Both my mother and my grandmother died of sudden heart attacks. Heart disease is the No. 1 killer of women. For too many years, research and public policy have neglected the woman's voice and story in health.
Until recently, women's health issues were largely ignored. Ignored, even though women are the predominant users of health services in the United States, arranging for their own health-care needs as well as those of their families. Ignored, even though women have assumed an essential role in building a healthy world.
With persistence and vigilance, we now see major changes in women's health research and practice. Psychology played a major role in these advances. For decades, sex and gender differences in the prevention, diagnosis and treatment of disease were overlooked or considered irrelevant. Women were viewed primarily in relation to their reproductive functions, and for the most part, were excluded from clinical research. After much advocacy work by APA, women's health advocates, women's health organizations, researchers and other professional associations, the National Institutes of Health (NIH) in 1985 established a policy mandating the inclusion of women in clinical research. And in 1990, NIH established the Office of Research on Women's Health. The U.S. Department of Health and Human Services established its own Office on Women's Health the following year. These offices and the other women's health offices in major federal agencies have been instrumental in increasing research funding for and awareness of critical issues in women's health.
Research and practice implications
Research on women has revealed some important information with great implications for women's health. For instance:
Cardiovascular disease is the leading cause of death of American women. While men are experiencing a decline in deaths due to cardiovascular disease, the number of cardiovascular disease deaths in women is increasing. In addition, women have a worse prognosis for survival one year after a heart attack. Research has shown that psychosocial and behavioral interventions reduce morbidity and mortality in patients with coronary heart disease.
The incidence of lung cancer in women as a whole has climbed at an alarming rate, and this increase is clearly attributable to the increase in the number of women who have smoked. Quitting smoking is the single most important health behavior a woman can undertake to reduce her chances of premature mortality. However, women appear to be less successful at quitting smoking than men. Psychologists have been at the forefront of developing successful smoking cessation interventions for women.
Unipolar major depression is the leading cause of disability in the world measured in years lived with a disability. Women are twice as likely to suffer from depression as men. Depression has been associated with higher medical costs, greater disability, poor adherence to medical regimes and increased morbidity and mortality from medical illness. Last year's White House Conference on Mental Health and Surgeon General David Satcher's reports on Mental Health did much to draw attention to the importance of depression and other mental health issues.
Psychology researchers and practitioners increasingly look at the interaction of variables such as gender, culture and sexual orientation upon health and the burden of disease. At APA's 2001 Annual Convention, I was honored to introduce Dr. Satcher as he released his report on the impact of culture on health. Last fall, APA also convened a Summit on Women and Depression, the findings of which should further increase our knowledge of depression etiology, treatment and services.
Violence is a major cause of distress, injury and even death for women worldwide. This July, while attending the Interamerican Society of Psychology XXVIII Congress in Chile, I heard repeatedly of the impact violence and eating disorders have on the health of girls and women. In addition to depression, substance abuse and anxiety, women who have been sexually or physically abused tend to have a range of physical problems and to visit physicians more frequently than nonabused women. Psychologists have been involved in research on violence and post-traumatic stress as well as treating survivors of violence.
APA Conference on Women's Health
As APA members, you are part of the expanding knowledge on women's health and part of the increased delivery of psychological services for women. Chronic illness, mental illness and social behavioral causes of illness are all topics to be covered during APA's Conference on Women's Health Oct. 4-6. This conference will showcase the nation's leading researchers and practitioners as it examines ways to enhance women's health by translating research into practice.
We can all be proud of this and other efforts to change the outcomes in women's health.