Women's Health: 30 Years of Progress in the U.S. Department of Health and Human Services

In 1983, the Assistant Secretary for Health at the U.S. Department of Health and Human Services (HHS) convened the first-ever U.S. Public Health Service Task Force on Women's Health Issues to identify important women's health issues and develop a blueprint for enmeshing those issues with the priorities of the U.S. Public Health Service (PHS). The landmark Report of the Public Health Service Task Force on Women's Health Issues,¹ published in Public Health Reports in 1985, outlined recommendations to accomplish this goal. One recommendation supported the creation of a standing committee comprising HHS agency representatives who would report regularly to the PHS and HHS leadership. To fulfill this recommendation, HHS established the Coordinating Committee on Women's Health (CCWH) in 1984 to advise the Assistant Secretary for Health on activities to safeguard and improve the physical and mental health of women in the United States. This deliberate focus on women's health, which continues today, has led to substantial advances in the field.² This commentary highlights the work done by HHS agencies and offices, through collaborations and partnerships, to address the categorized recommendations of the 30-year-old report:

• Promote a safe and healthful physical and social environment

• Provide services for the prevention and treatment of disease

• Conduct research and evaluation

• Recruit and train health-care personnel

• Educate and inform the public and disseminate research information

• Design guidance for legislative and regulatory measures

PROMOTE A SAFE AND HEALTHFUL PHYSICAL AND SOCIAL ENVIRONMENT

HHS remains committed to addressing the impact of various environmental factors on health³ and has developed programs, reports, and campaigns to increase public awareness of environmental and behavioral health influences on women's health. In the realm of the social environment, for example, HHS has funded emergency shelters and supportive services for victims of domestic violence and their children.⁴ Programs such as the National Domestic Violence Hotline, tribal domestic violence programs, state domestic violence coalitions, and the National Health Resource Center on Domestic Violence have helped coordinate community responses to intimate partner violence.⁵ HHS has also provided comprehensive substance abuse treatment programs for women and their infants,⁶ addressed the needs of pregnant and nursing women following disasters,⁷ and helped boost awareness about workplace health challenges facing women.⁸ In addition, HHS has published reports and guidance on the health consequences of smoking in women^9,10 and harmful exposures for pregnant and lactating women.^11,12

PROVIDE SERVICES FOR THE PREVENTION AND TREATMENT OF DISEASE

During the past 30 years, federal policies, initiatives, and research have supported chronic disease prevention and better access to health care for women. For example, transmission of human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) from mother to child has been reduced by recommended routine screening,¹³ the use of antiretroviral drugs approved by the Food and Drug Administration (FDA), and other efforts.¹⁴ Policies such as Part D of the Ryan White HIV/AIDS program,¹⁵ and support of HIV testing and linkage to care in Title X family planning centers through the Secretary's Minority AIDS Initiative Fund,¹⁶ have helped create better systems for HIV/AIDS disease management. Similarly, the National Action Plan on Breast Cancer and the National Breast and Cervical Cancer Early Detection Program have provided comprehensive strategies to address breast cancer. FDA approvals of the first chemopreventive product for treating pre- and post-menopausal women at high risk for breast cancer,¹⁷ and other products for conditions that disproportionately affect women (e.g., osteoporosis and depression),^18,19 have also helped women prevent or manage disease.

HHS funding for women's health services at Federally Qualified Health Centers, Title X family planning clinics, public health departments, tribal health facilities, community-based organizations, and other organizations have benefited women of all ages and races/ethnicities, those with disabilities, and women who would not otherwise receive health care. Additionally, the Affordable Care Act has increased access to health care for millions of women who previously would have forgone health care due to cost.²⁰ To help prevent disease, the law requires most health plans to cover, without cost sharing, 22 preventive services recommended specifically for women.^21,22

CONDUCT RESEARCH AND EVALUATION

Since 1984, more investigations have been conducted on conditions and diseases that are unique to, or more prevalent in, women of all age groups and cultural conditions than ever before. These investigations, for example, have furthered our understanding of why hip implants fail more often in women²³ and how drugs might interact to produce a life-threatening arrhythmia to which women are particularly prone.²⁴ As another example, the National Institutes of Health (NIH) Women's Health Initiative, a 15-year national study, has assessed the health benefits and risks of hormone therapy, dietary patterns, and calcium/vitamin D supplements on the prevention of heart disease, cancer, and osteoporosis in postmenopausal women aged 50–79 years.²⁵

Research has also led to the development and implementation of guidelines for the inclusion of women and minorities in clinical research.^26,27 Drug, device, and biologic manufacturers provide analyses of effectiveness and safety data for women and other demographic subgroups.²⁸ The NIH is now formulating policies that will support further exploration of sex differences for experimental design and analysis, both in vitro and in animals.²⁶

RECRUIT AND TRAIN HEALTH-CARE PERSONNEL

HHS collaborations have established programs to better integrate knowledge of sex and gender differences into research and practice.²⁹ Mentored career development programs have increased the number of investigators pursuing research on women's health and sex differences.^30–33 The number of female applicants to research programs almost doubled from 1990 to 2006.³⁴ Awards of research grants to women by the NIH also increased steadily from 1998 to 2013.³⁵ In addition, HHS has made concentrated efforts to promote the science of women's health and sex-based differences in health professions' curricula.^36–38

EDUCATE AND INFORM THE PUBLIC AND DISSEMINATE RESEARCH INFORMATION

In 1998, HHS launched the National Women's Health Information Center (www.womenshealth.gov) to provide reliable, accurate, commercial-free information on the health of women. In 2000, HHS launched National Women's Health Week,³⁹ an annual observance to empower women to make their own health a priority. In 2003, HHS launched National Women's Check-up Day,⁴⁰ an observance that encourages women to schedule routine well-woman visits. As a result of the Affordable Care Act, these visits are now covered for many women without cost sharing.^41,42 HHS also led the development of National Women and Girls HIV/AIDS Awareness Day,⁴³ Domestic Violence Awareness Month,⁴⁴ and Teen Dating Violence Awareness Month.⁴⁵ In addition, agencies have developed evidence-based guides^46–51 and health promotion campaigns^52–55 to encourage women's health across the lifespan. Many of these initiatives have been in partnership with private organizations.

DESIGN GUIDANCE FOR LEGISLATIVE AND REGULATORY MEASURES

In the time since the release of the 1985 report, organizations devoted to women's health have advocated for policies to improve healthful conditions for women and elevate the importance of women's health. As a result of these efforts, several laws have been enacted that give HHS authority to develop programs, guidance, and regulations in critical areas. For example, the 1992 Mammography Quality Standards Act required that HHS establish national standards for mammography.⁵⁶ The Violence Against Women Act, first signed in 1984 and reauthorized in 2013,⁵⁷ increased public awareness of domestic violence. After the Act made reducing violence against women a federal priority,⁵⁸ fewer women and children have experienced intimate partner violence.⁵⁹ Also, passage of the Affordable Care Act prohibited insurance companies from charging women more than men for the same health coverage, included preventive services for women, and legislated Offices on Women's Health across HHS in Section 3509 of the law.⁶⁰

IMPLICATIONS

As noted in the 1985 report,¹ all levels of government, public and private sectors, community and faith groups, businesses, families, and women themselves must participate to help achieve the best results for women's health. Notable progress has been made through HHS initiatives and funding and through the work of the CCWH. Improvements in diagnosis, treatment, care, support, prevention, and inclusion in research for women have set the stage for even greater advances. The ultimate goal is a nation in which major preventable causes of morbidity and mortality in women are no longer a threat, and cost-effective, evidence-based, quality care and health equity are a reality for all women.