The Annual Physical: Analyzing the State of Women’s Health
Despite the U.S. being one of the wealthiest, technologically advanced nations in the world, the crisis in women’s health remains because of a lack of research and systemic misogyny.
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Our understanding of women’s health usually relies on an interpretation of the past. Experts collect and analyze large amounts of data, hoping to describe an extremely complex assemblage of experiences. This is why, for example, we know that around 14 percent of women in the United States view their health as “fair or poor,” or that one in five women have experienced a mental health condition in the past year.
Yet the fall of Roe v. Wade in 2022 resulted in millions of people losing the right to safe, legal abortion. It is well established that the inability to obtain a wanted abortion has severe consequences for physical and mental health. These cascading effects mean it is difficult to accurately assess how well women really are; the current state of women’s health in the U.S. is consumed by the future.
Sonya Borrero is a professor of medicine at the University of Pittsburgh and director of its Center for Innovative Research on Gender Health Equity. As access to abortion decreases, we can expect an increase in deaths, Borrero says. The U.S. is already in the thick of a maternal mortality crisis, a situation which is increasingly getting worse. While more women die from pregnancy-related complications in the U.S. in comparison to other high-income countries, these tragedies are not spread equally: Black, American Indian, and Alaska Native women are two to three times more likely to die than white women.
“We can anticipate severe social, health, and economic consequences,” Borrero says. “This is terrible for the health of the nation.”
Layers of inequality influence outcomes across the spectrum of health. It’s understood that social determinants, such as access to safe housing and nutritious foods, are shaped by structural factors, like racism. These influences, alongside the fact that nearly 13 million women in the U.S. are uninsured, are critical to our understanding of women’s health trends, explains Gloria Bachmann, a physician and director of the Women’s Health Institute of Rutgers University. However, Bachmann is “hopeful that more and more women will continue to take preventive health measures throughout their life cycle, particularly when they’re pregnant.”
What aspects of health should women be especially mindful of? Let’s dive in.
Historically, certain mental health conditions are more common among women than men, including major depressive disorder, post-traumatic stress disorder, and generalized anxiety disorder. Experts say Covid-19 exacerbated these preexisting hardships, and significantly worsened many women’s mental health, such in a way disproportionate to the experience of men.
According to the 2022 Stress in America survey, women are also more stressed than men. Relatedly, women have experienced greater unemployment and increased stress from family responsibilities than men during the pandemic. Meanwhile, women are more likely than men to receive any form of mental health treatment.
The most recent data collected by the Centers for Disease Control and Prevention (CDC) on the subject also suggests one in eight women experience symptoms of postpartum depression. Furthermore, a 2019 study found the rate of depression disorders recorded during delivery hospitalizations is increasing.
Women are also more likely to have long Covid, compared to men. Long Covid compromises brain health, causing issues such as brain fog and headaches.
While heart disease is the leading cause of death for women in the U.S., there is declining awareness of this fact. The most recent data collected on heart health by the CDC suggests heart disease causes one in five female deaths — an improvement from 2016, when cardiovascular disease accounted for one in three female deaths. Compared with men, women are more likely to die within a year of a heart attack.
Despite this, a study published in 2022 in the journal Circulation found women are underrepresented in heart disease research. It also found just 22 percent of physicians and 42 percent of cardiologists feel prepared to assess heart disease specific to women. But while experts agree much still needs to be done to address the disparities in women’s heart health, there has been some progress in recognizing symptoms specific to women and in utilizing preventive healthcare as a way to reduce risk factors.
Cardiovascular diseases intersect with other aspects of health. For example, cardiovascular diseases are the leading cause of pregnancy-related deaths. Another study released in 2022 found six in 10 women have poor cardiovascular health before pregnancy — and the percentage of women with healthy hearts is declining.
Furthermore, heart disease in young women is increasing, causing alarm among experts. Delay in care is linked to misdiagnosis, racial biases, and dismissiveness. Heart health is influenced by a number of factors, including stress levels, diabetes, smoking, and diet.
According to the National Cancer Institute, as of May there are an estimated 287,850 new cases of breast cancer. These make up 15 percent of all new cancer cases in 2022; breast cancer is the most common cancer in women in the United States.
The probability that one of these individuals will survive their cancer for 5 year after diagnosis is an astounding 90.6 percent. Survival rates have improved over the past 25 years because of improvements in treatment and early detection. Scientists continue to develop new technologies, which may further improve screenings.
However, survival rates are not the same across patient populations. According to the American Cancer Society, Black women are 41 percent more likely to die from breast cancer than white women, although they are diagnosed less frequently. The racial differences in cancer deaths have very little to do with genetics. Instead, inequalities in social determinants of health play a larger role, such as inadequate health insurance and less access to high-quality care.
Disparities are felt during the course of illness as well. Yamilé Molina is an associate professor at the University of Illinois Chicago whose work is grounded in improving breast cancer outcomes among Latinx populations. They explain that research supports troubling trends when it comes to the worsened quality of life among Latinas after they receive a breast cancer diagnosis. This may be in part to later stage diagnoses and limited treatment options, among other factors.
“While we focus on death, often, when considering public health priorities, I would urge us to consider the importance of survival and how that looks across identities,” Molina says.
It’s fair to say that, when it comes to reproductive and sexual health, things are getting worse for women in the U.S. (“That is a very, very fair assessment,” Borrero says.)
While category refers to a wide range of health issues, the maternal mortality rate is an especially striking feature of reproductive health in the U.S. In 2020, 861 women died of maternal causes, compared to 754 women in 2019. Maternal deaths are steadily increasing, despite being highly preventable.
According to the American Board of Obstetrics & Gynecology, women who live in counties with the highest poverty rates also have the highest rates of maternal mortality. Overall, people of color and rural residents are more likely to die of a cause linked to pregnancy than white people and urban residents.
Menopause is another reproductive health issue where racial disparities are evident. For example, a 2022 study found that while Black women reach menopause earlier and have worse symptoms, they are less likely to receive medical aand mental health services related to menopause.
The gastrointestinal (GI) tract stretches from the mouth to the rear. The phrase “gut health,” meanwhile, refers to the state of the bacteria living within this tract. There are some differences between men and women when it comes to the GI tract: Women, for example, are two to six times more likely to have Irritable Bowel Syndrome.
The liver is also part of the GI system. According to recent research, alcohol-associated liver disease is increasingly common in women — though they are less likely to seek treatment. Meanwhile, a 2020 study suggests women in their teens and early twenties are now getting drunk at higher rates than young men. Women over the age of 26 are also increasing how much they drink faster than men. Beyond the liver, excessive drinking can also negatively affect the brain, heart, and increase the risk of cancer.
Women may be drinking more in an effort to better cope with life’s challenges, experts say. This is in line with previous findings which suggest women are more likely than me to drink to regulate stress.
The immune system
Autoimmunity is most common in women: 80 percent of all patients diagnosed with an autoimmune disease are women. Meanwhile, 85 percent of patients with multiple autoimmune diseases are female. When someone has an autoimmune disease, this means their immune system is attacking healthy cells in the body.
There are more than 80 types of autoimmune diseases, and a number occur more frequently in women than men. These include lupus, multiple sclerosis, and rheumatoid arthritis, among others. While the reason is not yet clear, autoimmunity is also on the rise in the U.S. In turn, there is an overall increased interest in investing in new treatments for autoimmune diseases and a growing availability of new therapies.
Although most studies on autoimmune diseases have primarily focused on white patients, a 2021 study found Black and Latinx people in the U.S. with autoimmune disease often experience poorer outcomes than white people due to worsened access to specialists and diagnostic tools.
It’s perhaps an understatement to say much can be done to improve the state of women’s health in the U.S.. In the 2022 Commonwealth Fund report, maternal mortality rates are described as a “bellwether for the U.S.’s wider failures with respect to women’s health and health care.” Gender bias, an ongoing issue in healthcare, helps fuels these failures and undermines wide-ranging efforts.
For example, the underrepresentation of women in health studies and clinical trials is viewed as a pervasive problem. We need data to know who needs help in what exact way. This extends to trans women, explains Joshua Safer, the executive director of the Mount Sinai Center for Transgender Medicine and Surgery. While there is an increasing number of healthcare providers who care for trans and gender diverse people, there is still a lack of data concerning transgender health, he says. Most surveys do not identify subjects by gender identity — we don’t know how many trans women are included in large estimates, such as the prevalence of heart disease in women. In turn, there has only been “incremental improvements in understanding” health needs. (Safer says the biggest health care concern experienced by transgender women remains “lack of access to quality healthcare.”)
Meanwhile, the historic trivialization of women’s health concerns lives on in both patient encounters with care providers, and in how decisions are made concerning investments in care. A 2021 paper found the National Institutes of Health (NIH) “applies a disproportionate share of its resources to diseases that affect primarily men, at the expense of those that affect primarily women.” Chronic fatigue syndrome, which is primarily diagnosed in women, illustrates this disparity — it is one of the lowest funded diseases by the NIH.
Improving women’s health must also involve addressing social determinants of health, alongside prioritizing patient-centered outcomes, Molina explains. “If we want to address equity, we should consider the importance of understanding not only survival, but optimal survival,” they say. Their own work focuses on leveraging the resilience among Latinx populations; strengths, they explain, can be leveraged to enhance intervention effectiveness and reach.
What gives Borrero hope for the future is witnessing more healthcare and research teams incorporate community and patient voices in the hunt for solutions.
“We haven’t done enough,” Borrero says. “But I am beginning to see movement.”
This story was updated in May 2023 to reflect Dobbs v. Jackson Women’s Health Organization, in which the Supreme Court ruled to overturn the constitutional right to abortion.
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