Women face unique health challenges compared to men. Some are obvious, for example, chronic conditions that result from pregnancy and cancers of the female reproductive tract are exclusive to women. Sometimes the impact of chronic disease for women is more nuanced. For example, fewer women smoke than men proportionally, but the consequences of smoking-related diseases have a greater negative health impact on women. Other conditions, such as migraine headaches, simply affect women (18%) at a higher rate than men (6%). Chronic disease is the most expensive group of conditions in the United States. It is also the most preventable, as the majority of prevention efforts address behavior such as good nutrition, tobacco use and excessive alcohol consumption.
Chronic Disease: Cardiovascular Disease
Cardiovascular disease is an umbrella term that includes conditions such as coronary artery disease, heart rhythm conditions (arrhythmias), blood vessel diseases and heart diseases present from birth (congenital heart defects).
Often thought of as a man’s condition, cardiovascular disease is the leading cause of death for women in the United States, with nearly 48 million women living with or at risk of heart disease. In the United States, 1 in 4 women will die of heart disease. There are racial disparities in cardiovascular disease rates, with African American and Latina women dying at higher rates than white women. While overall mortality has decreased over the last five decades, the racial disparities remain.
Protective factors such as avoiding tobacco use, increasing physical activity and healthy nutrition are true for all populations. The Center for Disease Control and Prevention’s (CDC) Division for Heart Disease and Stroke Prevention developed the WISEWOMAN screening program to reach women at high risk of cardiovascular disease. Between 2008 and 2013, the program served 101,000 women, 91% of whom had at least one risk factor for heart disease.
Chronic Disease: Osteoporosis
Osteoporosis is a disease that results in bone loss. Bone mass becomes low and the structure of the bone tissue deteriorates, increasing the risk of fracture. Osteoporosis is responsible for 2 million fractures in 2018. Yet nearly 84% of older Americans who sustain broken bones are not screened or treated for osteoporosis. Fractures and their estimated cost to society and the health care system are expected to rise as the U.S. population continues to age. According to the National Osteoporosis Foundation (NOF), 1 in 2 women, compared to 1 in 4 men, will suffer a fracture after the age of 50 due to osteoporosis. The risk of a woman breaking her hip is greater than the risk of breast, ovarian and uterine cancer combined. The National Osteoporosis Foundation states that of the 300,000 annual hip fractures:
- 25% of those women will die within a year.
- 50% will never walk independently again.
- 20% require permanent nursing home placement.
Most prevention efforts focus on healthy eating. Healthy bones begin during childhood while bone mass is increasing. Peak bone mass usually occurs during early adulthood and slowly decreases over a lifetime. Healthy nutrition is important early in life, but also protects bones as people age.
Chronic Disease: Migraine Headaches
As noted in the introduction, migraine headaches disproportionately affect women compared to men. Researchers point to data showing variations in hormone levels as a potential explanation for the difference in prevalence between men and women. While women have higher rates of migraines than men, that is only true until puberty where certain hormonal systems activate for both boys and girls. Drawing clear conclusions about the cause of gender disparities in migraines can be difficult due to the range of environmental and genetic factors, as well as female-specific health events such as menstruation, pregnancy and menopause. There is a range of treatments for migraine headaches and many patients may have better chances of responding to their treatments if taken within the first few hours of symptoms or the onset of pain.
Chronic Conditions: Cancer
Breast cancer is the second-most common type of cancer for women. The first is skin cancer. Substantial increases in funding and research over the last few decades have significantly improved survival rates and decreased overall deaths. Early detection, personalized treatments and increased understanding have contributed to advances in breast cancer outcomes. Efforts to better understand and treat breast cancer are ongoing. According to the American Cancer Society, there are research efforts to understand the effect of exercise, diet and weight loss/gain, the best use of genetic testing on breast cancer mutation and possible environmental causes for breast cancer (environmental research is in the early stages). In addition to these efforts, the National Institutes of Health also references research to address disparities and quality of life for survivors.
Ovarian cancer begins in the ovaries. In the early stages, ovarian cancer rarely causes any symptoms. Advanced-stage ovarian cancer can cause fewer or nonspecific symptoms that may be mistaken for less serious conditions. Researchers are also developing “targeted therapies” that may decrease the pain from traditional chemotherapy, by only targeting cancerous cells, as opposed to cancerous and healthy cells. Genetic therapies are also starting to show promise for ovarian cancer patients, by achieving lower levels of mutations to treat the disease.
As in ovarian cancer, cervical cancer usually produces no symptoms in the early stages, when it is most easily treatable. Late-stage cervical cancer has more distinct symptoms and is more difficult to treat. Most cervical cancer is caused by human papillomavirus (HPV). HPV is spread through sexual contact. Although most women’s immune systems successfully fight off the virus, it sometimes leads to cervical cancer. There are CDC-recommended vaccines to prevent the contraction of the HPV virus. Screening and prevention efforts have reduced the impact of cervical cancer, but there are still more than 13,000 diagnoses of the disease each year. The rates of new cases of cervical cancer in the U.S. went from 11 per 100,000 people in 1992 to 6.7 in 2016.
Policy Options: Cardiovascular Disease
Although cardiovascular disease presents differences in risk and outcomes between men and women, efforts to address cardiovascular disease generally can still benefit women as a population. The CDC’s Division for Heart Disease and Stroke Prevention provides state policy analysis, state law fact sheets and tools for state policymakers to better understand cardiovascular disease in their state and available options to address it. For efforts to specifically address women’s heart health, the CDC’s WISEWOMAN program also provides state policymakers with resources and toolkits to determine the scope of and response to women’s heart disease.
State legislators can also support national efforts to bring attention to women’s heart health, such as the American Heart Association’s Wear Red Day awareness campaign. For example, Tennessee enacted Senate Joint Resolution 76, recognizing National Wear Red Day on Feb. 1, 2019.
Policy Options: Osteoporosis
State legislators often focus osteoporosis-related efforts on prevention and screening. States can increase access to osteoporosis screenings. Nevada SB 130 (2019) addressed licensure for providers authorized to perform bone density screenings. State legislation can also address an insurer’s responsibility to cover osteoporosis screenings. For example, Connecticut HB 5210 (2018) expanded the federally mandated essential health benefits to include bone density screenings for women older than 65. Related to prevention and awareness, California ACR 113 (2018) declares a breastfeeding awareness month and cites the protective factors of breastfeeding as it relates to osteoporosis.
State lawmakers can also look to the U.S. Preventive Task Force for recommendations on osteoporosis screening for women.
Policy Options: Migraine Headaches
Legislative action to address migraine headaches has largely taken place on the federal level in the form of disability legislation and incentives for employers to accommodate employees suffering from migraines or other headache disorders. The Americans with Disabilities Act of 1990 covers migraine headaches, according to former U.S. Congressman Tony Coelho. More recent Congressional efforts include the pending Disability Employment Incentive Act (2018), which would allow employers to use three tax incentives if they make physical or online workspaces more accessible for people with disabilities. Another piece of proposed legislation, the ABLE Age Adjustment Act (2019), would allow people with disabilities to set aside tax-free money to help with disability-related expenses.
Policy Options: Cancer
State legislators can address issues in a number of ways. Some legislation addresses one female-specific cancer, while other legislation can address a number of female-specific cancers. The scope of the legislation can include insurance coverage mandates, screening recommendations for providers and resolutions to garner awareness. States also support various forms of female-specific cancer research, treatment programs and prevention initiatives through line items in their annual budgets.
- Louisiana HB 345 (2019) requires health insurance companies to cover genetic screenings for breast and ovarian cancers in certain populations of women.
- Illinois SB 1506 (2019) requires facilities that provide mammography services to notify patients whose mammograms demonstrate dense breast tissue.
- Georgia HR 21 (2019) recognizes Jan. 16, 2019 as Cervical Cancer Day and January 2019 as Cervical Health Awareness Month.
- Colorado HB 1302 (2019) continues the breast and cervical cancer screening program and creates a treatment program for underinsured women with breast and cervical cancer.