Alcoholism, Obesity Mark Downward Spiral In Women's Health

A new study shows that the health-status of women in the United States is much worse than anticipated, in some key areas. The report, by the Oregon Health and Science University and the National Women's Law Center, found that binge drinking is on the rise among women and that more women are obese, diabetic and likely to be suffering from hypertension than just a few years ago. Host Michel Martin speaks with Dr. Michelle Berlin, associate director of Oregon Health and Science University's Center for Women's Health and CEO and President of the National Alliance for Hispanic Health, Dr. Jane Delgado.

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MICHEL MARTIN, host:

I'm Michel Martin, and this is TELL ME MORE from NPR News.

Coming up a little later in the program, the election crisis in Haiti deepens as the two top presidential candidates reject a recount of a vote that just about nobody else accepts. All this while health experts are trying to curb a growing cholera epidemic that's already killed 2,000 people and sickened more than 91,000 others.

But we're going to start first today with matters of health here in the U.S. A new study tells us that the health status of women is much worse than anticipated in some key areas. A report from the Oregon Health and Science University and the National Women's Law Center found that in most states women were not meeting expected federal health goals.

Among other things, binge drinking is on the rise among women. Also, more women are obese, diabetic and likely to be suffering from hypertension than just a few years ago. And fewer women are being screened for conditions like cervical cancer. We wanted to know more about this. So we've called Dr. Michelle Berlin, associate director of Oregon Health and Science University's Center for Women's Health. She's on the line with us from Portland.

We also have with us Jane Delgado. She's a clinical psychologist. She's the CEO and president of the National Alliance for Hispanic Health, and she joins us from time to time to talk about health issues. I welcome you both and thank you so much for joining us.

Dr. MICHELLE BERLIN (Associate Director, Oregon Health and Science University Center for Women's Health): Glad to be here.

Dr. JANE DELGADO (CEO and President, National Alliance for Hispanic Health): Good morning.

MARTIN: OK, Dr. Berlin, there's a little bit of encouraging news here. For example, fewer women are smoking and dying of stroke or coronary heart disease, as the report suggests. But on the headline, you know, issues, like the binge drinking, for example, what do you think is going on here?

Dr. BERLIN: Well, I think the biggest thing to focus on is sort of the overall picture. And I'd say, as you've pointed out, there's been some improvement in the last decade and there's been some decline. I think that to me the biggest story from this is if we look at sort of the constellation of conditions that can affect people long term. So, one of the biggest ones is obesity that we're concerned about.

And if you look at things like high blood pressure, I think those are correlated as well. So to me the biggest story here is that everyone's health, women's health in the United States is declining for the indicators that we know of.

MARTIN: But why? Why do you think that is?

Dr. BERLIN: It's a good question. I think it's complex set of issues and I look forward to seeing what Jane's going to suggest. I think that the economic situation certainly is contributing. I think that exercise is still not as prevalent as it should be. You know, another indicator we have has to do with looking at exercise in high schoolers and whether there's a policy on the books in states requiring that high schoolers get exercise and we're not doing well.

When we devised that indicator, we were under the assumption and understanding at that point that physical education was still required in junior high school and elementary school. We've known that's on the decline. So I think those things matter. I think the built environment makes a difference too. It's very, very complex, not a simplistic set of answers.

MARTIN: And Jane Delgado, let's bring you into this conversation. First of all, and I do want to also mention that women of color, according to the report, black and Hispanic women particularly are disproportionately showing poor health status indicators. And that's probably not new news. But Jane Delgado, what is your sense of this? Why would you, why would some of these health status indicators be worse than they were just a few years ago?

Dr. DELGADO: Well, I think the important thing to remember is that when they did the goal for 2010, it was in the late '90s, was the data that they have available. And it wasn't even until 2001, now that's just around the corner, that the Institute of Medicine concluded that NIH, when they did research, really had to have a look at men and women differently.

So, part of the problem we have is that we know so little about women's health and we've always assumed that what's true for men was also true for women. So, not only did we have bad data, but the activities we told women to do were not always with the same outcomes. Something as simple as taking an aspirin every day, we thought that was good for everyone, we now know it has one effect on men, another effect on women.

So when it comes to women's health, as a country, we really don't know what we should know because for a long time we assumed that what's true for women was true for men.

MARTIN: Once again, you're listening to TELL ME MORE from NPR News. We're talking about a new study that shows that women's health indicators are much poorer than many people had anticipated, that most states are not meeting the health goals, federal health goals that have been set out.

And we're speaking with Dr. Michelle Berlin of the Oregon Health and Science University Center for Women's Health, and Jane Delgado of the National Alliance for Hispanic Health. She's the CEO of that organization. She's also a clinical psychologist.

I'll just read a couple more data points from the survey. Approximately 20 percent of women aged 18 to 64 have no health insurance. That's a significant increase compared to 2007. The healthy people 2010 goal of having every woman insured for health care - now that's one of those federal health benchmarks that the report is analyzing - it says that that goal hasn't been met by any state. Massachusetts is the highest with 95 percent insured.

I'm curious to know, and I'd like to hear from each of you whether you think the recession is part of this. You think the recession is part of the reason that perhaps these health indicators show some worsening in recent years. That perhaps there are fewer people who are insured or fewer people have access to health services than did previously. Dr. Berlin, what do you think?

Dr. BERLIN: I think you're right. I think there's a significant impact. So for things like the pap smear indicator, why are women getting fewer pap smears? It's not like women don't know they need them, they absolutely do. But if you have no health insurance or if you have catastrophic insurance only, or if you have health insurance where you have to pay co-pays to get any preventive screening exams, you may not be getting them.

Fortunately, the Affordability Care Act, one of its provisions in September says no more co-pays for preventive screening. So that's a good thing. I think the other thing we have to remember is that in many families, women take care of themselves last. They will make sure that their partners and their children obtain whatever health care they need before they go themselves.

And I think for those reasons, if there's a limitation of finances in one way or another, that may make a difference. But I don't think we can entirely say it's due to economics. I think that's a significant issue. But I think there are a lot of other societal things we need to look at too that really make a difference in this.

MARTIN: Jane Delgado, what do you think? You see patients as well as do the policy work. So, what are you seeing in your practice? What do you think?

Dr. DELGADO: Well, I see two things. First of all, I see that a lot of the issues, which are important for women, do not get the kind of analyses that they should. You know, for years women always lived longer than men. And that still continues. But we live long and suffer because we have chronic conditions, which compromise our lives.

Now, this is also true, for example, for Hispanic and African-American women that we live longer lives than the men, but it's compromised by all sorts of things.

One of the areas which is more important is the area of depression and how that impacts on our physical health. We all know this is something that we find with heart disease and diabetes, a whole host - the binge drinking - so that the mental health status of women and how it interacts with the physical health is so sorely neglected. And that's an area where we need a lot more work.

MARTIN: What kind of work would you like to see? And I'd like to ask each of you this question because you both work in the area of policy as well as treating patients individually. So, Jane Delgado, why don't you start? What would you like to see in the area of policy?

Dr. DELGADO: Oh, in policy, I would like, for example, the community health centers and the community mental health centers to work a lot closer together. Right now, they have different funding streams and they do not work together. They're in separate agencies. So, more coordination even in that level to understand that your physical health and your mental health are connected.

MARTIN: But I'm still pushing on the question of why would health indicators be worse than they were when this report was delivered a couple of years ago? This is the fifth such report, the last report delivered in 2007. Why would some of these health indicators be worse now than they were then? Presumably, there's been more awareness since then - more of public health discussion of the importance of some of these issues since then.

Dr. DELGADO: Well, some of the indicators, remember, when they report them, they don't take into account age. So, for example, as a population ages, and in the United States we're aging, you're going to have a lot more - the chronic illnesses like diabetes, like heart disease, like high blood pressure. Things that, you know, as you age you see more of.

What concerns me is the things which we don't see looked at so carefully. The incidents of Chlamydia, the binge drinking, those which are on the increase, those are things that we really have to target. You know, we live in a very different environment now. Between the messages that young women get, between clean air and clean water, there are a lot of things impacting our health in major ways, which is going back to what Dr. Berlin said, there's no one thing.

So if government is looking for simplistic answer of what is the answer, there is no one answer. You have to do many things at many times. You have to do what works.

MARTIN: OK, Dr. Berlin, what do you want to see - what many things do you want us to do - as Jane Delgado was telling us, you have to do many things - what are some of the many things that we ought to be doing that you'd like to see us doing as a country to address these numbers?

Dr. BERLIN: Well, some of them may seem mundane in terms of data collection, but they matter, exactly for some of the reasons that Jane suggested. So we need better data that's better collected and better analyzed. The data that we used for the report card are primarily from federal sources of a number of different types. But one of the most basic issues is that even though there's a requirement for the federal government that all data be collected the same, there still isn't - particularly for race/ethnicity.

So that's a problem from my standpoint. You can't plan if you don't know what the data is. So, that's one. The second thing is that because things like stroke death rates and heart disease and such are such a long timeline, in other words, if you smoke today, we're not going to see if you have lung cancer or not for 20 or 30 years.

So while we look at lung cancer and we think it's important, it's reflecting what happened a long time ago. That's why we have indicators like smoking right now, high blood pressure right now, to help us understand what we need to be looking at, because we can affect those things now.

The other thing is I think that the Affordability Care Act, if its major provisions are retained, will make a difference. The concept of medical home, as Jane was saying, to have people working together and have one particular site or virtual site of care where care is coordinated as it's needed throughout, is going to make a huge difference.

So, even for things like smoking cessation, expecting that I and a 15-minute visit with a patient, can do a lot for smoking cessation isn't workable. I can start the process, but I can be a lot more effective and the patient will do better if there's someone else in my office who can carry through and follow up with them well.

MARTIN: Dr. Michelle Berlin is the associate director of Oregon Health and Science University's Center for Women's Health. She joined us from Portland, Oregon. Jane Delgado is a clinical psychologist, a practicing psychotherapist. She's also the CEO and president of the National Alliance for Hispanic Health. And she was on the phone with us from her office. Thank you both so much for speaking with us.

Dr. BERLIN: Thank you.

Dr. DELGADO: Thank you.

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