The Women's Health Policy and Advocacy Program informs policy on a broad range of issues in women’s health and health care delivery, including clinical topics where gender biology plays a key role and issues affecting women's access to affordable, quality care. Our work encompasses issues on an active policy agenda as well as problems in the earliest stages of policy awareness. In each case, we draw on knowledge of gender biology and health care delivery to craft effective policy solutions.
U.S. Health Care Reform
Women have a great deal at stake in national health reform. Women use more health care throughout their lives than men and have higher out-of-pocket health costs. Women live longer than men, and are more likely to have multiple chronic conditions. Women are also more likely than men to have insurance through a spouse’s job, making them vulnerable to losing coverage due to changes in family status, such as divorce or death. Women are often the organizers of family care, arranging for and managing health services for their families and serving as caregivers for sick relatives. Women tend to have lower incomes than men, and face more barriers to accessing affordable care.
The Women’s Health Policy and Advocacy Program works with policymakers in Washington to promote understanding of key issues in women’s health and health care delivery through policy analysis, testimony, and collaboration with women’s health advocates. Our goal is to ensure that gender biology and the unique needs of women in health care delivery are understood and incorporated throughout the health care reform debate.
Massachusetts Health Reform
In 2006, Massachusetts enacted groundbreaking health insurance reforms designed to bring universal coverage to the state. Two years later, the legislature began tackling cost-containment and other challenges by creating the Massachusetts Health Care Quality and Cost Council, which has recommended that a system of global payments replace fee-for-service reimbursement throughout the state. These reforms are widely touted as a national model for health reform, yet may have unintended consequences and/or a disproportionate impact on certain groups of women.
The Women’s Health Policy and Advocacy Program is studying how Massachusetts’ reforms are affecting women’s access to care, particularly with regard to cardiovascular, breast and cervical cancer screening; affordability for low-income women; and the impact of physician shortages in the state. Our goal is to present a more robust story of how Massachusetts’ model is working in practice, and to recommend policy interventions where necessary to ensure that all women can achieve the highest standard of health and health care.
Physician Shortages
The U.S. faces a growing shortage of physicians in specialties that particularly affect women, including primary care, ob/gyn, mammography, and mental health. Over the past decade, for example, the percentage of U.S. medical students entering family medicine and internal medicine residencies has declined substantially. These shortages come against the backdrop of an aging U.S. population with growing health needs, and national debate over how to expand coverage and access for millions of Americans. In Massachusetts, reducing the number of uninsured residents has exacerbated physician shortages and this is likely to recur nationally. Moreover, although more women are entering the physician workforce, the medical field has not adequately adapted to the unique needs of female physicians.
The Women’s Health Policy and Advocacy Program is working to understand the root causes of physicians shortages, and propose policy options to ensure women’s access to care while creating a delivery system that addresses the needs of women as patients and caregivers.
Women and Lung Cancer
Lung cancer is the leading cause of cancer death in both men and women in the United States, killing more people than breast, prostate, colon, kidney and melanoma cancers combined. Since 1987, lung cancer has surpassed breast cancer to become the leading cause of cancer death in women; in 2009 alone, it is estimated that 70,490 women will die from the disease. There is accumulating evidence suggesting that the development of lung cancer is different in women than in men; researchers have found important distinctions between the sexes in the clinical characteristics, risk factors, screening, progression and treatment of lung cancer. Moreover, while the incidence of men developing lung cancer is steady or declining, the incidence among women, particularly younger women, is increasing.
The Women’s Health Policy and Advocacy program is pursuing multiple strategies to address to rising incidence of lung cancer in women, including raising awareness of sex and gender differences among policymakers, patients, providers; advocating for more equitable research funding for lung cancer; and working to de-stigmatizing the disease.
Women and Diabetes
Type 2 diabetes affects an average of 21 million Americans while an additional 54 million Americans have pre-diabetes. Type 2 diabetes causes a host of health problems including heart disease, stroke, renal disease, nervous system and circulatory problems and is the principal reason adults go blind. Pregnant women with type 2 diabetes are at risk of giving birth to children with birth defects. Additionally, between 2 and 7 percent of pregnant women develop gestational diabetes mellitus (GDM), which predisposes both mother and child to type 2 diabetes in the future. Despite this risk, there are gaps in the knowledge of diabetes risk among patients and providers, and inadequate management of patients at risk.
The Women’s Health Policy and Advocacy Program is working to increase patient and provider awareness of diabetes risk; ensure continuity of care and early identification of women at risk; develop appropriate payment strategies for integrated care; and promote additional research to understand how diabetes affects women.
Community Outreach and Research Program
The mission of the Community Outreach and Research Program is to promote women’s health scholarship and leadership from a community-oriented, health disparities perspective in order to improve the health of women and their families through research, education and public policy. Current activities include a women’s health data assessment in the greater Boston area; a review of lung cancer trends and risk factors in Boston and surrounding communities; and “To the Heart of Minority Women” – a pilot program evaluating the impact of a cardiovascular disease curriculum on African American women’s cardiovascular disease and type 2 diabetes knowledge and risk factor reduction. For more information, please contact Erin George, Research Manager, at egeorge3@partners.org.
Women and Heart Disease
Heart disease is the leading cause of death among women in the U.S., claiming more lives than the next 7 causes combined. African American women have the highest rates of heart disease of all racial / ethnic groups and are more likely to die prematurely from heart disease than white women. The Center for Cardiovascular Disease in Women, based at the Connors Center, has conducted groundbreaking research to understand the barriers faced by low-income women in preventing heart disease by increasing physical activity and eating a heart-healthy, culturally appropriate diet. These challenges include the availability of heart-healthy choices in inner-city neighborhoods and the higher cost of purchasing food included in heart-healthy menus.
In collaboration with the Center for Cardiovascular Disease in Women, the Women’s Health Policy and Advocacy Program has worked to raise awareness of heart disease as a major contributor to health disparities; target heart disease prevention as a method of reducing other chronic illnesses, and developed community partnerships aimed at increasing the availability of culturally-appropriate heart-healthy food in Boston neighborhoods.
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Laura Cohen
This page was last modified on 10/20/2011