A greater emphasis on preventive and health promoting measures is key to improving overall health.
- Rates of screening for key diseases are improving in some areas, but remain low in others. The greatest advancement in the 2010 Report Card is in the area of colorectal cancer screening—all states and DC now meet the benchmark for this indicator. Forty-four states meet the national goal for mammograms for women age 40 and older, up from 39 in 2007. Once again, however, every state fails to meet the national goal for women receiving annual Pap smears—the primary screening test to help detect cervical cancer.
- Though the coronary heart disease death rate has decreased in every state and the stroke death rate has gone down in all states but one, the country as a whole still receives a failing grade on these benchmarks because so much progress is still required.
- It is also clear that policies must be implemented that address the higher death rates of Black women from these diseases. Black women are significantly more likely to die from coronary heart disease (162.0 per 100,000 Black women, for example, compared to only 116.7 for White women and 97.8 for Hispanic women), breast cancer (32.8 per 100,000 Black women compared to 24.0 for White women and 15.2 Hispanic women), and stroke (61.9 per 100,000 Black women compared to 44.4 for White women and 33.6 for Hispanic women).
- Just as in 2007, no state meets the benchmark for obesity. Obesity rates actually increased in nearly every state. This has serious consequences for women’s health, since obesity is often associated with illness and death from cardiovascular disease, high blood pressure, diabetes, and others. Indeed, nationally the number of women with diabetes has also increased, and all but four states are doing worse on this indicator.
- States are making steady progress in adopting policies to facilitate essential health screening by requiring insurance coverage of screening tests. Twenty-two states—two more than in 2007—require private insurers to cover annual mammograms for women over 40. Since 2007, nine additional states began requiring coverage for colorectal cancer screenings, so that 29 states overall now meet this policy goal.
- All 51 states meet the policy goal for Food Stamp Nutrition Education Programs. Most (34) also meet the policy goal for Food Stamp Outreach programs, a considerable improvement from the last Report Card when only 22 states met this goal. Notably, however, every state fails to meet the health status benchmark for nutrition (50% of women eating five fruits and vegetables a day).
- Preventive health policies that address the high prevalence of AIDS among Black women are desperately needed. The AIDS rate for Black women is 39.8 per 100,000 women, compared to the rate of 7.5 among all women. In the District of Columbia the AIDS incidence rate is 90.2 new cases per 100,000 women. This is by far the highest rate, with Maryland being the next highest at 22.2 per 100,000 women. Thirty-six states require STD/HIV education be taught in schools, just as in 2007.
- More than half of the women in the United States report having been raped and/or physically assaulted in their lifetime. Vast improvement is needed to curtail the excessive violence experienced by American women. In particular, culturally sensitive policies that address the higher rates of violence experienced by Native American and Alaska Native women are needed, as 64.8% are likely to report having been raped and/or physically assaulted in their lifetime, compared to 54.5% of White women. Given the difficulties experienced by all women in reporting such incidents, the actual number of Native American/Alaska Native women experiencing violence is likely to be even higher.
Disparities and gaps in economic security continue to compromise women’s health because lower income women have more difficulty getting their health care needs met.
- Nationwide, 13.4% of women live in poverty. Women’s poverty rates have increased in 33 states. Even the top-ranked (i.e., lowest poverty level) state of New Hampshire experienced a considerable rise—from 6.3% in the 2007 Report Card to 8.5% in the current report. In bottom-ranked Mississippi, 21.1% of women live in poverty.
- Poverty rates for women of color are markedly higher than those of White women—24.8% of American Indian/Alaskan native women, 23.7% of Black women, 23.1% of Hispanic, and 11.9% of Asian/Pacific Islander women live in poverty compared to 9.7% of White women. Women of color are also less likely to have completed high school than White women (e.g., only 65.1% of Hispanic women complete high school compared to 92.2% of White women).
- Once again, only Washington and Oregon have a minimum wage that allows a family of three to reach the federal poverty threshold. Sixteen states did worse on this policy indicator when compared to the previous Report Card. The gap between the wages of men and women also reflects the particular economic hurdles facing women at every income level. Nationwide, women earn 78.2% of what men earn (an increase from 77% in 2007) and state “wage gap” figures vary widely.
- Child support payments can make a substantial difference in the financial well-being and health of a woman and her family. Overall, the states have shown considerable improvement in their child-support collection rates—15 states have improved in this policy area while three declined, bringing the total to 22 states collecting child support in over 60% of their cases.
- Discriminatory practices can affect women’s health by creating barriers to securing health care services and health insurance, by creating stress that contributes to adverse physical and mental health and by creating barriers to financial achievement. States have made some progress in adopting strong legal protections against some forms of discrimination. Twenty-two states—one more than in 2007—prohibit employment discrimination based on sexual orientation, and 34 states—one more than in 2007—prohibit employment and health insurance discrimination based on genetic information.
The country has a great deal of work to do to improve women’s health status, evidenced by the fact that the nation as a whole and all but two states receive unsatisfactory or failing grades in women’s health. The end of the decade has arrived, and nearly all of the Healthy People 2010 benchmarks used in the Report Card are still unmet. Establishing policies that expand access to health care, promote wellness and prevention, and create healthier communities can lead to health status improvements, yet states have moved slowly to adopt the changes that are necessary to advance women’s health.
As described in the special supplement to the 2010 Report Card, “The Past and Future in Women’s Health: A Ten-Year Review and the Promise of the Affordable Care Act and Other Federal Initiatives,” the new federal health care law has already produced positive health policy changes and can continue to shape an improved health system where many more women have access to affordable and high-quality health care. In the meantime, states must continue to pursue policies that will improve women’s health and well-being—both by implementing the ACA in ways that will benefit women and by making progress in areas that are beyond the scope of the new law.
1 The definition of binge drinking among women used by the Behavioral Risk Fact Surveillance System (BRFSS: the Report Card’s data source for this indicator) from 2000 to 2005 was five or more drinks per occasion and was modified in 2006 to be, for women, four or more drinks per occasion. The apparent change in the prevalence of binge drinking between 2000 and 2010 among women may be related, in part, to this change in definition. Note that the same Healthy People 2010 benchmark (to reduce the prevalence of binge drinking, with no definition specified, to 6%) is used to determine grades for binge drinking in the 2004, 2007, and 2010 Report Cards.