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|WOMEN’S HEALTH ISSUES: AN OVERVIEW

**[Previous section]**

ACTIONS BY THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES (DHHS)

As part of its overall mission to promote and protect the Nation’s health and to
provide essential human services, DHHS is pursuing a comprehensive agenda to improve
women's health. Through its agencies and offices, and in coordination with other
governmental, national, and international organizations, DHHS is promoting the health of
women across the lifespan, empowering women to make informed choices about their health,
and translating policy decisions into effective women's health programs. DHHS funding for
women's health totaled just under $ 5 billion in FY 1999, an increase of more than $2
billion in just 5 years. These funds support health care services for women, the
development of innovative public and health care professional education programs,
intensified research, and other specific initiatives targeted to women.
OFFICE ON WOMEN’S HEALTHThe Office on Women’s Health (OWH), the focal point for women’s health within
the Department of Health and Human Services (DHHS), is pursuing a comprehensive agenda to
ensure that women’s health is a top national health priority. The OWH was established
in 1991 to improve the health of American women of all ages, races, and ethnicities by
advancing and coordinating a comprehensive women’s health agenda throughout the DHHS,
working with other Federal and public organizations, consumer groups, and associations of
health care professionals. The Office focuses on critical health issues affecting
women’s lives today and has implemented a number of important initiatives to improve
the health of women in the United States and internationally.
NEW RESEARCH STUDIESResearch on women’s health has increased substantially since the beginning of the
1990s. Basic, clinical, epidemiological, and health services research supported by the
National Institutes of Health (NIH), the Agency for Health Care Policy and Research
(AHCPR), and the Centers for Disease Control and Prevention (CDC) is focusing on the
causes, treatment, and prevention of a broad spectrum of diseases and health concerns
affecting women across the lifespan, including heart disease, breast and ovarian cancers,
mental and addictive disorders, osteoporosis, autoimmune disorders, gynecologic disorders,
and AIDS. Major longitudinal studies are under way to examine adolescent and mid-life
behaviors and their effect on future health, disease, and disability.Ensuring Inclusion of Women in Clinical Trials. New policies
    ensure that women and minorities are included as subjects in government-supported research
    and in evaluation of drugs and medical devices.
  The National Longitudinal Study on Adolescent Health, based on a
    survey of 90,000 students in grades 7 through 12 across the country, is sponsored by the
    National Institute of Child Health and Human Development. A recent analysis of interview
    data found that family and school contexts as well as individual characteristics were
    associated with health and risky behaviors (such as the use of alcohol and drugs and early
    sexual activity). Study findings will be analyzed over the next decade.
  Health of Mid-Life Women. The National Institute on Aging is
    sponsoring the Study of Women's Health Across the Nation (SWAN), a large-scale study to
    examine the health of women in their forties and fifties and its impact on health in later
    life. SWAN focuses on the physical, psychological, and social changes that take place at
    mid-life and on the later effect on health, looking at such factors as body composition,
    bone density, cardiovascular function, sexuality, menstrual patterns, diet, physical
    activity, stress, social support, use of health care services, relationships with families
    and friends, and other information related to health, function, and overall well-being.
  The NIH Women's Health Initiative. The Women's Health Initiative
    is investigating the risk factors for major diseases, death, and disability among older
    women—heart disease, cancer, Alzheimer's disease, and osteoporosis. This multi-year
    study, carried out in more than 40 centers across the country, is the largest
    prevention-oriented clinical trial in U.S. history. It attempts to redress the inequities
    that have existed in research on older women and seeks to provide practical information to
    older women and their physicians about the effectiveness of hormone replacement therapy
    and behavioral interventions, including diet and exercise. The three major components of
    the Women's Health Initiative are a randomized, controlled clinical trial approach to
    prevention, an observational study to identify predictors of disease, and a study of
    community approaches to developing healthful behaviors. The latter component is being
    conducted in collaboration with the Centers for Disease Control and Prevention.IMPROVEMENTS IN EARLY DETECTION OF DISEASES

Identification of Genes for Diseases. Researchers supported by the
    NIH have identified genes that may increase susceptibility to diseases including breast,
    ovarian, and colon cancer and Alzheimer’s disease. The isolation of these genes may
    lead to new treatment and prevention strategies.
  New Imaging Technologies. Imaging technologies from the defense,
    space, and intelligence communities are being adapted to detect breast cancer and other
    disease in women earlier and with greater accuracy. This project was launched by the
    DHHS’ Office on Women’s Health to foster innovative partnerships with other
    Federal agencies, including the National Aeronautics and Space Administration, the
    Department of Defense, the Central Intelligence Agency, and the National Cancer Institute,
    as well as private sector organizations. Novel imaging techniques including MRI, PET, and
    ultrasound are being tested as improved methods to detect and diagnose disease in women.
  Tumor Markers. The National Cancer Institute is conducting a
    large-scale study which includes evaluating whether a test to detect CA 125 (a protein
    whose levels may rise in women with ovarian cancer) will reduce the number of deaths from
    ovarian cancer among women ages 55 to 74.HEALTH CARE SERVICE DELIVERYA priority for DHHS is to ensure the availability of health care services for women.
The Department has established a variety of initiatives to improve the delivery of health
care services to women including the following:Nationwide Breast and Cervical Cancer Screening. The Centers for
    Disease Control and Prevention (CDC) National Breast and Cervical Cancer Early Detection
    Program (NBCCEDP) provides free or low-cost mammograms and Pap tests to women with
    low-incomes and women of racial and ethnic minority groups in all 50 States, 6 U.S.
    territories, the District of Columbia, and 12 American Indian/ Alaska Native
    Organizations. Women can locate screening services in their area by calling
    1-888-842-6355.
  Preventing Sexually Transmitted Diseases and Infertility. DHHS
    supports implementation of the National Infertility Prevention Program to prevent and
    treat STDs, particularly chlamydia. This program is a collaborative effort between the
    Centers for Disease Control and Prevention and the PHS Office of Population Affairs and
    involves partnerships among family planning, STD, and primary health care programs.
  The Mammography Quality Standards Act. In October 1994, the Food
    and Drug Administration (FDA) implemented a certification and inspection program for
    mammography facilities in the United States to ensure that they meet high-quality
    standards for equipment, personnel, record-keeping, and quality control. Women can find a
    certified mammography facility by calling 1-800-4-CANCER.
  Promoting Mammography Use by Older Women. In May 1995, First Lady
    Hillary Rodham Clinton joined DHHS in a campaign to educate women older than age 65 that
    mammography saves lives and to encourage them to use their Medicare mammography benefit.
  Community Health Centers. Through the Health Resources and
    Services Administration (HRSA), health centers that serve the poor and uninsured, migrant
    workers, homeless people, and residents of public housing are available.
  Indian Health Service. The Indian Health Service (IHS) provides
    health care services and assistance to Native American and Alaska Native Women. IHS
    addresses reproductive health, cancer, diabetes, maternal-infant health, substance abuse,
    child/sexual abuse, family violence, behavioral health issues, and teenage pregnancy. Pap
    smear registries (including a tracking system) and screening mammography services have
    been made available in all IHS areas.
  Ryan White CARE Act. HRSA provides comprehensive health care and
    support services for women living with HIV/AIDS through the authority of the Ryan White
    CARE Act.
  Counseling Pregnant Women To Prevent HIV Transmission. Physicians
    are being urged to counsel all pregnant women on the benefit of HIV testing to prevent
    transmission of HIV to their infants. The Centers for Disease Control and Prevention has
    produced new guidelines and educational material for women and health care providers in
    response to evidence that treating HIV-positive pregnant women with the drug AZT will
    reduce the risk of transmitting the disease to their infants from 25 percent to 8 percent.
  Enhanced Alcohol, Drug Abuse, and Mental Health Services. The
    Substance Abuse and Mental Health Services Administration (SAMHSA) supports demonstration
    programs for substance abuse prevention among adolescent women and women with dependent
    children. In FY 1996, SAMHSA directed about $127 million to women's substance abuse and
    mental health activities.PUBLIC AND HEALTH CARE PROFESSIONAL EDUCATION

New educational initiatives are under way to enhance women’s knowledge of health
issues and to improve the care women receive by ensuring that health care professionals
have up-to-date information and training on women's health issues. The following
educational programs/initiatives have been instituted:National Women's Health Information Center. This comprehensive
    information resource center was established by the Office on Women’s Health (OWH) to
    provide the public, health care professionals, and researchers with a single point of
    entry to state-of-the-art Federal and private sector information about women's health via
    a toll-free telephone number (1-900-994-9662 — TDD 1-888-220-5446) and on the
    Internet (www.4woman.gov).
  Domestic Violence Hotline. A federally supported, nationwide,
    24-hour domestic violence hotline (1-800-799-SAFE; 1-800-787-3224, TDD line for hearing
    impaired) is providing immediate crisis information and assistance, counseling, and local
    shelter referrals to women across the country.
  Mental Health and Substance Abuse Resource Center. The Substance
    Abuse and Mental Health Services Administration's National Women's Resource Center
    provides information and referral services (1-800-354-8824) addressing the prevention and
    treatment of both mental illness and substance abuse. This Center also provides knowledge
    development and information dissemination services on women's substance abuse prevention
    and treatment as well as mental health services issues throughout the life cycle.
  Cancer Information Service (CIS). The CIS toll-free number,
    1-800-4-CANCER, provides rapid access to the latest information on cancer for the general
    public, patients/family members, and health professionals in both English and Spanish.
    This free and confidential service provides information on cancer prevention,
    detection/diagnosis, causes and risk factors, state-of-the-art treatment, and cancer
    research. The CIS also provides referral to clinical trials and to community resources and
    services, free publications, and professional consultation for nurses, nutritionists, and
    physicians.
  Health Education for Mid-Life and Older Women. The Food and Drug
    Administration’s new Take Time to Care program is encouraging women to use medicine
    wisely. The program is designed to reach women ages 45 and older, particularly those who
    are medically underserved. The program is a collaboration among Government agencies,
    national health and consumer organizations, women's groups, and health care providers and
    health institutions. **FDA:** 1-800-532-4440 www.fda.gov
  Mental Health Education Campaigns. The National Institute of
    Mental Health (NIMH) runs three major educational programs and information resource
    services: the Depression Awareness, Recognition, and Treatment Program (1-800-421-4211),
    the Anxiety Disorders Education Program (1-888-8-ANXIETY), and the Panic Disorder
    Education Program (1-800-64-PANIC). These programs provide information to the public and
    health care professionals about symptoms and treatment of these diseases as well as
    referrals to other organizations for further information.
  HIV/AIDS Information Clearinghouses. Educational campaigns
    spearheaded by DHHS are under way to inform health care professionals and counsel pregnant
    women about HIV testing and treatments to reduce the rate of HIV transmission from mother
    to child. Free information is available through the HIV/AIDS Treatment Information Service
    by calling toll-free 1-800-448-0440 or 1-800-243-7012 (TTY for the hearing impaired).
    Other DHHS information services on HIV/AIDS are the CDC's National AIDS Clearinghouse
    (1-800-458-5231) and the AIDS Clinical Trials Information Service (1-800-874-2572).
  Office of Minority Health Resource Center (OMH-RC). The OMH-RC
    (1-800-444-6472) serves as a national resource and referral service on minority health
    issues. It collects and distributes information on health topics including substance
    abuse, cancer, heart disease, violence, diabetes, HIV/AIDS, and infant mortality. Other
    resources include customized database searches, mailing lists, referrals, and specific
    information on health issues affecting Native American and Alaska Native, African
    American, Asian American and Pacific Islander, and Hispanic populations.
  HealthFinder. In April 1997, DHHS launched HealthFinder, a
    gateway Web site to help consumers find health and human services information.
    HealthFinder (www.healthfinder.gov) leads users to selected online publications,
    clearinghouses, databases, Web sites, and support and self-help groups, as well as the
    Government agencies and not-for-profit organizations that produce reliable information for
    the public.
  HRSA in partnership with the Chronic Fatigue and Immune
    Dysfunction Syndrome Association of America is educating health professions students and
    health workers through the Area Health Education Centers Programs about CFIDS and
    management of this chronic illness.
  Medical School Education. Recommendations for a model medical
    school curriculum on women's health issues has been developed and widely disseminated by
    the Health Resources and Services Administration (HRSA), the National Institutes of Health
    (NIH), and the Office on Women's Health (OWH) in collaboration with private sector
    organizations. Recommendations were also published to encourage dental schools to continue
    incorporating women’s health issues into their curriculum as part of a study and
    report by the NIH Office of Research on Women’s health and HRSA with the American
    Association of Dental Schools. The OWH has also prepared and widely disseminated a
    first-of-its-kind directory of women’s health residency and fellowship opportunities
    in medicine. 
    A comprehensive national mentoring program is needed to encourage women's careers in the
    medical professions and scientific careers. The OWH is exploring the establishment of such
    a mentoring program to address women's needs at all stages of their academic and
    professional careers.
    HRSA: 301-443-2086www.hrsa.gov
    NIH: 301-496-4461www.nih.gov
    OWH: 202-690-7650www.4woman.govCROSS-CUTTING WOMEN’S HEALTH INITIATIVES

National Centers of Excellence in Women's Health. The Office on
    Women’s Health (OWH) supports CoEs in academic health centers across the U.S. and
    Puerto Rico. They combine the latest advances in women’s health research and teaching
    with community outreach and clinical service delivery to promote new standards of
    excellence in women’s health. The CoEs also promote the career advancement of women,
    including minority women in the health sciences. An important focus of the CoE program is
    to address racial and ethnic disparities in women’s health.
    OWH: 1-800- 994-WOMANwww.womenshealth.gov/owh/coe
  The National Action Plan on Breast Cancer. In October 1993,
    President Clinton directed the establishment of a National Action Plan on Breast Cancer
    (NAPBC)—an innovative public-private partnership that is coordinating a national
    strategy to catalyze new action in research, service delivery, and education about this
    disease. The NAPBC is focusing on six priority action areas:
    (1) facilitating communication among scientists, consumers, and health care professionals
    and enhancing information dissemination; (2) establishing national biological resource
    banks to enhance research capacity; (3) ensuring consumer involvement in the development
    of health programs and research relating to breast cancer; (4) increasing knowledge
    about the causes of breast cancer, especially environmental factors; (5) broadening the
    opportunities for women to participate in breast cancer clinical trials; and (6)
    implementing a comprehensive plan to address the health needs and ethical, legal, and
    policy issues related to breast cancer susceptibility genes. 
    NAPBC: 202-401-9587www.4woman.gov/napbc
  Federal Interagency Breast Cancer Coordinating Committee. This
    committee mobilizes all departments of the Federal Government in the fight against breast
    cancer by sharing information and fostering collaborations on breast cancer across
    government agencies.
  Reducing Teen Pregnancy. A National Campaign to Reduce Teen
    Pregnancy involves a group of prominent Americans to bring the message to youth across the
    Nation. DHHS efforts to reduce teen pregnancy include abstinence-focused demonstration
    programs as well as support for community-wide coalitions to test innovative approaches.
    DHHS has published a community guidebook: *Preventing Teen Pregnancy: Promoting
    Promising Strategies.*
  Microbicide Initiative. This DHHS effort, which includes a $100
    million commitment for research and development, is focused on developing safe and
    effective topical microbicides to help women protect themselves against HIV infection.
  Initiative on Older Women. Launched in 1994 by the Administration on
    Aging, this initiative is creating partnerships designed to address the needs of older
    women and women's capacity to contribute significantly to society throughout their lives.
  Minority Women's Health. In 1994, DHHS cosponsored the first
    National Minority Women's Conference on the Status of Health and, in collaboration with
    the Indian Health Service, convened a National American Indian and Alaska Native
    Conference on the Status of Women's Health. Health education projects for women of color
    have also been sponsored in several regions. In 1997, the Office on Women’s Health
    convened a national minority women's health conference, *Bridging the Gap: Enhancing
    Partnerships to Improve Minority Women's Health*, to focus attention on special health
    issues affecting women of color and to develop partnerships to improve the health of
    minority women. A national panel of experts was established to implement an action plan
    that advances the conference's recommendations to improve minority women's health.
  Prevention of Adolescent Smoking. A Presidential initiative is under
    way to end the epidemic of adolescent smoking by limiting access and the appeal of tobacco
    products to young people. Smoking prevention campaigns featuring influential role models
    including the U.S. Women's National Soccer Team, emerging rock singer Leslie Nuchow, and
    fashion super model Christy Turlington target messages specifically to young women. The
    OWH has also developed smoking prevention initiatives with the Girl Scouts, including a
    merit badge program and educational materials.
  Young Women's Health Promotion. DHHS is implementing a major
    strategy, Safe Passages, to promote a healthy and productive transition from childhood to
    adulthood for the Nation's 12 million girls between the ages of 9 and 14. SAMHSA has
    developed "Girl Power," a public information campaign to help reduce and delay
    the onset of drug use among girls ages 9 to 14. In addition, a public/private partnership
    is educating the public and health care professionals about eating disorders. "Get
    Real: Straight Talk on Young Women’s Health," a video educational kit targeting
    young women between the ages of 18 and 22, has been developed and widely distributed. A
    roundtable series on healthy behaviors utilizing this kit has been launched on college
    campuses nationwide.
    SAMHSA
    Public Affairs: 301-443-8956www.samhsa.gov
  Violence Against Women. New programs dedicated to fighting violence
    against women are being implemented. Joint DHHS-Department of Justice initiatives include
    establishing a National Advisory Council on Domestic Violence to develop strategies for
    eradicating this public health problem. Increased funding has been provided to support
    research, develop intervention and prevention programs, and train health care
    professionals. A domestic violence hotline, 1-800-799-SAFE, has been established to refer
    people to community resources and services.
  Elder Abuse Prevention. The Administration on Aging (AoA) and the
    Administration on Children and Families (ACF) are funding a 3-year study of the national
    incidence of elder abuse. The Centers for Disease Control and Prevention (CDC) is
    providing funding to improve data collection, identify effective prevention strategies,
    and explore new ways to increase public awareness.
    AoA: 202-619-0724www.aoa.dhhs.gov 
    ACF: 202-401-9215www.acf.dhhs.gov 
    CDC: 1-800-311-3435www.cdc.gov
  Reproductive Health Initiatives. DHHS initiatives include efforts to
    develop new and more effective means of contraception, prevent teen pregnancy, examine the
    causes of infertility, develop effective treatments, and evaluate alternative
    interventions for hysterectomy for noncancerous uterine conditions such as endometriosis
    and fibroids. DHHS also supports a $100 million prevention initiative for the development
    of safe and effective microbicides to help women protect themselves against HIV infection.
    DHHS: 202-690-7850
  Family Planning. DHHS supports the provision of reproductive health
    and family planning services through the Title X program. Each year, some 5 million
    persons receive Title X-supported services. Total Title X funding in FY 1996 was $192
    million, an increase of about $40 million since 1992.
    OPA: 301-594-4001www.dhhs.gov
  Women's Health and the Environment. The Office on Women’s
    Health (OWH) has established the Federal Coordinating Committee on the Environment and
    Women's Health, which is focusing attention on how occupational, home-based, atmospheric,
    and other environmental exposures affect women's health and developing a national strategy
    to identify these preventable health hazards and eliminate them from the lives of American
    women.
    PHS OWH: 202-690-7650www.4woman.gov/owh
  Integration of Prevention Services Into Reproductive Health Services. CDC
    is supporting a national effort to develop improved training strategies for service
    providers in the delivery of integrated reproductive health and HIV prevention services.
    Regional Training Centers, one in each of the 10 DHHS regions, develop, conduct, and
    evaluate theory based training and other service integration interventions to reproductive
    health services providers in a variety of settings, including Tittle X family planning
    clinics, primary care clinic, community-based organizations, managed care organizations
    and State and local health departments
    CDC: 770-488-5227www.cdc.gov/nccdphp/drh**[Next Section] [Endnotes]**


May 2000
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