US Fails to Meet Key Women's Health Goals
United States has failed to meet most goals for women's health --
largely federal objectives drawn from the U.S. Department of Health and
Human Services' Healthy People 2010 agenda --according to a report
released on the status of women's health by the National Women's Law
Center (NWLC) and Oregon Health & Science University (OHSU).
the nation is so far from meeting the Healthy People and related goals
that it receives a general grade of "Unsatisfactory." Of the 26 health
indicators that were graded, the country received a "Satisfactory"
grade in only three and received a failing grade in half.
in "Making the Grade on Women's Health: A National and State-by-State
Report Card," this is the fifth in a series of reports since 2000. It
grades and ranks each state based on 26 health status benchmarks and
also identifies whether states have met 68 health policy goals. NWLC
and OHSU developed the report as a resource for advocates,
policymakers, and health experts to assess women's health at the
federal and state levels. The Report Card provides comprehensive data
for researchers to analyze changes in women's health and well-being.
This edition of the Report Card includes an analysis of the current
status of women's health, a 10-year look back at progress and setbacks,
and a comparison to women's health status in 2007, when the Report Card
was last published.
10-year Look Back
Less Smoking, More Colorectal Cancer Screening, Lower Heart Disease and Cancer Death Rates; but More Chlamydia, Diabetes, High Blood Pressure and Binge Drinking, Fewer Pap Tests
the years since the original Report Card was published, the nation has
made notable progress on several women's health indicators, including
lower death rates from coronary heart disease, stroke, and breast and
lung cancer. In addition, fewer women are smoking and more women are
being screened for colorectal cancer. Unfortunately, however, there are
now greater proportions of women with high blood pressure and who
haven't had a recent Pap test. Since 2000, declines in women's health
status have been most pronounced in the areas of diabetes, chlamydia
and binge drinking.
good news is that when the nation rallies around a health problem with
federal and state policies and programs as well as public attention, we
can achieve real progress," said Judy Waxman, NWLC Vice President for
Health and Reproductive Rights. "Unfortunately, we have much more work
to do in many areas of women's health."
Key Findings from 2007-2010
Improvements in Cholesterol Screening, but Fewer Women Having Regular Pap Tests and More Reporting Binge Drinking
most disturbing trends in the past three years (since the Report Card
was last published) have been a marked increase in the proportion of
women who report binge drinking -- a dangerous form of alcohol abuse
that involves having five or more drinks on one occasion -- and a
considerable decline in the percentage of women who get a regular Pap
smear, the primary test todetect cervical cancer. The nation's grade
for binge drinking declined from a "Satisfactory minus" to an "F," and
the grade for Pap test rates dropped from an "Unsatisfactory" to an
screening was the only area where women's health improved enough to
merit a higher grade when compared with 2007 (moving from an
"Unsatisfactory" to a "Satisfactory minus"). Other gains -- including
lower proportions of women dying from heart disease, stroke, lung
cancer, breast cancer, and during or shortly after pregnancy -- fell
far short of the national goals and were not enough to generate better
grades on the 2010 Report Card.
2010, not one state received an overall "Satisfactory" grade for
women's health and just two states received the next highest grade of
"Satisfactory minus" -- Vermont and Massachusetts -- a decline from the
2007 edition of the Report Card, when three states received this grade.
A majority of states (37) receive an "Unsatisfactory" grade and nearly
a quarter of all states (12) receive an overall failing "F" grade. Nine
of the 10 states that ranked at the bottom in the original Report Card
in 2000 continue to rank at the bottom today; these include Alabama,
West Virginia, Oklahoma, Arkansas, Louisiana, and Mississippi. The only
state that moved out of the bottom 10 over the course of the decade was
Texas, which nonetheless receives an "F" in 2010.
is shocking that there is not a single state in this country where
women enjoy overall satisfactory health status," said Michelle Berlin,
M.D., M.P.H., Vice Chair and Associate Professor of Obstetrics and
Gynecology, OHSU School of Medicine; and Associate Director, OHSU
Center for Women's Health, a National Center of Excellence in Women's
State Policy Indicators
addition to health status indicators, the report also assesses 68
health and health-related policies. Of these, only two policy goals
were met by all the states: Medicaid coverage for breast and cervical
cancer treatment and participation in the Food Stamp Nutrition and
Education Program. Only nine states meet a majority (35 or more) of the
policy goals, with California (44), New Jersey (43), Massachusetts
(40), and New York (39) meeting the most. The four states that meet the
fewest policy indicators are Mississippi (10), Idaho (11), South Dakota
(11), and Alabama (12).
most states have made only piecemeal progress in adopting policies to
improve women's health, many of the policy goals examined in the Report
Card will be realized with the implementation of the new federal health
care law, the Patient Protection and Affordable Care Act. For example,
four Medicaid eligibility and enrollment policy goals will be
accomplished when new Medicaid eligibility rules take effect in 2014.
Several of the Report Card's policy goals for private insurance
coverage of preventive services (such as Pap smears, mammograms and
osteoporosis screenings) were achieved when a provision of the law that
requires all new health plans to cover recommended preventive care with
no cost-sharing took effect on Sept. 23.
Affordable Care Act emphasizes access to health care, including the
critical preventiveservices that women need to stay healthy," said
Waxman. "There is no doubt that it will make an enormous difference in
addressing the problems identified in the 2010 Report Card."
Women need better access to health insurance to get necessary health care.
in 5 women aged 18 to 64 is uninsured, representing a considerable
increase since 2007, the highest rate since the Census Bureau began
reporting such data.
state meets the Healthy People 2010 goal of 100 percent of women having
health insurance; Massachusetts comes the closest with 95 percent of
disparities in insurance coverage between White women and women of
color are alarming. Nationwide, 37.6 percent of Hispanic women, 32
percent of American Indian/Alaska Native women, and 23.4 percent of
Black women do not have health insurance coverage, compared with 13.9
percent of White women.
Access to reproductive health services is insufficient.
half of all pregnancies are unintended, thereby missing -- by a
substantial margin -- the national goal to reduce unintended
pregnancies to 30 percent or less of all pregnancies.
seven states recognize the importance of access to comprehensive
maternity care by requiring that these services be covered in all
individual and group health plans. Only eight states meet the policy
goal of requiring that private insurers cover contraceptives as they do
other prescription drugs.
states restrict private insurers' ability to cover abortion services,
and 26 states diminish women's access to abortion care by requiring
that they receive biased counseling and endure a mandatory delay before
receiving an abortion.
Gaps in economic security continue to compromise women's health.
number of women living in poverty has increased in 33 states, with 13.4
percent of women living in poverty nationwide. Even the top-ranked
(i.e., lowest poverty level) state of New Hampshire experienced a
considerable rise in poverty -- from 6.3 percent in the 2007 Report
Card to 8.5 percent in 2010. In bottom-ranked Mississippi, 21.1 percent
of women live in poverty.
rates for women of color are markedly higher than for White women with
23.7 percent of Black women and 23.1 percent of Hispanics living in
poverty compared with 9.7 percent of White women.
in 2007, only Washington and Oregon have a minimum wage that allows a
family of three to reach the federal poverty threshold ($8.31/hour).
Sixteen states did worse on this policy indicator when compared with
the previous Report Card.
A woman's health varies depending on where she lives.
District of Columbia has the highest heart disease death rate at 174.8
deaths per 100,000; Hawaii, which ranks first, has a heart disease
death rate of 60.9 per 100,000. More than one third of women in
Mississippi (36.8%) are obese, compared with fewer than 1 of 5 in
Virginia has the highest rate of diabetes, with 12.9 percent of women
diagnosed with this condition compared with 5 percent of women in
For more information on the Oregon Health & Science University, visit www.ohsu.edu and for more information on the National Women's Law Center visit, www.nwlc.org.