To improve health nationally, focus on women

A healthy society depends on healthy women. That’s the message delivered in a new position paper by the American College of Physicians in the Annals of Internal Medicine.

While women live longer than men, they are significantly more likely to suffer from a chronic condition (38 percent vs 30 percent), write authors Hillary Daniel, Shari Erickson and Dr. Sue Bornstein. They are also more likely to have insurance as a dependent, making them more vulnerable to losing coverage as the result of divorce or the death of a spouse. Women are also more likely to delay or forgo preventative care due to cost.

Despite all of this, women also make up the majority of primary caregivers (75 percent, according to the paper) to the nations’ young and old populations. Not only does this role contribute to a higher risk for poor physical or emotional health, it means caregiver’s health can have a significant impact on the patient’s health.

The authors also shine a spotlight on reproductive care, which is hard for women to access for a number of reasons, including cost, geography and policies pushed by Republican lawmakers at the federal and state level aimed at making it as hard as possible to operate an abortion clinic.

The paper includes seven recommendations for improving care for women.

Three of the recommendations were largely directed at the medical community. They called on internists in all fields to receive more training in medical issues “of particular relevance” to women, such as gynecology, as well as to improve screening for victims of sexual violence or domestic abuse. It also calls on the inclusion of more women in clinical trials and for greater research into medical issues specific to women.

The rest of the recommendations centered on public policy, notably the polarizing debate surrounding abortion and access to reproductive health care.

The authors urged federal and state lawmakers to oppose any attempts to allow insurers to charge women higher premiums for health insurance, as was often the case before the Affordable Care Act.

In addition to opposing any legislation to “erode or abrogate a woman’s right to continue or discontinue a pregnancy,” the authors noted their opposition to regulations that impose “medically unnecessary restrictions” on abortion providers.

In a number of states, Republican lawmakers have put in place rules that they say are aimed at enhancing safety but that the medical community has rejected as unnecessary. In 2016, the Supreme Court struck down a Texas law that required abortion doctors to have hospital admitting privileges and that abortion clinics be held to the same standards as ambulatory surgical centers.

Finally, the authors urge policymakers to establish universal paid family leave, suggesting a minimum of six paid weeks. They nevertheless acknowledged some of the challenges such a policy might bring to small businesses.

“ACP recognizes that universal access to at least 6 weeks of paid family leave may bring unique challenges for smaller employers, including private physician practices and nonprofit organizations,” they wrote. “Therefore, legislation to expand paid leave should consider potential burdens on employers while upholding the intent of the programs through dedicated funding, necessary accommodation, and assistance to help small businesses transition to a minimum of 6 weeks of paid leave.”