San Francisco Health

San Francisco’s Women’s Leadership Alliance
Position Paper on Health Care
and the Report of the Health Care Task Force

Co-Chairs:

Roma Guy, Director, Bay Area Homelessness Program, Department of Health Education, SFSU.
Charlie Toledo, Director, SUSCOL Tribal Indian Council, Napa, CA.
Carolene Marks, Board Member, National Foundation on Alternative Medicine

Report prepared by Adele James, Program Officer, The Women’s Foundation

ACTIONS AND ACHIEVEMENTS

  1. We participated in several CAWA local and regional meetings to identify health as a priority issue affecting social and economic status. We recruited participants to provide leadership for the health access agenda that expands health concerns beyond the local community, traditional public health programs and hospital care. We established health priorities for a local CAWA network action plan and connected them to the other eleven areas of concern in the Beijing Plan of Action.
  2. We recruited activists to support the priority agenda on health and to outreach to other women’s and girls’ organizations working on related health issues – full access to care, holistic health and preventive programs. We brainstormed with activists and began investigating legislative proposals for health care financing and analyzing their impact on women and girls.

OBSTACLES ENCOUNTERED

  1. A lack of women’s and girl’s organizations and leadership advocating health care financing as a priority issue.
  2. Lack of understanding of how opponents of equality for women and girls use gender, as well as racial tactics (ranging from stereotypical definitions of “family” to challenging government participation in the provision of health care as “bad”) to defeat improvements in the nation’s health care systems. This is especially visible in media campaigns that use “wedge issues ” to target women and swing votes. Similarly, employers and medical associations (to maintain the status quo) focus their attention persuading women to support increased use of tertiary care (in hospitals), at the expense of primary care, holistic health and preventive methods.
  3. Lack of public understanding of health care financing, the minimal resources available at local community levels and the limited number of women’s and girls’ health organizaations with a broad-based policy focus combine to maintain the present system in which women’s voices are seldom heard at local, regional, state and national health strategy sessions.

LESSONS LEARNED

  1. Women and girls in California have documented many times over that their health status and access to basic physical, mental preventative health care and services are key issues. Organizing and building a statewide consensus on HOW this can be successfully accomplished is a major obstacle given historical and well-organized opposition. Women utilize the health care system 30% more than men and carry most of the burden of obtaining health care for their families. Policies which result in decrease in public spending and the “devolution” (transfer of public services and funding from the national tax base to the state and local tax base), severe cuts in the safety net (Medicaid, Medicare), teaching hospitals, the balance budget agreement of 1997, changes in Welfare (TANF/CalWorks), etc are dismantling the infrastructure needed from which to construct and expand basic health care. These policies, without constructing a new, more efficient and efficacious policy of universal health care fundamentally, creates risk for ill-health for all and increases the vulnerability of especially poor people, including the working poor, to highest risk of ill-health. This is of particular importance to women and girls since women account for two-thirds of all adults living in poverty and two-thirds of all elderly adults living in poverty. The Health Task Force has learned how the social factors of income and its relationship to wealth, gender, race, disability AND a few health behaviors are major indicators of health and ill-health. As Dr. Donald M. Berwick, pediatrician stated: “Tell me someone’s race, their income, whether they smoke and the answers will tell me more about their longevity and health status than any other question I could possibly ask.” (NYT, 1/26/98).
  2. We are developing organizing strategies and leadership, especially paid leadership. to accomplish the goal of educating women and girls, and develop a legislative health agenda as well as concrete local strategies for health access. We need collaborations of advocacy and policy at local and state levels to focus on health care for all. We need to insure that coalitions on health care include diverse communities, women and girls, and women and girls health care issues in overall legislation, research, and data collection and prevention strategies.
  3. We have investigated how the interrelationship of poverty, prejudice and gaps in wealth create ill-health for women and girls which in turn creates more poverty, violence and ill-health for generations of people and the environment. Heart disease, for instance, is the number one cause of death for women (28% of all deaths). The growth of cancer, especially breast cancer for women and girls, is undeniably related to environmental factors. Other health related significant information is that domestic violence is the single largest cause of injury to women, accounting for more emergency hospital visits than auto accidents, muggings and rape combined. AIDS is the leading cause of death among African American and Latina women ages 25-44. Overall, women and girls of color have higher disease-related morbidity and shorter life span than white women and girls.

ACTION RECOMMENDATIONS FROM THE CALL TO ACTION, 2/26/00

  1. Universal Comprehensive Health Care. We advocate the creation of a health care system that places the needs of women and children at the center and ensures access to quality, culturally appropriate primary care, holistic and preventative care regardless of a person’s ability to pay.

    All activities and actions are within the context of UN Universal Declaration of Human Rights as defined by the definition of health of the World Health Oganizatinon (WHO) and the Beijing Plan for Action (1995).

    • Develop a collaborative of public & private institutions, governmental agencies, and community-based organizations (CBOs) to establish relationships and representation with new and continuing California legislative initiatives & processes to influence policy and action toward achievable universal access to health care in California.
    • Continue to support the State-wide efforts toward universal health care, such as: expanding MediCal to disabled workers and enrolling parents of children who are enrolled in Healthy Families (also support simplifying applications and expanding outreach to immigrant communities) and SB480.
    • Support legislation to shift prison spending to health care and education.
  2. Incorporate competency training and standards (including gender, mental & physical disability, race, ethnicity, national origin, refugees, immigrants, sexual orientation, income disparity, age, geographic location) in every health service and teaching institution for health personnel. Re-institute affirmative action to ensure that women and people of color are trained as health care providers.
  3. 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. Collect researched data on women and girls and widely publish and distribute locally and to influence public policy.
  4. Provide universal access to community-based family planning reproductive health services and care. Establish universal testing for mammograms and pap smears. Include all available choices for all women and girls throughout the entire life cycle by:

    Providing access and affordability to all new modalities of birth control as may be established by professional standards of care and contraception and sexual education and services including emergency contraception; supporting the elimination of means testing for reproductive health care, family planning; stopping the erosion of Roe v. Wade caused by barriers to access for low income and rural women, threats and violence against abortion providers, and legislative backsliding on reproductive rights; working to develop policies specific to hospital mergers to ensure that the requirement for meeting community health needs includes maintain access to the full range of reproductive/sexual health and family planning services; provide access to alternative and traditional family planning in all communities and STD/HIV prevention, detection and management, medical and surgical abortion; seek immediate approval of RU486. 

  5. Provide reproductive health choices and health care for all women and girls throughout life from pregnancy, through pre-post-menopause. This means using our network to stop annual attacks eroding Roe v. Wade.