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AJN, American Journal of Nursing:
doi: 10.1097/01.NAJ.0000394283.17459.8e
AJN Reports

Women's Health: Progress, Not Perfection

Nelson, Roxanne

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Disparities still exist, especially in disadvantaged groups.

Although women make up more than half the U.S. population, women's health issues have been somewhat neglected over the years. Since the Public Health Service Task Force on Women's Health Issues concluded in 1985 that "the historical lack of research focus on women's health concerns has compromised the quality of health information available to women as well as the health care they receive," efforts have been made to increase research. Those efforts have included changes in government support of research, policies, and regulations, as well as advocacy by nongovernment organizations, politicians, clinicians, and researchers. To evaluate the overall impact of these changes, the Institute of Medicine (IOM) was asked in 2008 to examine what has been learned from that research and the extent to which it has been put into practice and communicated to both clinicians and women.

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The answers? Although much progress has been made—in decreasing morbidity and mortality from cardiovascular disease, for example—advances in other areas have been limited, according to a new consensus report from the Committee on Women's Health Research of the IOM, Women's Health Research: Progress, Pitfalls, and Promise. (The full report can be found here:

At a press briefing highlighting the findings of the report, Nancy E. Adler, professor of medical psychology and director of the Center for Health and Community at the University of California, San Francisco, said that relatively little attention was paid to women's health "beyond the narrow aspects of women's reproductive lives. Women's health was defined much more narrowly."

One of the IOM's early findings was how much has actually changed in the last 20 years, Adler said.

"We were pleased with how much progress has been made, but there are a few caveats. One is that progress hasn't been seen in all groups of women," said Adler. This is particularly true, she said, among those with social disadvantages related to race or ethnicity and lower socioeconomic and educational levels. Accordingly, women in these groups have disproportionate disease burdens and adverse health outcomes, and barriers to care remain. One of the committee's recommendations, therefore, was that the National Institutes of Health, the Agency for Healthcare Research and Quality, and the Centers for Disease Control and Prevention develop targeted initiatives that specifically focus on groups in whom disease burden is greatest.

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Most of the progress that's been made in women's health has been in three areas: breast cancer, cardiovascular disease, and cervical cancer. All three conditions have been characterized by multipronged research across different domains, said Adler.

The research on breast cancer has addressed many aspects of the disease.

"We can now identify women who are at very high risk and screen women to detect the disease early, and we now have very effective tools for treatment," said Alina Salganicoff, a committee member and vice president and director of women's health policy for the Kaiser Family Foundation.

The situation is similar with cardiovascular disease.

"Years ago, we didn't even think that women got heart disease," Salganicoff said.

The vaccine for cervical cancer was a major breakthrough in terms of vaccine development, according to Marietta Anthony, a committee member and associate director of women's health programs at the Critical Path Institute in Rockville, Maryland.

"In this case, there was an association between a virus and a cancer, and now we have a vaccine that prevents infection with the virus. And that can lead to a decrease in cancer," Anthony said, adding that it was a brilliant technologic breakthrough that "has the ability to change the incidence of cervical cancer all over the world."

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The committee found less progress in decreasing the disease burdens related to depression, HIV and AIDS, and osteoporosis. The committee also reported that few advances have been made in reducing unintended pregnancy, autoimmune diseases, maternal morbidity and mortality, alcohol and drug addiction, lung cancer, gynecologic cancers other than cervical cancer, nonmalignant gynecologic disorders, and Alzheimer's disease.

There's also a need to improve the translation of research findings into practice: it can take 15 or 20 years for that transition to occur. Barriers to translation identified by the committee include poor communication, social and political opposition, and confusion on the part of patients or the general public. Conflicting findings and contradictory recommendations in particular can confuse consumers and negatively affect women's health care. This is an area in which nurses can play a major role, according to Salganicoff.

"There's no doubt that nurses are a critical part of our health care system—particularly in terms of translation and communication of information to patients," she said. "They're really a gateway to patients" and can play a critical role "in helping to guide patients through many decisions that are difficult to make."—Roxanne Nelson

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