Building Effective Programs: Coping with the Patchwork Quilt of Women's Health Issues

Women's Health Across the Lifespan

Presenters: Arlene Bierman, M.D., M.S., Senior Research Physician, Center for Outcomes and Effectiveness Research, Agency for Healthcare Research and Quality (AHRQ). Lynne Wilcox, M.D., M.P.H., Director, Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC).

Arlene Bierman outlined the opportunities for intervening across the life span to improve women's health as they age. Great opportunities for improvement exist within each of these sectors, but the bigger challenge that was noted was in integrating across all the sectors:

• Health promotion.
• Clinical preventive services.
• Improved risk factor management for chronic conditions.
• Improved quality of care.
• Improved coordination and accountability across different sites and settings of care.

Dr. Bierman emphasized that many models exist for improving chronic disease care that may or may not be specific to women. The gaps in those models (where they do not meet the health needs of women) must first be identified. This includes gaps in access, organization, quality, payment, and knowledge.

For health care to be effective, the role of women as active participants in their health needs to be considered. Women must be:

• Participants in their own care.
• Decisionmakers.
• Evaluators who report on their experience in the system.

Lynne Wilcox considered women's life experiences before age 50 by the following groups: adolescence and early adulthood (13-25), mid-20s to mid-30s, and mid-30s to mid-40s. For each group, she provided selected examples of the developmental concerns of that age period, reproductive health issues, other health issues, and programs that have been designed to monitor or research health behaviors and trends for that age group.

Adolescence and Early Adulthood

• Developmental concerns: menarche, sexual development, early health behaviors, emotional maturation, completion of education.
• Reproductive health issues: sexual behavior, contraception, early childbearing, HIV/STDs.
• Other health issues: health education (e.g., tobacco, alcohol, nutrition, domestic violence).
• Program example: The Youth Risk Behavior Survey is one component of the Youth Risk Behavior Surveillance System developed by the CDC in collaboration with representatives from State and local departments of education and health, 19 other Federal agencies, and national education and health organizations. The Survey addresses the six priority health risks that contribute to the leading causes of morbidity and mortality among youth (e.g., use of tobacco or alcohol, experience with violence, sexual behavior). States use the Survey results to develop strategic plans, revise health-related policies, and monitor progress in achieving local health objectives.

Mid-20s to Mid-30s

• Developmental concerns: employment, finding a partner, raising children, adult health behaviors.
• Reproductive health issues: cervical cancer, permanent/temporary contraception, childbearing.
• Other health issues: depression, domestic abuse, health disparities, continuity of health care.
• Program example: The Pregnancy Risk Assessment Monitoring System (PRAMS), is a surveillance project of the CDC and State health departments that collects State-specific, population-based data on maternal attitudes and experiences prior to, during, and immediately following pregnancy. PRAMS provides data for State health officials to use in improving the health of mothers and infants.

Mid-30s to Mid-40s

• Developmental concerns: changing from young adulthood to middle age, stresses of job/marriage/children, success in job, divorce.
• Reproductive health issues: infertility, late unintended pregnancy, menopause.
• Other health issues: early signs of chronic disease (e.g., arthritis, diabetes, hypertension, cancer).
• Program example: As mandated by the Fertility Clinic Success Rate and Certification Act, the CDC issues an annual report on the success rates of assisted reproductive technology clinics around the country.

References:

Bierman A, Clancy C. Making capitated medicare work for women: policy and research challenges. Women's Health Issues 2000;10(2):59-69.

Bierman A, Clancy C. Women's health, chronic disease, and disease management: new words and old music? Women's Health Issues 1999;9(1):2-17

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