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

Indicators of State Performance

Identifying Priorities & Measuring Success

Presenters: Mary Jo Deering, Ph.D., Director of Health Communications and Telehealth, Office of Disease Prevention and Health Promotion, U.S. Department of Health & Human Services (HHS). Martha Romans, Executive Director, Jacobs Institute for Women's Health. Susanna Ginsburg, Director, SG Associates, San Francisco.

Information that helps States identify problem areas and measure the success of their efforts over time is central to strengthening women's health programs and policies.

Mary Jo Deering gave an overview of Healthy People 2010's progress on women's health objectives, focusing on its potential as a source of data for national benchmarks.

Healthy People 2010 is a national health promotion and disease prevention initiative with the goals of increasing the quality and years of healthy life and eliminating health disparities. Of the initiative's 467 specific objectives presented in Healthy People to improve the health of Americans, 236 relate to women's health. Because these objectives are national, not solely Federal, the achievement of these objectives is dependent in part on the ability of health agencies at all levels of the government and on non-governmental organizations to assess objective progress.

To accomplish this, the initiative relies upon data from many different sources to track objectives and identify and evaluate emerging public health issues at the national, State, and local levels. A few key sources are listed here:

• Tracking Health People 2010, a compilation of all the data sources used in Healthy People, discusses the specific data sources for each objective and provides the data's geographic availability.
• Data 2010 is an interactive database that contains the most recent monitoring data for tracking Healthy People 2010.
• Beyond 20/20 is an interactive CD-ROM data warehouse of information from many different data systems, sorted and analyzed by gender, race, and ethnicity.
• Ohio's Office of Women's Health has developed a Web-based presentation of data sources on more than 250 healthy people indicators at the national and State level, and compares State data on Healthy People's ten leading health indicators with national benchmarks.
• Healthfinder®, a gateway to consumer health and human services information developed by HHS, can lead to selected online publications, clearinghouses, databases, web sites, and support and self-help groups, as well as Federal agencies and non-profit organizations that produce information for the public.

The Women's Health Companion, a document that will be made available in the fall of 2001 by HHS's Office of Women's Health, will combine the 236 objectives on women's health with information on other related issues (e.g., research, specific populations) and, ideally, actions needed to accomplish these objectives. The document's content will include an examination of progress on the Healthy People 2000 objectives, new and continued objectives, women throughout the lifespan, women of color, and State Healthy People initiatives for women's health.

Martha Romans discussed State Profiles on Women's Health, issued in 1998 as a companion publication to the Institute's well-known Women's Health Data Book: A Profile of Women's Health in the United States. Where the Data Book focuses in detail on national data that describe the health status and major causes of morbidity and mortality for women in the U.S., Profiles offers information about women's health at the State level. A State focus offers the following opportunities:

• Public policy development.
• Needs assessment.
• Program development.
• Program evaluation.
• Funding opportunities.

Profiles examines 75 women's health indicators, all of which have a national data source with gender-specific data from all 50 States. The variables range from demographics, health status, and natality, to health care coverage and legislation. The following data sources were used in the development of Profiles:

• Bureau of the Census demographic data, including distribution of women by age, income, education, race/ethnicity, marital status, and household composition.
• CDC's Behavioral Risk Factor Surveillance System data on health status and behaviors, including diet, alcohol use, smoking, and health screening.
• National Center for Health Statistics data on births and deaths in the U.S., and characteristics of newborns and their parents.
• Data on cancer incidence and survival in the U.S. from the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute.
• Other data sources from research and policy groups (e.g., Urban Institute, Kaiser Family Foundation), advocacy organizations (e.g., American Cancer Society), and professional societies (e.g., American College of Obstetrics and Gynecology).

Ms. Romans shared some of her observations on the experience of developing Profiles:

• Better systems for collecting State-level data need to be developed.
• Data must be routinely analyzed by gender.
• Further research is needed to better understand the reasons for large variations between regions of the country and between individual States.
• State data (detailed by age, race, ethnicity, and income) are lacking in the areas of violence against women, mental health, and long-term care.
• Better measures of access are needed to distinguish between urban, suburban, and rural populations.
• Better measures of quality of care are needed.
• Better information about women's abilities to make informed health care choices is needed.

Susanna Ginsburg reviewed Making the Grade on Women's Health: A National and State-by-State Report Card, the first-ever report card to assess the overall health of women at the national and State levels. The Report Card was prepared by the National Women's Law Center, FOCUS on Health and Leadership for Women at the University of Pennsylvania School of Medicine, and The Lewin Group.

The Report Card provides "status" indicators that measure women's access to health care services, the degree to which they receive preventive health care and engage in health-promoting activities, the occurrence of key women's health conditions, and the extent to which the women's communities enhance their health and well-being. The Report Card also provides a set of "policy" indicators based on State statutes, regulations, policies, and programs that address the problems identified by the health status indicators.

In the Report Card, States are compared, but not graded, on the policy indicators. In contrast to the status indicators, where basic data were available, the absence of consistently collected policy data precluded meaningful comparisons of the States in key policy areas. Ms. Ginsburg highlighted the differences in States' policies to address women's health:

• No State has raised its Medicaid eligibility levels to the highest Federal match levels.
• Only seven States provide comprehensive health coverage to otherwise uninsured adults whose incomes are at the Federal poverty level.
• Four States provide mental health parity (including eating disorders and depression).
• Two States provide for private and expanded Medicaid coverage for contraceptives.

On the health status indicators, the nation received an "unsatisfactory" grade, because of the 25 status indicators with benchmarks, only one—mammograms for women over 50—was met by all States. In comparison, 10 benchmarks were missed by all States:

• Women without health insurance.
• First trimester prenatal care.
• Physical activity.
• Obesity.
• Eating five fruits and vegetables a day.
• High blood pressure.
• Diabetes.
• Life expectancy.
• Poverty.
• Wage gap.

Ms. Ginsburg presented the following examples of how States have used the Report Card's findings and recommendations:

To stimulate discussion of issues and to develop agendas:

• Maryland has held legislative hearings with testimony using the Report Card to identify the State's key problem areas.
• Ohio legislators have authored op-ed pieces in the State's newspapers based on the Report Card's findings and the implications for women's health in Ohio.

To build support for women's health initiatives:

• The Pennsylvania Women's Health Alliance has built on the Report Card's recommendations and launched a campaign on postmenopausal wellness.
• In Ohio, the Report Card has been used in conjunction with Women's Health Month to encourage women to focus on improving their health.

Ms. Ginsburg offered the following suggestions for States that may be considering acting on the Report Card's findings:

• Develop an expanded State report card, with expanded analyses in the health status and policy arenas and evaluation of current programs.
• Develop State agendas for evaluating existing policies or programs, or for assessing program needs.
• Convene groups and developing conditions for action.
• Building educational campaigns.

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