Commentary

Women’s Health: 30 Years of Progress in the U.S. Department of Health and Human Services

Caira M. Woods, PhDa Bethany Applebaum, MPH, MAb Yvonne Green, RN, CNM, MSNc Deborah L. Kallgren, BSd Evelyn Kappeler, BAe On behalf of the U.S. Department of Health and Human Services Coordinating Committee on Women’s Health

In 1983, the Assistant Secretary for Health at the U.S. Department of Health and Human Services (HHS) convened the first-ever U.S. Public Health Service Task Force on Women’s Health Issues to identify important women’s health issues and develop a blueprint for enmeshing those issues with the priorities of the U.S. Public Health Service (PHS). The landmark Report of the Public Health Service Task Force on Women’s Health Issues,1 published in Public Health Reports in 1985, outlined recommendations to accomplish this goal. One recommendation supported the creation of a standing committee comprising HHS agency representatives who would report regularly to the PHS and HHS leadership. To fulfill this recommendation, HHS established the Coordinating Committee on Women’s Health (CCWH) in 1984 to advise the Assistant Secretary for Health on activities to safeguard and improve the physical and mental health of women in the United States. This deliberate focus on women’s health, which continues today, has led to substantial advances in the field.2 This commentary highlights the work done by HHS agencies and offices, through collaborations and partnerships, to address the categorized recommendations of the 30-year-old report: • • • • • •

Promote a safe and healthful physical and social environment Provide services for the prevention and treatment of disease Conduct research and evaluation Recruit and train health-care personnel Educate and inform the public and disseminate research information Design guidance for legislative and regulatory measures

PROMOTE A SAFE AND HEALTHFUL PHYSICAL AND SOCIAL ENVIRONMENT HHS remains committed to addressing the impact of various environmental factors on health3 and has developed programs, reports, and campaigns to increase

U.S. Department of Health and Human Services, Office on Women’s Health, Washington, DC

a

U.S. Department of Health and Human Services, Health Resources and Services Administration, Office of Women’s Health, Rockville, MD

b

U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Office of Women’s Health, Atlanta, GA

c

U.S. Department of Health and Human Services, Food and Drug Administration, Office of Women’s Health, Silver Spring, MD

d

U.S. Department of Health and Human Services, Office of Adolescent Health, Rockville, MD

e

Address correspondence to: Caira M. Woods, PhD, U.S. Department of Health and Human Services, Office on Women’s Health, 200 Independence Ave. SW, Washington, DC 20201; tel. 202-690-7650; fax 202-401-4005; e-mail .

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public awareness of environmental and behavioral health influences on women’s health. In the realm of the social environment, for example, HHS has funded emergency shelters and supportive services for victims of domestic violence and their children.4 Programs such as the National Domestic Violence Hotline, tribal domestic violence programs, state domestic violence coalitions, and the National Health Resource Center on Domestic Violence have helped coordinate community responses to intimate partner violence.5 HHS has also provided comprehensive substance abuse treatment programs for women and their infants,6 addressed the needs of pregnant and nursing women following disasters,7 and helped boost awareness about workplace health challenges facing women.8 In addition, HHS has published reports and guidance on the health consequences of smoking in women9,10 and harmful exposures for pregnant and lactating women.11,12 PROVIDE SERVICES FOR THE PREVENTION AND TREATMENT OF DISEASE During the past 30 years, federal policies, initiatives, and research have supported chronic disease prevention and better access to health care for women. For example, transmission of human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) from mother to child has been reduced by recommended routine screening,13 the use of antiretroviral drugs approved by the Food and Drug Administration (FDA), and other efforts.14 Policies such as Part D of the Ryan White HIV/AIDS program,15 and support of HIV testing and linkage to care in Title X family planning centers through the Secretary’s Minority AIDS Initiative Fund,16 have helped create better systems for HIV/AIDS disease management. Similarly, the National Action Plan on Breast Cancer and the National Breast and Cervical Cancer Early Detection Program have provided comprehensive strategies to address breast cancer. FDA approvals of the first chemopreventive product for treating pre- and post-menopausal women at high risk for breast cancer,17 and other products for conditions that disproportionately affect women (e.g., osteoporosis and depression),18,19 have also helped women prevent or manage disease. HHS funding for women’s health services at Federally Qualified Health Centers, Title X family planning clinics, public health departments, tribal health facilities, community-based organizations, and other organizations have benefited women of all ages and races/ethnicities, those with disabilities, and women who would not otherwise receive health care. Additionally, the Affordable Care Act has increased access to health care for millions of women who previously

would have forgone health care due to cost.20 To help prevent disease, the law requires most health plans to cover, without cost sharing, 22 preventive services recommended specifically for women.21,22 CONDUCT RESEARCH AND EVALUATION Since 1984, more investigations have been conducted on conditions and diseases that are unique to, or more prevalent in, women of all age groups and cultural conditions than ever before. These investigations, for example, have furthered our understanding of why hip implants fail more often in women23 and how drugs might interact to produce a life-threatening arrhythmia to which women are particularly prone.24 As another example, the National Institutes of Health (NIH) Women’s Health Initiative, a 15-year national study, has assessed the health benefits and risks of hormone therapy, dietary patterns, and calcium/vitamin D supplements on the prevention of heart disease, cancer, and osteoporosis  in postmenopausal women aged 50–79 years.25 Research has also led to the development and implementation of guidelines for the inclusion of women and minorities in clinical research.26,27 Drug, device, and biologic manufacturers provide analyses of effectiveness and safety data for women and other demographic subgroups.28 The NIH is now formulating policies that will support further exploration of sex differences for experimental design and analysis, both in vitro and in animals.26 RECRUIT AND TRAIN HEALTH-CARE PERSONNEL HHS collaborations have established programs to better integrate knowledge of sex and gender differences into research and practice.29 Mentored career development programs have increased the number of investigators pursuing research on women’s health and sex differences.30–33 The number of female applicants to research programs almost doubled from 1990 to 2006.34 Awards of research grants to women by the NIH also increased steadily from 1998 to 2013.35 In addition, HHS has made concentrated efforts to promote the science of women’s health and sex-based differences in health professions’ curricula.36–38 EDUCATE AND INFORM THE PUBLIC AND DISSEMINATE RESEARCH INFORMATION In 1998, HHS launched the National Women’s Health Information Center (www.womenshealth.gov) to provide reliable, accurate, commercial-free information

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on the health of women. In 2000, HHS launched National Women’s Health Week,39 an annual observance to empower women to make their own health a priority. In 2003, HHS launched National Women’s Check-up Day,40 an observance that encourages women to schedule routine well-woman visits. As a result of the Affordable Care Act, these visits are now covered for many women without cost sharing.41,42 HHS also led the development of National Women and Girls HIV/ AIDS Awareness Day,43 Domestic Violence Awareness Month,44 and Teen Dating Violence Awareness Month.45 In addition, agencies have developed evidence-based guides46–51 and health promotion campaigns52–55 to encourage women’s health across the lifespan. Many of these initiatives have been in partnership with private organizations. DESIGN GUIDANCE FOR LEGISLATIVE AND REGULATORY MEASURES In the time since the release of the 1985 report, organizations devoted to women’s health have advocated for policies to improve healthful conditions for women and elevate the importance of women’s health. As a result of these efforts, several laws have been enacted that give HHS authority to develop programs, guidance, and regulations in critical areas. For example, the 1992 Mammography Quality Standards Act required that HHS establish national standards for mammography.56 The Violence Against Women Act, first signed in 1984 and reauthorized in 2013,57 increased public awareness of domestic violence. After the Act made reducing violence against women a federal priority,58 fewer women and children have experienced intimate partner violence.59 Also, passage of the Affordable Care Act prohibited insurance companies from charging women more than men for the same health coverage, included preventive services for women, and legislated Offices on Women’s Health across HHS in Section 3509 of the law.60 IMPLICATIONS As noted in the 1985 report,1 all levels of government, public and private sectors, community and faith groups, businesses, families, and women themselves must participate to help achieve the best results for women’s health. Notable progress has been made through HHS initiatives and funding and through the work of the CCWH. Improvements in diagnosis, treatment, care, support, prevention, and inclusion in research for women have set the stage for even greater advances. The ultimate goal is a nation in which major prevent-

able causes of morbidity and mortality in women are no longer a threat, and cost-effective, evidence-based, quality care and health equity are a reality for all women. The findings and conclusions in this article are those of the authors and do not necessarily represent the views of the U.S. Department of Health and Human Services (HHS) or its components. The authors wrote this commentary on behalf of all members of the HHS Coordinating Committee on Women’s Health, which includes representatives from each of the federal agencies and offices within HHS.

REFERENCES   1. Department of Health and Human Services (US), Public Health Service. Women’s health: report of the Public Health Service Task Force on Women’s Health Issues. Public Health Rep 1985;100:73-106.  2. Department of Health and Human Services (US), Office on Women’s Health. 30 achievements in women’s health in 30 years (1984–2014) [cited 2014 Jun 25]. Available from: URL: http:// womenshealth.gov/about-us/government-in-action/achievements   3. Department of Health and Human Services (US). HHS environmental justice strategy. 2012 [cited 2014 Oct 1]. Available from: URL: http://www.hhs.gov/environmentaljustice/strategy.html   4. Department of Health and Human Services (US), Family & Youth Services Bureau. Family Violence Prevention and Services Program [cited 2014 Jun 16]. Available from: URL: http://www.acf.hhs.gov /programs/fysb/programs/family-violence-prevention-services   5. Department of Health and Human Services (US), Family & Youth Services Bureau. Family Violence Prevention and Services formula grants to states and territories [cited 2014 Jun 26]. Available from: URL: http://www.acf.hhs.gov/programs/fysb/programs /family-violence-prevention-services/programs/formula-grants   6. Department of Health and Human Services (US), Substance Abuse and Mental Health Services Administration. Services grant program for residential treatment for pregnant and postpartum women [cited 2014 Jun 25]. Available from: URL: http://beta.samhsa.gov/sites /default/files/grants/doc/ti-14-005.doc   7. Centers for Disease Control and Prevention (US). Emergency preparedness and response: information for pregnant women—fact sheet [cited 2014 Jun 25]. Available from: URL: http://emergency .cdc.gov/preparedness/pregnantfactsheet.asp   8. Centers for Disease Control and Prevention (US). Women’s safety and health issues at work [cited 2014 Jun 27]. Available from: URL: http://www.cdc.gov/niosh/topics/women  9. Department of Health and Human Services (US). Women and smoking: a report of the Surgeon General. Atlanta: Centers for Disease Control and Prevention (US), National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2001. Also available from: URL: http://www.ncbi.nlm.nih .gov/books/NBK44303 [cited 2014 Oct 21]. 10. Department of Health and Human Services (US). The health consequences of smoking—50 years of progress: a report of the Surgeon General. Atlanta: Public Health Service (US), Office of the Surgeon General; 2014. Also available from: URL: http:// www.surgeongeneral.gov/library/reports/50-years-of-progress /exec-summary.pdf [cited 2014 Oct 21]. 11. Food and Drug Administration (US). Fish: what pregnant women and parents should know [cited 2014 Jun 27]. Available from: URL: http://www.fda.gov/food/foodborneillnesscontaminants/metals /ucm393070.htm 12. Agency for Toxic Substances and Disease Registry (US). Birth defects and childhood cancers study [cited 2014 Jun 25]. Available from: URL: http://www.atsdr.cdc.gov/sites/lejeune/birthdefectstudy.html 13. Centers for Medicare & Medicaid Services (US). Preventive health services for adults [cited 2014 Jun 4]. Available from: URL: https:// www.healthcare.gov/what-are-my-preventive-care-benefits/#part=2? 14. Achievements in public health: reduction in perinatal transmission of HIV infection—United States, 1985–2005. MMWR Morb Mortal Wkly Rep 2006;55(21):592-7. 15. Department of Health and Human Services (US). The Ryan White

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health curricula: final report on expert panel recommendations for interprofessional collaboration across the health professions. May 2013 [cited 2014 Oct 21]. Available from: URL: http://www .hrsa.gov/about/organization/bureaus/owh/report111413.pdf Health Resources and Services Administration (US). Health professions training, education, and competency: women’s health in the pharmacy school curriculum. 2006 [cited 2014 Oct 21]. Available from: URL: http://mchb.hrsa.gov/womenshealth/pharmacyschool .pdf Health Resources and Services Administration (US). Integrating women’s health into schools of public health curricula [cited 2014 Oct 21]. Available from: URL: http://mchb.hrsa.gov/training /documents/SPH-womens-health-brief-final.pdf Department of Health and Human Services (US), Office on Women’s Health. National Women’s Health Week [cited 2014 Jun 4]. Available from: URL: http://womenshealth.gov/nwhw/learn /index.html Department of Health and Human Services (US), Office on Women’s Health. Celebrate National Women’s Check-up Day [cited 2014 Jun 4]. Available from: URL: http://womenshealth .gov/nwhw/learn/checkup.html Health Resources and Services Administration (US). Women’s preventive services guidelines [cited 2014 Nov 12]. Available from: URL: http://www.hrsa.gov/womensguidelines Department of Health and Human Services (US). Preventive health services for women [cited 2014 Nov 12]. Available from: URL: https://www.healthcare.gov/preventive-care-benefits/women Department of Health and Human Services (US), Office on Women’s Health. National Women and Girls HIV/AIDS Awareness Day [cited 2014 Jun 4]. Available from: URL: http://womenshealth .gov/nwghaad National Coalition Against Domestic Violence. Domestic Violence Awareness Month [cited 2014 Nov 12]. Available from: URL: http:// www.ncadv.org/takeaction/domesticviolenceawarenessmonth.php Department of Health and Human Services (US). Teen Dating Violence Awareness Month [cited 2014 Jun 4]. Available from: URL: http://healthfinder.gov/nho/FebruaryToolkit2.aspx Department of Health and Human Services (US), Office on Women’s Health. The healthy woman: a complete guide for all ages [cited 2014 Jun 4]. Available from: URL: http://www.womenshealth .gov/publications/our-publications/the-healthy-woman/index.html National Institutes of Health (US). A primer for women’s health: learn about your body in 52 weeks [cited 2014 Jun 4]. Available from: URL: http://52weeks4women.nih.gov Health Resources and Services Administration (US). Bright futures for women’s health and wellness [cited 2014 Jun 4]. Available from: URL: http://www.hrsa.gov/womenshealth/wellness/index.html Agency for Healthcare Research and Quality (US). Women: stay healthy at any age: 2014 update. May 2014 [cited 2014 Oct 21]. Available from: URL: http://www.ahrq.gov/patients-consumers /prevention/lifestyle/healthy-women.html Substance Abuse and Mental Health Services Administration (US). Substance abuse treatment: addressing the specific needs of women. Treatment Improvement Protocol (TIP) Series, No. 51. HHS Publication No. (SMA) 13-4426. Rockville (MD): SAMHSA; 2009. Also available from: URL: http://store.samhsa.gov/shin /content//SMA13-4426/SMA13-4426.pdf [cited 2014 Oct 21]. Gavin L, Moskosky S, Carter M, Curtis K, Glass E, Godfrey E, et al. Providing quality family planning services: recommendations of CDC and the U.S. Office of Population Affairs. MMWR Morb Mortal Wkly Rep 2014;63(RR-4):1-29. Food and Drug Administration (US). Use Medicines Wisely campaign [cited 2014 Jun 4]. Available from: URL: http://www.fda .gov/ForConsumers/ByAudience/ForWomen/TakeTimetoCare Program/default.htm National Institutes of Health (US). About The Heart Truth® [cited 2014 Jun 4]. Available from: URL: http://www.nhlbi.nih.gov /educational/hearttruth/about/index.htm Centers for Disease Control and Prevention (US). Inside Knowledge: Get the Facts About Gynecologic Cancer campaign [cited 2014 Jun 25]. Available from: URL: http://www.cdc.gov/cancer/knowledge Department of Health and Human Services (US). National Breastfeeding Awareness campaign [cited 2014 Oct 21]. Available from: URL: http://www.womenshealth.gov/breastfeeding/governmentin-action/national-breastfeeding-campaign/adcouncil/babies.pdf

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56. Pub. L. No. 102-539 (1994). 57. S. 47, 113th Cong. (2013). 58. Department of Justice (US). Office on Violence Against Women [cited 2014 Jun 27]. Available from: URL: http://www.ovw.usdoj .gov

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Women's health: 30 years of progress in the U.S. Department of Health and Human Services.

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