The Barnard
Summit was supported by the Bill & Melinda Gates Foundation,
Merck & Co., Inc. and Pfizer Inc.
A report summarizing each of three panel discussions -- health
trends, changing health care, and women's health globally -- follows:
WOMEN'S HEALTH TRENDS: A CURRENT ASSESSMENT
Women's Health Issues Reflect Positive Changes and Difficult Challenges
Not long ago, if a woman complained to her doctor of chest pains,
she probably would have been told to take antacids and sent on
her way. Today, doctors are more likely to treat this complaint
seriously, based on the evidence that more women die from heart
disease than from any other illness.
The change comes largely because of a quiet but critical movement
that has been stirring over the past decade, one being waged not
in rallies but in laboratories, clinics and hospitals. Gender-specific
research, technological advances in treatment for women and media
coverage of both have distinguished women's health issues as unique
and altogether different from men's, paving the way toward gender-appropriate
treatment and help.
But not all women can appreciate the good news. Many throughout
the world remain unable to access or afford adequate care for
even their most fundamental health needs.
Members
of the first panel. From left to right: Joan Brumberg, Judith
Shapiro, Dr. Cristina Beato, Dr. Marianne Legato, Cindi Leive,
and Dr. Judith Reichman |
According
to experts who assembled at the 2003 Barnard Summit: Women
and Health positive changes have occurred in the study of
women's health, but much work remains to insure equitable care
for women around the globe.
With the goal of emerging with a better understanding of women's
health trends globally and access to health care, 700 women and
men, including health care professionals, scholars, journalists,
Barnard students and alumnae, attended the Summit. The day-long
forum brought together a distinguished group of 21 experts and
specialists, including top U.S. government policymakers, influential
health advocates and leading medical specialists and researchers,
for discussion of findings in medical research, challenges in
health care and influences on global health issues.
Dr.
Marianne Legato |
"While
Americans spend nearly $35 million annually on weight loss products
and programs, nearly half of all women of reproductive age in
regions of Africa and South Asia continue to be undernourished,"
said Barnard President Judith Shapiro, moderator of the first
panel on health trends. "But positive trends must be emphasized.
Women have taken an increasingly active role as health care providers.
Nearly half of all medical school graduates in the U.S. are women.
The topics are many and far reaching and the ramifications loom
large."
The fact that
attention is paid to women's unique health needs is "an exciting
revolution," according to Dr. Marianne Legato, a physician,
author of Eve's Rib and founder of the Partnership for
Gender-Specific Medicine at Columbia University. "That in
itself is a major change that's really only happened in the last
ten years, but one that can ultimately help both women and men."
Dr.
Cristina Beato |
Such efforts
have helped move the focus beyond the two areas that have most
often defined women's health issues-breast cancer and reproductive
diseases-and into a comprehensive approach to gender-specific
medicine. For instance, since 1950 lung cancer mortality rates
for women have increased an estimated 600 percent, Shapiro said.
And according
to Dr. Cristina Beato, the principal Deputy Assistant Secretary
for Health to Secretary of Health and Human Services Tommy Thompson,
obesity rates have also increased, environmental concerns such
as clean water and air pollution have broadened, the scope of
women's health, and concern about heart disease has prompted increased
advocacy for behavioral changes and federal preventative programs.
"We're living longer but we're picking up bad habits along
the way," said Beato. "We've become good on treatment
but lousy on prevention."
Dr.
Judith Reichman |
Still, most
women under 45 years of age seem more concerned about breast cancer
or reproductive cancer than anything else, according to Glamour
magazine Editor-in-Chief Cindi Leive. "The reality, though,
is that they are more likely to die from heart disease or even
a car accident," said Leive.
The perceptions
remain in part due to differing medical opinions throughout the
years and the amount of information now available through the
Internet, which can be difficult to navigate.
"It can be confusing," said Dr. Judith Reichman (Barnard
'66), gynecologist, obstetrician, and medical contributor for
NBC's "Today Show." "Reporting from various studies
in the media can have a huge impact on the public's perception
and our quality of life. But it's essential that each patient
is treated uniquely and individually."
Faye
Wattleton and Gina Kolata |
What is clear
to professionals and patients alike is that women must "take
personal responsibility for their health," said Faye Wattleton,
president of The Center for the Advancement of Women, a research,
education, and advocacy organization created in 1995. "Especially
for those of us in the privileged class, we must remember it's
all of our responsibility, since so many don't have access to
care."
With over 45 million people lacking health insurance in the United
States, Beato said health literacy "is the key to empowering
women and eliminating health care disparities."
WOMEN
AND HEALTHCARE: A CRITICAL ANALYSIS
Access to Care and Information Are Stumbling Blocks in Women's
Health Progress
Byllye
Avery |
When Byllye
Avery took her children to the dentist for their regular check
up, she decided to ask him about a chronic toothache of her own.
The dentist suggested she should have the tooth pulled and Avery
found herself in the patient's chair. She left the office with
one less tooth, amazed at how quickly her dentist had acted.
But later when Avery, a teacher, told colleagues in their Gainesville,
Fla., school about the procedure, they wondered why the dentist
had not performed a root canal instead. That was normal protocol,
they said. But this was her children's dentist and Avery had trusted
him without questioning his hasty decision. The more she thought
about it, though, and discussed it with others, the more Avery
concluded that the dentist's action could only be interpreted
in one way: racism.
That was 1981. Avery went on to start the National Black Women's
Health Project, and recently joined other health care specialists
and advocates for a panel discussion at The Barnard Summit:
Women and Health to address such issues of discrimination
in healthcare, what progress has been made and the challenges
that remain.
ABC News 20/20
Correspondent Lynn Sherrr, moderator of one of the three panel
discussions, began by asking whether there still was a disparity
between health care for women and men.
Judy
Norsigian |
"Discrimination
is a tricky term," said Judy Norsigian, executive director
and co-founder of the Boston Women's Health Book Collective and
co-author of the groundbreaking book, Our Bodies, Ourselves.
"There is a
huge problem with the amount of information out there (about health
care) and a bigger problem of access to services. Women are often
discriminated against in terms of prevention alone."
Traditional research, for instance, has long targeted men rather
than women in helping shape medical opinion about both genders.
According to Dr. Isaac Schiff, professor of gynecology at Harvard
Medical School and chief of the Vincent Obstetrics and Gynecology
Service at Massachusetts General Hospital, studies in the 1960s
confirmed that estrogen did lead to heart disease for men while
women were frequently given medicines that included it.
"Women had to wait 35 years to have a study confirm for them
that estrogen increased their chances for heart disease,"
Schiff said, referring to the Women's Health Initiative study,
which examined the effects of estrogen and progestin on post-menopausal
women. The study was stopped in July 2002 because results showed
participants were at an increased risk for heart disease, stroke
and breast cancer.
Dr.
Vivian Pinn |
Because women
tend to be more dependent on a spouse or the public sector for
health care, insurance discrepancies have also created difficult
situations for women struggling to access appropriate care. Women's
mental health issues are being recognized as essential here and
throughout the world, according to Dr. Vivian Pinn, director of
the Office of Research on Women's Health at the National Institutes
of Health, and yet few insurance plans include it.
"If you're lucky enough to have health insurance, it's unlikely
it will cover mental health issues," said Elizabeth Wurtzel,
author of Prozac Nation: Young and Depressed in America.
What changes have occurred are largely because women have begun
to address them from within the system. Pinn believes that many
changes are the result of "grass root efforts that led to
changes in public policy requirements and laws," such as
the 1993 law that requires the inclusion of women and minorities
in medical studies. More women are entering the field and medical
schools are training doctors to spend more time with patients
in taking their histories seriously, said Ellen More, professor
of history and medical humanities at the Institute for the Medical
Humanities at the University of Texas Medical Branch.
Ellen
More |
"Input
from women has filtered up to making some crucial changes,"
More said. "Now the most important thing we can do is get
political again."
Avery also suggested that because more women have started to speak
out and organize regarding these issues, conditions and treatment
are improving. Before, she said, too many victims of abuse or
domestic violence "participated in a conspiracy of silence
because of their psychological distress. It's at least better
today because women have started helping themselves," Avery
said. "We need to keep at it, and develop a system that delivers
health care to all people, giving access to everyone regardless
of who they are or what their politics might be."
WOMEN
AND WORLD HEALTH: A MATTER OF SURVIVAL
Economic Issues Affect Women's Health Status Around the Globe
For countless women around the world, basic health care is a matter
of survival. Although gains have been made for women in Western
countries, those in developing countries still find themselves
trapped by poverty's far-reaching effects. If they cannot support
their families, many will turn to prostitution to earn money and
in the process risk their health through sexually transmitted
diseases. And if there is a medical clinic available to
them, most lack the fundamental resources to access them.
Dr.
Afaf I. Meleis, Dr. Helene Gayle, Dr. Nafis Sadik |
Unless radical
steps are taken to address such economic challenges, health care
advocates who gathered at The Barnard Summit were not optimistic
about women's health conditions throughout the world.
"It was difficult to bring women's health issues to the agenda,"
said Dr. Nafis Sadik, special advisor to the United Nations Secretary
General and special envoy for HIV/AIDS in Asia. "Family planning
now is at least legal in many countries and many are beginning
to discuss female mutilation and violence on women where neither
before was possible. But so many [developing] countries have yet
to address these issues."
Part of the
problem is the destructive impact of poverty and the economic
disparity between countries, according to economist Jeffrey Sachs,
special advisor to the United Nations Secretary General and director
of The Earth Institute at Columbia University. Sachs defined poverty
as "a lack of access to services" as well as the "absence
of life chances for millions of people," and said that today
alone, thousands of people will die simply because they are poor.
Jeffrey
Sachs |
"Getting
out of poverty is complicated and involves things like health
care development, linking economies, building roads, education,
etc. The world community wants to eliminate poverty by encouraging
rich countries to increase giving in helping the poorest of the
poor," Sachs said. "The U.S. government said we couldn't
afford it. Instead we're literally dropping $75 billion dollars
on Iraq. We're putting more into the war in Iraq than we are in
addressing the issues of disease and death."
Women are faced with difficult health risks as a result of poverty,
said Dr. Helene Gayle (Barnard '76), director of HIV, Tuberculosis
& Reproductive Health at the Bill & Melinda Gates Foundation.
"Poverty is a
fundamental issue which leads to other issues," said Gayle.
"Poor women get HIV because they enter the sex industry to
put food on the table. HIV is the new paradigm lens through which
to see how everything else affects them."
The solutions are clear and possible, experts said. Dr. Afaf Meleis,
dean of the School of Nursing at the University of Pennsylvania
and president of the International Council on Women's Health Issues,
suggested that as more women come into the workforce, positive
change could result in women's health progress. "But too
many have remained in low income, low status, low image positions.
The key will be to put our resources into developing women in
these developing countries, not just men," Meleis said
Carolyn
Hannon |
The key also
will be to look at what has worked and continue to support it,
said Soledad P'Brien, NBC co-anchor of "Today-Weekend Edition"
and moderator of the discussion. O'Brien asked panelists to emphasize
what has been working. In response, Carolyn Hannan, director of
the division for the advancement of women at the United Nations,
suggested it is important to deal with grass roots efforts, village
by village.
"We have to stop talking about 'the poor' and talk about
poor women and poor men," Hannan said. "We need to look
at the total picture. For instance, we're even starting to look
at what makes men [in these villages] violent in hopes of moving
men and women partnerships forward." Next year, Hannan said
the United Nations would discuss for the first time how men and
boys can become involved in progress toward equality of the sexes.
Gayle agreed that a critical element in addressing these issues
is to learn from those already in the field. "People in developing
countries have a lot to teach us on domestic issues," Gayle
said. "Involvement in communities overseas can teach us how
to be better involved here in our own communities. In a country
as rich as ours, there are far too many disparities that exist.
So the question becomes how can we be better global citizens in
responding to these issues?"
Summarizing the many questions and challenges involved in progress
on women's health issues around the globe, it is important to
take responsibility both on a personal basis and as advocates
and professionals, said Barnard President Judith Shapiro.
"We need to think more rationally about health risks and
the system and then make hard decisions about what's most important.
Prevention is a lot more cost effective," Shapiro said. "Health
care issues don't exist in
solitude; they are enmeshed in social, cultural, and political
spheres. That's why we must be informed citizens as well."
Your comments are welcome. To see video or transcripts from the
Summit, visit the Kaiser Family Foundation web site by clicking
here. For additional information, please contact: Suzanne
Trimel, Vice President for Public Affairs, Barnard College, strimel@barnard.edu
