AJPH ON THE PRESIDENTIAL CAMPAIGN TRAIL
Wood Responds Zuckerman makes very important points on the need to have a broad and comprehensive approach to women’s health—to ensure that research, prevention, and access to health care for women is based on evidence relevant to women. Her analysis examines data related to costs of new medicine, the regulatory approval system, and the new focus on precision medicine. Each of these has profound impact on women’s health, quality of life, and indeed the effectiveness of treatments and health care for women. Beginning in the 1990s, policymakers began to focus on women’s health across the life span, addressing research, prevention, and services with a comprehensive approach. Are policymakers, politicians, and their staff sufficiently educated in the scientific method and public health approach to make a difference—and ultimately, will that lead to good policymaking in a highly politicized time for women’s health? Explanation of the current best available data is a critical activity that must be ongoing, and must be supported by our leading organizations, academic and research entities, and individual experts. Data and evidence-based information should be the basis of good policymaking and, although it can only be part of the solution, we must ensure that candidates, whether for President or for Congress, have the best information available upon which to make their decisions. Some candidates already have a depth of knowledge and understanding not only about women’s health, but about the range of health policy issues, whereas others
792
Editorial
Wood
appear to actively avoid the role of science in policymaking—and they are supported by advocates who provide misleading information. We now are living through the quadrennial presidential election season, and this time around the politics and policies about women’s health have once again been forced to focus on reproductive health, pushing many broader women’s health issues aside. Unfortunately, there is now a clear partisan divide, which the public health community should not allow to continue; we must challenge both the misuse of science and the policies that spring from it. Whether it is abortion, access to contraception, comprehensive sex education, or fetal tissue research, “women’s health” is again shorthand for controversy around reproductive health. In the United States, in contrast to other high income nations, the controversies around reproductive health are confounded by individual and institutional religious views that often overshadow the public health and individual health benefits of access to reproductive health services. These issues are under heightened threat at both the state and national levels and, thus, have risen to the top of the agenda not only for policymakers and politicians, but also for advocacy organizations and individuals. Family Planning was identified by the Centers for Disease Control and Prevention as one of the “Ten Great Public Health Achievements of the 20th Century,”1 noting the benefits of smaller families, child spacing, preconception care, reduced
maternal and child death, and barrier methods that reduce transmission of sexually transmitted diseases including HIV. The Institute of Medicine included contraception as one of the key women’s health preventive health services that should be covered without additional cost-sharing under the prevention provisions of the Affordable Care Act.2 Within the public health and clinical communities, it is clear that access to voluntary family planning should be an easy and obvious policy decision, and that focus should be on implementation, education, and providing women and men with the range of contraceptive or family building options that will work best for their lives and health. At one time, this was a bipartisan issue, long supported by Republicans and Democrats alike. Yet for many of those who work in health policy that does not involve reproductive health, even the topic of contraception is now a third rail, not to be touched, because the controversy might risk the broader health agenda. Multiple Supreme Court cases (notably Hobby Lobby v. Burwell) have conflated and confused the clear individual and public health benefit of family planning options with the claimed religious objections of women’s employers. This has led to for-profit companies being allowed to limit coverage of contraception for
their female employees based on corporate religious belief. Even now, we see the response to the Zika virus, with its clear need for women’s access to contraception, complicated by the fact that many countries in the region lack access to contraception and abortion care. When the topic is abortion care, the politics goes into overdrive. Despite evidence of safe and effective abortion procedures, new opportunities for early abortion using medication, advances in telemedicine, and the clear evidence that family planning and contraceptive methods reduce the need for abortion care, policymakers at all levels are limiting access. Through legal, regulatory, and rhetorical strategies, they are limiting access to abortion and promoting the dissemination of inaccurate information to women. These include restrictions on facilities, denial of insurance coverage, limitations on use of telemedicine, restrictions on medication abortion, consent requirements, waiting periods, forced procedures, and information (including discredited information on link to breast cancer and “reversal” of medical abortion). No other medical procedures or health care systems have such interference from politicians with so little basis on science, data, or public health perspectives. But reproductive health is only part of women’s health. Zuckerman is right. Those who care about women’s health
ABOUT THE AUTHOR Susan F. Wood is with the Department of Health Policy and Management, Jacobs Institute of Women’s Health, Milken Institute School of Public Health, George Washington University, Washington, DC. Correspondence should be sent to Susan Wood, 950 New Hampshire Ave, NW, Washington, DC 20052 (e-mail: [email protected]). Reprints can be ordered at http://www.ajph.org by clicking the “Reprints” link. This editorial was accepted February 25, 2016. doi: 10.2105/AJPH.2016.303167
AJPH
May 2016, Vol 106, No. 5
AJPH ON THE PRESIDENTIAL CAMPAIGN TRAIL
should care at least as much about Medicare as they do about reproductive health. Those working on precision medicine and other efforts to improve the quality of health care should take sex and gender and other demographic variations into account as part of the policies aimed at making health care in the United States more affordable and more effective. Those advocating for more research funds should ensure that the research is well designed and can answer the treatment questions that matter to patients. Researchers must evaluate their data for sex and gender differences and report the findings, so that the results are applicable to us all. Unfortunately, at the same time that we have gone backward with regard to critical reproductive health issues, our capacity to focus on those key health policy issues that affect women’s health across the life span has been stretched too thin, and we have lost needed momentum. Hopefully, we will soon move to an era where evidence and education will be the foundations for the decisions of our policymakers, and where comprehensive women’s health—including reproductive health—is truly central to all aspects of health policy, not just a political sound bite. This requires working with our elected officials—and Presidential candidates—to support them with both research data and policy recommendations that will advance women’s health from a comprehensive and public health perspective.
MMWR Morb Mortal Wkly Rep. 1999, 48(12);241–243. 2. Institute of Medicine. Clinical preventive services for women: closing the gaps. National Academy of Sciences. 2011. Available at: https://iom. nationalacademies.org/Reports/2011/ Clinical-Preventive-Services-forWomen-Closing-the-Gaps.aspx. Accessed March 8, 2016.
Susan F. Wood, PhD REFERENCES 1. Centers for Disease Control and Prevention. Ten great public health achievements—United States, 1900–1999.
May 2016, Vol 106, No. 5
AJPH
Wood
Editorial
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Wood Responds Zuckerman makes very important points on the need to have a broad and comprehensive approach to women’s health—to ensure that research, prevention, and access to health care for women is based on evidence relevant to women. Her analysis examines data related to costs of new medicine, the regulatory approval system, and the new focus on precision medicine. Each of these has profound impact on women’s health, quality of life, and indeed the effectiveness of treatments and health care for women. Beginning in the 1990s, policymakers began to focus on women’s health across the life span, addressing research, prevention, and services with a comprehensive approach. Are policymakers, politicians, and their staff sufficiently educated in the scientific method and public health approach to make a difference—and ultimately, will that lead to good policymaking in a highly politicized time for women’s health? Explanation of the current best available data is a critical activity that must be ongoing, and must be supported by our leading organizations, academic and research entities, and individual experts. Data and evidence-based information should be the basis of good policymaking and, although it can only be part of the solution, we must ensure that candidates, whether for President or for Congress, have the best information available upon which to make their decisions. Some candidates already have a depth of knowledge and understanding not only about women’s health, but about the range of health policy issues, whereas others
792
Editorial
Wood
appear to actively avoid the role of science in policymaking—and they are supported by advocates who provide misleading information. We now are living through the quadrennial presidential election season, and this time around the politics and policies about women’s health have once again been forced to focus on reproductive health, pushing many broader women’s health issues aside. Unfortunately, there is now a clear partisan divide, which the public health community should not allow to continue; we must challenge both the misuse of science and the policies that spring from it. Whether it is abortion, access to contraception, comprehensive sex education, or fetal tissue research, “women’s health” is again shorthand for controversy around reproductive health. In the United States, in contrast to other high income nations, the controversies around reproductive health are confounded by individual and institutional religious views that often overshadow the public health and individual health benefits of access to reproductive health services. These issues are under heightened threat at both the state and national levels and, thus, have risen to the top of the agenda not only for policymakers and politicians, but also for advocacy organizations and individuals. Family Planning was identified by the Centers for Disease Control and Prevention as one of the “Ten Great Public Health Achievements of the 20th Century,”1 noting the benefits of smaller families, child spacing, preconception care, reduced
maternal and child death, and barrier methods that reduce transmission of sexually transmitted diseases including HIV. The Institute of Medicine included contraception as one of the key women’s health preventive health services that should be covered without additional cost-sharing under the prevention provisions of the Affordable Care Act.2 Within the public health and clinical communities, it is clear that access to voluntary family planning should be an easy and obvious policy decision, and that focus should be on implementation, education, and providing women and men with the range of contraceptive or family building options that will work best for their lives and health. At one time, this was a bipartisan issue, long supported by Republicans and Democrats alike. Yet for many of those who work in health policy that does not involve reproductive health, even the topic of contraception is now a third rail, not to be touched, because the controversy might risk the broader health agenda. Multiple Supreme Court cases (notably Hobby Lobby v. Burwell) have conflated and confused the clear individual and public health benefit of family planning options with the claimed religious objections of women’s employers. This has led to for-profit companies being allowed to limit coverage of contraception for
their female employees based on corporate religious belief. Even now, we see the response to the Zika virus, with its clear need for women’s access to contraception, complicated by the fact that many countries in the region lack access to contraception and abortion care. When the topic is abortion care, the politics goes into overdrive. Despite evidence of safe and effective abortion procedures, new opportunities for early abortion using medication, advances in telemedicine, and the clear evidence that family planning and contraceptive methods reduce the need for abortion care, policymakers at all levels are limiting access. Through legal, regulatory, and rhetorical strategies, they are limiting access to abortion and promoting the dissemination of inaccurate information to women. These include restrictions on facilities, denial of insurance coverage, limitations on use of telemedicine, restrictions on medication abortion, consent requirements, waiting periods, forced procedures, and information (including discredited information on link to breast cancer and “reversal” of medical abortion). No other medical procedures or health care systems have such interference from politicians with so little basis on science, data, or public health perspectives. But reproductive health is only part of women’s health. Zuckerman is right. Those who care about women’s health
ABOUT THE AUTHOR Susan F. Wood is with the Department of Health Policy and Management, Jacobs Institute of Women’s Health, Milken Institute School of Public Health, George Washington University, Washington, DC. Correspondence should be sent to Susan Wood, 950 New Hampshire Ave, NW, Washington, DC 20052 (e-mail: [email protected]). Reprints can be ordered at http://www.ajph.org by clicking the “Reprints” link. This editorial was accepted February 25, 2016. doi: 10.2105/AJPH.2016.303167
AJPH
May 2016, Vol 106, No. 5
AJPH ON THE PRESIDENTIAL CAMPAIGN TRAIL
should care at least as much about Medicare as they do about reproductive health. Those working on precision medicine and other efforts to improve the quality of health care should take sex and gender and other demographic variations into account as part of the policies aimed at making health care in the United States more affordable and more effective. Those advocating for more research funds should ensure that the research is well designed and can answer the treatment questions that matter to patients. Researchers must evaluate their data for sex and gender differences and report the findings, so that the results are applicable to us all. Unfortunately, at the same time that we have gone backward with regard to critical reproductive health issues, our capacity to focus on those key health policy issues that affect women’s health across the life span has been stretched too thin, and we have lost needed momentum. Hopefully, we will soon move to an era where evidence and education will be the foundations for the decisions of our policymakers, and where comprehensive women’s health—including reproductive health—is truly central to all aspects of health policy, not just a political sound bite. This requires working with our elected officials—and Presidential candidates—to support them with both research data and policy recommendations that will advance women’s health from a comprehensive and public health perspective.
MMWR Morb Mortal Wkly Rep. 1999, 48(12);241–243. 2. Institute of Medicine. Clinical preventive services for women: closing the gaps. National Academy of Sciences. 2011. Available at: https://iom. nationalacademies.org/Reports/2011/ Clinical-Preventive-Services-forWomen-Closing-the-Gaps.aspx. Accessed March 8, 2016.
Susan F. Wood, PhD REFERENCES 1. Centers for Disease Control and Prevention. Ten great public health achievements—United States, 1900–1999.
May 2016, Vol 106, No. 5
AJPH
Wood
Editorial
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