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Women's Health in South Carolina

Posted on: Monday, 3 October 2005, 12:00 CDT

By Messias, DeAnne K Hilfinger

"In examining the health statistics of women in South Carolina, there is currently little to celebrate."

Considerable progress has been made in the area of women's health in recent decades, including an increasing awareness of the diversity and complexity of women's health issues, both here in South Carolina and across the nation. Providers, researchers, and public policy makers have expanded the definition of women's health from its previous, relatively narrow emphasis on pregnancy, childbirth, and reproductive health.

Today, women's health programs focus not only on sexual and reproductive health but also encompass many other issues ranging from violence to tobacco use, substance abuse, mental health, heart disease, and cancer. Although biology and reproduction are important factors in women's health, it is clear that women's health status is intricately related to the social, economic, and environmental conditions in which women live and work.

Women's Health and Employment

Women's health and women's roles in the home, community, and workplace are intricately woven together and reflect broader societal issues. The nature of women's health and women's work is continually being transformed in the face of changing patterns of childbearing, family structure, and employment. Yet the relationship between women's employment and women's health is not clear-cut.

Much of the research on women's employment and health has shown paid employment to be a good predictor of women's health. Employment has been associated with better health whether women are single, married, or with or without children. Other studies have shown married women who are employed and engaged in family work to be healthier and have lower death rates than other groups of women. Important health benefits of employment for many women include increased income, better access to health care, and an improved sense of well-being. But employment may have direct or indirect negative effects on women's health. Exposure to physical, chemical, and biological hazards in the workplace, as well as employment- related stress and work overload, can increase a woman's risk for physical and mental health problems.

Women's multiple roles and workloads not only put them at risk for disease but also increase obstacles for accessing adequate and timely health care. One of the advances in women's health in recent years is the recognition that heart disease is a dis ease of women as well as men. For years, medical research and treatment regimens were based on the assumption that heart disease and stroke were men's health problems.

Despite increased media attention and public awareness, however, heart disease in women continues to be underdiagnosed, undertreated, and undermanaged. Women frequently do not recognize cardiac symptoms and, even when they do, may delay or not seek medical care because of their responsibilities to home, family, and employment.

Cost and Access

At the national level, an overarching area of concern is that of cost and access to health care services. Delaying or choosing not to seek medical care because of the inability to pay is a common practice among women. According to the Centers for Disease Control and Prevention, 47 percent of women in the United States who delay seeking prenatal care when they know they are pregnant report that they do so because of lack of money or insurance. In a recent study by the Kaiser Family Foundation, more than a quarter of the women ages 64 and under reported delaying or choosing not to seek medical care because they could not afford to pay. Among the uninsured women who participated in the survey, the rate was 67 percent! And 20 percent of all the women reported they had not filled prescription drugs in the past year because of cost.

Uninsured women may be especially vulnerable to heart disease and other chronic diseases because they are more likely than insured women to smoke and to be overweight, and are less likely to engage in physical activity and participate in screening tests for chronic diseases (hypertension, diabetes, cardiovascular disease). The Kaiser Family Foundation study also reported that mammography rates among women ages 40 to 64 have dropped in recent years, from 73 percent in 2001 to 69 percent in 2004.

According to Paula Johnson, chief of the Division of Women's Health at Brigham and Women's Hospital in Boston, the fact that there are fewer radiologists interested in the field of mammography is a factor in the declining rates. A similar decline was also noted in the rate of women who had a pap smear, from 81 percent in 2001 to 76 percent in 2004. Screening tests are an essential tool for early detection and prevention of many diseases, but only 38 percent of women ages 50 and older reported having a colon cancer screening test, and only 37 percent of women ages 45 and older had had a bone density test (for osteoporosis) in the past two years.

Nationally, uninsured women are more likely to be of minority racial and ethnic groups, to have less education, and to be poorer than insured women. Immigrant women, particularly those with limited English proficiency, face the additional barrier of language as they attempt to navigate the fragmented and complex health care system in the United States.

Breast cancer is widely recognized as a major women's health issue. Yet most people do not realize that lung cancer is the leading cause of cancer deaths among women in the United States. Here in South Carolina, however, more African American women die of breast cancer than lung cancer. African American women have a lower incidence of breast cancer, but they are twice as likely to die within five years of diagnosis.

Little to Celebrate

In examining the health statistics of women in South Carolina, there is currently little to celebrate. The results of a recent national study by the Institute for Women's Policy Research (IWPR) indicate that South Carolina faces significant challenges in women's health. The IWPR has been tracking the status of women in the United States since 1996. To measure women's health and well-being, the IWPR used an index composed of several key indicators, including death rates among women from heart disease, breast cancer, and lung cancer; the frequency of diseases such as diabetes, Chlamydia, and AIDS; mental health status; suicide rates; and limitations on women's everyday activities.

With a grade of D on the 2004 Women's Health and Well-Being Composite Index, South Carolina ranked 44th among the 50 states. Sadly, this ranking represents a decline from the 2002 report (grade D+, rank 40). (see cover story for more details.)

Heart disease is a major killer of African American women, but lung cancer mortality is higher among White women in the Palmetto State. The rate of diabetes among South Carolina women is nearly 7.7 percent, ranking us 5th highest in the nation in 2004.

Perhaps even more surprising to many, the frequency of AIDS among women in South Carolina is significantly higher than the national norm. The highest rate of new HIV infection in South Carolina is among African American women, who constituted 84 percent of the new cases diagnosed in 2003.

Health problems affect women's ability to carry out their daily activities at home and in the workplace. The South Carolina women who responded to the IWPR survey reported 4.4 days of limited activity in the past 30 days because of health problems, which ranked South Carolina 45th on this indicator of women's health. South Carolina also ranks near the top in terms of the number of women's deaths related to intimate partner violence, an indicator that was not considered in the IWPR report.

These data indicate there are significant challenges - and opportunities - for improving women's health and well-being in South Carolina. It is time to get moving, as there is much work to do!

DeAnne K. Hilfinger Messias, Ph.D., R.N., is an associate professor in the College of Nursing at the University of South Carolina and Graduate Director of the Women's Studies Program, also at USC.

Copyright Moore School of Business Oct-Dec 2005

Source: Business and Economic Review

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