By Marian Lief Palley and Howard A. Palley
Women’s health care issues are increasingly a part of the political agenda in the United States. Below, Marian Lief Palley and Howard A. Palley argue that the organised women’s movement has often been successful in changing the definition of women’s health and has played a significant role in getting many elements of women’s health care needs on the agenda.
In a May 28, 1998 speech in which President Bill Clinton discussed subjects such as nuclear weapons and a Patient’s Bill of Rights, he nevertheless focused his attention primarily on women’s health care needs. He noted that “(t)hree quarters of all the health care decisions in this country are made by women”. On the podium with him were 22 health care workers only one of whom was a man. Two observations seem appropriate regarding this event and the content of the talk. First, women’s health care is certainly on the nation’s policy agenda when the President addresses the issue so pointedly. Second, women are a political force with whom elected officials must be concerned.
However, the political commitment to dealing with these health care needs is still “uncertain”. When President Barack Obama presented his State of the Union Address to the nation in January 2011 he noted that there would have to be some attention paid to curtailing spending. After his speech NBC’s Brian Williams interviewed Senator Barbara Mikulski (D. MD). She expressed a concern that these cutbacks in discretionary spending not come at the expense of women and children’s health care needs.
Women’s Health and Public Awareness
The visibility of women’s health as a policy issue has gained prominence and women’s health care research has emerged on the nation’s policy agenda in the past 20 years. There seem to be several reasons for this new public awareness. In June 1990 the Government Accounting Office report, National Institutes of Health: Problems in Implementing Policy on Women in Study Populations, was released. This publication seems to have brought the issue of women’s health forthrightly to the attention of public policy decision makers. Though this report was relatively narrow in its scope, dealing primarily with an equity issue, the exclusion of women from research projects funded by the National Institutes of Health (NIH) – despite 1986 regulations that sought to forestall this situation – it served as a catalyst for action. The Congressional Caucus for Women’s Issues and Representative Henry Waxman (D., CA,) who was then the Chair of the Energy and Commerce Committee’s House of Representatives Subcommittee on Health and the Environment, had requested the report. In the decade prior to the issuance of the report, the Congressional Caucus on Women’s Issues already had begun to question the paucity of research on women’s health.
In 1990, Dr. Bernadine Healy Was appointed Director of the National Institutes of Health. Dr. Healy was the first woman to be appointed to this post. Early in her tenure as Director of the NIH she required that all research protocols supported by the NIH include women in the sample population. (Of course, research on ailments that are male specific such as prostate cancer were excluded from this rule.)
The definition of a woman’s health agenda emerged in an era when the “social construction” of women as a group was changing. Political scientists Anne Schneider and Helen Ingram identified four types of target populations: advantaged, contenders, dependent populations, and deviants. The advantaged are in the best position to receive beneficial policy outcomes because they are politically powerful and positively constructed whereas the contenders are politically powerful though they are negatively constructed. Dependent groups lack political power though they are positively constructed and the deviants are both politically weak and negatively constructed.
Women were traditionlly defined as a dependent target group. However, in the post 1966 era, the date that is usually used to signify the emergence of the second wave women’s movement, women began to be considered a more advantaged target population. In part this was a function of successful interest group and social movement mobilisation by women’s rights organisations, such as the National Organization for Women (NOW), the American Civil Liberties Union (ACLU) Reproductive Rights Project and the Women’s Equity Action Alliance (WEAL), and traditional women’s organisations such as the League of Women Voters and the American Association of University Women (AAUW). Women’s groups became more engaged in asking questions. Leaders of such organisations tried to frame issues in terms of role equity. They then worked to move these issues onto the nation’s policy agenda. They could no longer be patronised or ignored as they became more important participants in the political process. Their political power is measured in votes, office holding, wealth and the ability to mobilise for action, the defining characteristics of a target population’s power.
Empowerment and Responsibility
In 1973, the Boston Women’s Health Collective published Our Bodies, Ourselves. This book had a very clear message; women must take responsibility for their own health. In the parlance of the social constructionists, they must show that they are not dependent. In addition, the book embraced empowerment – i.e. the ability to control one’s own fate. It also provided practical information about women’s health.
In the years following its publication many things changed in the world of women’s health. As previously noted, almost 20 years later the first woman director of the NIH was appointed and she established rules that require all NIH funded research to include women in the sample populations. Women are becoming more aware of the diseases that can afflict them and increasingly they are looking beyond their sexuality and their reproductive cycles as they define their health status. Also, as the demographic profile of the nation has begun to change, and as commercialisation of medicine has become more apparent, commercial incentives increasingly have become a factor and drug companies are targeting more of their research and marketing towards women.
In addition, in part as a result of the efforts of groups in the organised women’s movement to increase women’s awareness and to demand equal opportunities, the number of women who enter and then graduate from medical school has increased dramatically. More women are becoming physicians and some of these women doctors have begun to question the provision of health care to women. Some of these female health care providers also have become engaged in redefining women’s health needs. Thus organisations such as the American Medical Women’s Association (AWMA) have been active along with women’s advocacy groups in helping to redefine a women’s health agenda.
Women account for about 52 percent of the US population yet they make three-quarters of the health care decisions and spend approximately two out of three health care dollars annually. This is a big market and as suggested above, there have been efforts by the commercial private sector to tap into this population.
Though heart disease is the number one killer of US women (37 percent of all female deaths), heart disease in women is often undetected and untreated until the disease has become severe. Hypertension, a major cardiovascular risk is two to three times more likely to strike women – especially African-American women – than men.
Also, the leading cause of cancer deaths among women is lung cancer. However, studies indicate that doctors are more likely to provide stop smoking messages to male patients than to female patients although there is evidence that these messages increase the likelihood of a person quitting.
Breast cancer is the leading cause of death among women aged 40 to 55. In 2011 the American Cancer Society estimated that 202,964 women were diagnosed with breast cancer and 40,598 women died from breast cancer. What is interesting about this situation is that more money is spent on breast cancer research then on research for cures for other cancers that affect women. One possible explanation for this research reality may be the symbolism and the sexuality associated with breasts by both men and women in the United States. In addition, the National Breast Cancer Coalition (NBCC), as well as other groups that represent breast cancer victims and survivors, have been active in increasing women’s awareness of early warning signs and the need for regular examinations to prevent breast cancer from becoming a killer of women. Also, these groups have been vigilant in lobbying for increased funding for research to find cures and new treatments for breast cancer.
There are other health realities that are associated with women that should be noted. American women have more hysterectomies than women in any other nation in the world, a circumstance that many health specialists associate with the over-utilisation of surgery by American physicians. It is estimated that one in three women in the United States have had their ovaries removed by the time they reach the age of 60. Also, one third of babies born in the United States are delivered by Caesarian Section.
Women have a longer life expectancy than men but women do not necessarily lead healthier lives. Associated with ageing and more likely to strike women than men are osteoporosis, Alzheimer’s, Parkinson’s disease and arthritis. In addition, women are twice as likely to be afflicted by depression as men; women are 10 times as likely to suffer from eating disorders as men; one quarter of all women are abused at some point during their lives; and, women are one of the most rapidly growing demographic groups affected by the HIV infection.
In conclusion, one should note that the confluence of the increasing recognition of the broad range of women’s health care needs with the mobilisation by both women’s rights and women’s health-focused organisations has led to the recognition of women’s health issues and an increased focus on addressing them. However, there are some health issues that have emerged as central concerns for women activists and that have outspoken, and often effective, adversaries. Among these issues are contraception, abortion rights and violence against women, including rape. These are issues that are not defined in terms of role equity but are politically and religiously charged and unresolved but prominent on the nation’s policy agenda and of the agenda of those concerned with the achievement of women’s rights.
The article is based on the authors’ recent book Women and Health Care in the United States (Palgrave, 2014).
About the Authors
Marian Lief Palley is a Professor Emerita of Political Science and International Relations at the University of Delaware. She is the author or co-author of twelve books and numerous articles. Her most recent book is Women and Health Care in the United States (Palgrave, 2014) co-authored with Howard A. Palley. She has been a Fulbright Scholar in Korea and a Fellow of the Salzburg Seminar. She was awarded the Erica Fairchild Award by the Women’s Caucus of the Southern Political Science Association.
Howard A. Palley is professor emeritus of social policy at the School of Social Work and is a distinguished fellow at the Institute for Human Services Policy at the University of Maryland. He has authored or co-authored a number of studies on health service delivery policies and long-term care policies in the United States, Canada, Sweden, the Republic of Korea, Japan, Ukraine and Israel. He has received Fulbright Awards to the Republic of Korea, Taiwan and Ukraine.
