HEALTH POLICY PAPER, CALIFORNIA WOMEN’S AGENDA, 2005
By Roma Guy, CAWA Health Policy Co-Chair
Carolene Marks Co-Chair
Plan of Action for Health in California
The California Women’s Agenda (CAWA) advocates for a health care system that provides comprehensive health for the needs of women and children and ensures appropriate data collection and access to quality, culturally and linguistically appropriate, basic and preventative care, regardless of a person’s ability to pay.
The United Nations Universal Declaration of Human Rights states that every individual has the right to a standard of living that is adequate to their own well being, as well as that of their family. This standard of living includes access to adequate food, clothing, housing, medical care, necessary social services and security, even in the event of unemployment, sickness, disability, old age or widowhood. History has shown that the promotion of health and human rights is integral, and that health depends on the fulfillment of all human rights. As defined by the World Health Organization, health encompasses more than just an individual’s medical condition and is inclusive of “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”.
This vision of universal human rights, despite its original intent towards equity, has not fully encompassed women’s and girls’ experiences. Many of the rights defined as universal human rights, to which women and girls are assured equal access, very often have not met the specific needs of women and girls. Health is a human right. Therefore, governments are obligated to protect, promote and fulfill this right. As stated in the Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW) and the Beijing Platform for Action, concrete steps are necessary in order to protect the human rights and more specifically the right of all women and girls to access health services. If we are to improve the health status of women and girls, then we must also address the provision of health from a human rights perspective that integrates the notion of access to quality health services for all through the development and strengthening of the health care infrastructure. By providing access to health care for all, we ensure the basic mechanism necessary in order to exercise the fundamental right to health.
At the turn of the twenty-first century, we find that:
• Women utilize the health care system 30% more than men and carry most of the burden of obtaining health care for their families.
• Only 34% of women in California gain health care insurance directly through their employers.
• Among women ages 18-64, 21% have no public or private health insurance coverage. For Latinas this figure is almost 40%.
• Overall, women of color suffer higher disease-related morbidities and mortalities than white women, and women of color also have a shorter life expectancy than non-white women.
• Heart disease is the number one cause of death for women in America, accounting for 28% of all deaths to women.
• AIDS has become the leading cause of death among African-American and Latina women ages 25-44.
• Battery is the single largest cause of injury to women, accounting for more emergency room visits than auto accidents, muggings, and rapes combined.
• Women historically have been excluded from clinical trials and are the recipients of women specific care generally based on research that test the safety and effectiveness of drug treatment utilizing male subjects only.
RECOMMENDED RESPONSE TO CURRENT SITUATION
Five major priority actions recommended at the local community and state legislative levels are to:
1. Develop a universal comprehensive health care system.
2. Incorporate cultural competency training and standards in every health service and teaching institution for health care personnel.
3. Re-institute affirmative action to ensure that women and people of color are trained as health care providers.
1. Allocate more research dollars to explore the health care needs of women of various ethnic groups in California. Include women and girls in clinical trials and research, with publication and wide distribution of results in order to influence public policy.
2. Establish universal testing for mammograms and pap smears with follow-up care provided.
Recommendations for CAWA Actions 2005
Major priority actions recommended at the local community and state legislative levels are to:
• Develop a universal comprehensive health care system. Support current local and state universal health care initiatives and legislation. Actively support Senate Bill 921 for universal health coverage submitted by California Senator Shelia Kuehl.
• Actively support local initiatives and health universal coverage for children and youth from birth to 25 years old.
• Defend and maintain current safety net coverage such as MediCAL, Healthy Families until universal health care coverage is achieved. Work with national legislative delegation to support universal health care and protection of the safety net until universal health care is achieved state-wide.
• Defend and monitor the state of California’s current reproductive health and access to Choice.
• Incorporate cultural competency training and standards in every health service and teaching institution for health care personnel locally and state-wide. Establish universal testing for mammograms and pap smears with follow-up for cultural and linguist competency care.
• Support the Department of Women’s Health to ensure that data collection and monitoring of women and girls’ health is maintained. Allocate more research dollars to explore the health care needs of women of various ethnic groups in California. Include women and girls in clinical trials and research including wide distribution of results in order to influence public policy.
• Ensure that local and state policy and legislation links the environmental health with health care and prevention.
FREQUENTLY RAISED ISSUES RELATED TO THE HEALTH CARE OF WOMEN
1.) Why Do We Need Universal Health Care?
Basic health care for all, regardless of one’s ability to pay, is in everyone’s health interest. Currently the USA provides and administers a two-tier system, one for those who have the ability to pay wage-based health insurance and different one for those who cannot afford it. This approach is unnecessary and administratively more costly (15% to 30%) to the overall health care than one that is universally financed. Additionally, research indicates that the health status of Americans is less than optimal because of the inequities in the current approach. The ill health of an uninsured person who does not have access to primary or preventive health care often results in a longer recovery period, higher death and disease rates, higher usage of hospital emergency room care due to advanced and untreated health conditions, and overall higher costs to tax payers.
2.) Why are cultural competence and a diverse work staff important to the provision of health care services?
Today our communities are becoming more and more diverse. Lack of awareness about cultural differences can make it difficult for both providers and patients to achieve the best, most appropriate care. Cultural competence is the ability to respond respectfully and effectively to people of diverse backgrounds regardless of gender, ethnicity, immigration status, sexual orientation, class, disability and/or other differences. Awareness and training about different cultural norms, lifestyles, and personal preference can provide health professionals with the skills to better understand patient needs and provide more effective and appropriate care, which in-turn can lead to improved treatment adherence rates. Employing a diverse health services workforce is one means of ensuring effectiveness in service provision because patients are more likely to receive care from providers who share and understand their cultural backgrounds.
3.) Why Should Women be Included in Clinical Trials?
There is no way of knowing how safe a drug or treatment is for women without including women in clinical trials. If the differences in female and male responses to disease and treatment are understood, this in-turn has implications for both genders in clinical practices, disease prevention, and medical education. Studying women can not only help to improve treatment of women, but also men. The scientific evidence yielded by inclusion of women in clinical trials on treatment safety and efficacy would also provide information on how to more effectively meet women’s health care needs.
RESOURCES FOR MORE INFORMTION
Diversity Rx: http://www.diversityrx.org/HTML/DIVRX.htm Promoting language and cultural competence in health care for diverse communities.
Lesbian Health Foundation: http://www.lesbianhealthfoundation.org/
Web-based LBT health issues resources for research, information and services.
Office of Minority Health Resource Center: http://www.omhrc.gov/welcome.htm
San Francisco Commission on the Status of Women: http://www.ci.sf.ca.us/cosw/
Society for Women’s Health Research: http://www.womens-health.org/
U.S. Office of Health Policy: http://aspe.os.dhhs.gov/health/hphome.htm