Ten years ago, a woman suffering a heart attack was too often misdiagnosed. Without the chest pains commonly seen in men, her symptoms of dizziness or back pain were often dismissed as unimportant.
If she did happen to be taken seriously, her doctor might have given her a diagnostic test. But some tests, doctors now know, aren't reliable when used in women.
Today, however, a woman in cardiac arrest is more likely to be diagnosed properly and live to tell about it. In fact, thanks in large part to an unprecedented national focus on women's health, women are being more effectively screened and treated for a whole host of diseases.
"Women's health has moved beyond something people just talk about at the policy level," says Elena Rios, M.D., Executive Director of the National Hispanic Medical Association.
According to the National Institutes of Health, screening for cervical cancer has resulted in a 40% decline in the incidence and death from the disease since 1970. Similarly, the death rate for breast cancer declined by 6% just between 1990 and 1994.
"Now we're going beyond screening, to improving management and treatment of diseases," says Rios. Women are being diagnosed earlier and living longer. But, she stresses, the way women are educated and treated once they are diagnosed still needs improvement.
The Long Road to Equality
Progress in women's health has been a long time coming, says Rios. Women's issues didn't come to the forefront of politics until there were enough women in Congress to keep them on the agenda. At first, she says, female politicians focused on equal rights and other equity issues. In the mid-1980s, they got around to health care. "Since then, women's health has gotten more attention and more support."
The advancement of women in other areas of society has also fueled progress, says Cindy Pearson, Executive Director of the National Women's Health Network, an industry watchdog group in Washington, D.C. "We've finally cracked the old-fashioned notions that only men can be professionals," Pearson says. That changing notion has meant more women have become health care professionals. "Women now make up over 40% of medical students," Pearson says.
But some old-fashioned notions still persist. A 1993 study by The Commonwealth Fund -- a private foundation that supports research on health and social issues -- found that some health providers still give women less thorough evaluations than men for similar complaints. They may give less weight to women's symptoms, provide fewer interventions for the same diagnoses, and give less explanation in response to questions.
But, says Pearson, communication is getting easier as women become more involved in the health care system. Women are interacting with more female physicians, as well as with an increasing number of counselors and nurse practitioners -- most of whom are also female -- who now provide both care and information that once was provided only by doctors.
Making Women's Health Gender-Specific
Despite the good news, progress in women's health care is still stymied by a lack of health information specific to women. Right now, all doctors can do is extrapolate data from clinical trials that used male subjects, says Amy Law of the National Asian Women's Health Organization.
Starting in the mid-1990s, drug companies were required to include women in clinical trials. Results from long-term studies using women as subjects are only now beginning to be released. The Nurses' Health Study being conducted by Harvard University's School of Public Health, for example, included more than 80,000 women. Researchers recently released results about nutrition, exercise, and the prevention of heart disease, saying that modest changes in both areas reduce a woman's risk dramatically.
The National Institutes of Health is beginning a 15-year project involving more than 160,000 women between the ages of 50 and 79 years. The study, called the Women's Health Initiative, will look at issues specific to post-menopausal women, such as the use of hormone replacement therapy to prevent osteoporosis and heart disease.
Progress Still Needed
Despite these advances, this year's Congress failed to increase its funding for the Office on Women's Health in the U.S. Department of Health and Human Services -- the nation's highest office that looks out for women's health. "We're working under a tight budget this year, very tight," says Susan Wood, PhD. The lack of funds means the office will not be able to increase support to programs on domestic violence or enact changes to existing programs.
After decades of focusing on men's health, many experts agree that this apparent backlash is premature. "We still haven't done all the catch-up that we need to do," Wood says. "We don't want women's health to be a flash in the pan."
