cancer showed up on a scan, she was treated, and later relapsed. A so-called navigator on Bryant’s team has helped guide Maria into a clinical trial.

Such faces “represent an inescapable public health crisis of our time,” Bryant told those at the briefing. “We live in a world troubled with health challenges complicated by the stress of social pressures, poverty, fear, and a complex health environment.” The toll is high: Relative to women in other high-income countries, US women lose about twice as much life before age 50 from a host of conditions. These range from troubled pregnancies  to falls, traffic accidents and other unintentional injuries, to diseases linked to obesity, hypertension, and smoking.

Sometimes, part of that toxic stew harming women can be drug and alcohol abuse, according to Nora Volkow, director of the National Institute of Drug Abuse, another lead speaker at the briefing. Fluctuating hormone levels influence women’s responses to these substances and make them prone to abuse and addiction over the course of their lifetimes.

And with women more likely than men to report suffering from chronic pain, Volkow painted a troubling picture of high rates of prescriptions for opioids and other pain-relieving drugs. The surge has led to a sharp increase in deaths from opioid overdoses, which as of 2008 exceeded deaths from heroin and cocaine use combined.

Both Bryant and Volkow lamented the fact that evidence-based interventions and policy responses that could address these problems either go unused or aren’t adopted. Bryant pointed to the fact that her state, South Carolina, has so far declined to expand Medicaid eligibility under the Affordable Care Act. Yet a recently released report from the President’s Council of Economic Advisers estimated that if the state expanded Medicaid, 8,000 more women would receive mammograms and 12,000 more would get pap smears to rule out cervical cancer.

Similarly, Volkow noted, depression often goes hand in hand with chronic pain and is a risk factor for drug use and abuse. But millions of Americans have unmet mental health needs, with about half of them citing unaffordability of care as the key reason.

Clearly, throughout the country, many faces of desperation are female. That’s all the more reason to insure that efforts to build a Culture of Health in America have a distinctly feminine cast.