| Moving Into the Future: New
Dimensions and Strategies for Women’s Health Research for the National
Institutes of Health
Written Statement from the American Psychological Association
(APA) and the APA Committee on Women in Psychology
Office of Research on Women’s Health/NIH/DHHS, Northwestern
University, Feinberg School of Medicine, and Northwestern Memorial Hospital
- October 14-16, 2009
On behalf of the 150,000 members and affiliates of the American Psychological
Association (APA), we thank you for holding this important series of hearings
to discuss ways to update the research agenda of the Office of Research on Women’s
Health (ORWH).
APA is the largest scientific and professional organization representing psychology
in the United States and is the world's largest association of psychologists.
Comprised of researchers, educators, clinicians, consultants, and graduate students,
APA works to advance psychology as a science, a profession, and a means of promoting
health, education and human welfare.
APA acknowledges the important role of ORWH and its founding director in spurring
interest in women’s health research. It is of paramount importance to
promote women’s health. Through the years, advocates have focused on many
critical issues in women’s health, including access to health care, health
promotion across the lifespan, violence against women, gender-based research,
and mental health. In addition, advocates and researchers have recognized that
due to health inequities, women across various racial and ethnic groups, lesbian,
bisexual, and transgender women, women with disabilities, and low-income women
are bearing a disproportionate burden of disease; therefore, special attention
is warranted for these populations.
APA views ORWH as a valued partner and applauds the behavioral research that
ORWH has funded or co-funded since its inception. Themes given emphasis in the
Office’s Fiscal Year 2009 priorities strike a resounding chord. APA particularly
applauds the lifespan perspective and emphasis on quality of life.
Women have traditionally experienced lower earning power than men, with a current
gender gap of 23 percent. This has resulted in a disproportionate number of
women who are economically disadvantaged. Access to care is a key factor contributing
to poorer health outcomes in economically disadvantaged individuals. Therefore,
research that contributes to public policy changes by eliminating barriers to
care in women with low socioeconomic status will have a significant impact in
terms of facilitating health promotion in all women.
Health promotion for women includes attention to the entire spectrum of a woman's
life. During early childhood, health depends on proper nutrition and physical
activity, immunizations, and the prevention of conditions including osteoporosis
and skin cancer. As girls move into the teen years and early adulthood, awareness,
prevention and treatment for sexually transmitted infections (STIs), HIV/AIDS,
tobacco use, substance abuse, and violence become a concern.
Women's health needs change upon entering mid-life. The management of cardiovascular
and other chronic diseases is essential, as is screening for and knowledge about
cancer, diabetes and a number of other important health conditions. Throughout
a woman's lifespan, mental health services greatly affect her overall health,
as well as access to prescription drugs, long-term care facilities, and community-based
care services during the later years of womanhood.
We strongly support efforts made to educate women to be partners in their health
and wellness, holistically defined to include wellness in emotional, social,
environmental, physical, intellectual and spiritual realms.
Violence against women has become a global social epidemic that demands our
attention through research and intervention. There is a growing body of evidence
that indicates that gender-based violence is a risk factor for multiple physical,
mental, reproductive and psychosomatic disorders affecting women. Physical consequences
include homicide, serious injuries, injuries during pregnancy, and vulnerability
to disease. The psychological consequences are grave, ranging from suicide,
depression, anxiety, posttraumatic stress disorder, eating disorders, and chemical
dependency.
Additionally, the costs to society are significant. Direct costs include those
incurred by police, courts and legal services to prosecute perpetrators, the
costs of treating offenders, the medical and mental health care costs of treating
sexually and physically abused women, social service costs, including child
protection services, and the loss of productivity and employment by abused women.
To address this, APA recommends that ORWH partner with other institutes and
centers, including the National Institute of Mental Health (NIMH), the National
Institute on Aging, the National Institute of Child Health and Human Development
(NICHD) and the National Institute of Nursing Research, to help prevent and
eliminate violence against women, and address the ongoing patriarchal systems
that institutionalize women’s diminished worth.
The recognition that women’s health outcomes vary according to race and
ethnicity has brought with it an increased effort on the part of the National
Institutes of Health (NIH) to address these inequities. We applaud these efforts
and would like to see these sustained and expanded. We especially encourage
additional grant mechanisms to support research at the community level with
marginalized populations, including the use of novel, community-based, non-mainstream
methodologies. We also support research studies focused on the cultural and
conceptual aspects of health literacy, and how these aspects are related to
health promotion and health outcomes in women.
This research is certainly relevant to health care reform discussions and to
women who tend to make health care decisions for their families. We recognize
that at the NIH, the number of studies examining health literacy and health
disparities vary widely by Institute, and we encourage greater attention to
mental health disparities, especially in marginalized and medically underserved
populations.
We also acknowledge that there has been a dearth of studies conducted with
populations who have diverse sexual orientations. The lack of funding for large-scale
studies with this population has significantly hampered efforts to promote the
health of lesbian, bisexual, and transgender women. Other populations traditionally
neglected in research that should be a focus in future studies include American
Indian women and immigrant populations (e.g., Asian and Pacific Islander (API)
and Latino populations). A greater focus on API and the Latina population is
consistent with demographic projections of a dramatic population growth for
both populations, particularly at certain age ranges..
Gender-based research is also critical to the promotion of women’s health.
There are women who may react differently than men to certain medications, yet
often medications are tested on men. Women may also be more vulnerable to certain
diseases and have different symptoms from men, and may respond differently to
various diagnostic procedures. A focus on inclusion of women in clinical trials
and on research to understand how biological differences affect health outcomes
is warranted. ORWH is encouraged to participate in research designed to improve
and/or assess the external validity in randomized clinical trials so that sampling,
recruiting participants, and interpreting results of clinical trials important
to women’s health may be improved.
Furthermore, postpartum depression (PPD) is a serious mental health problem
that can have significant consequences for both the new mother and family.
For mothers, PPD can affect their ability to function in everyday life
and increases their risk for anxiety, cognitive impairment, guilt, fear,
sleep disturbance, and thoughts of hurting oneself and one’s child.
Additionally, PPD may lead to difficulty in providing developmentally
appropriate care to infants. As a result, children of mothers with PPD
may experience problems in cognitive, social, and emotional development
and have a higher risk of anxiety disorders and major depression in childhood
and adolescence. APA supports research on the causes, differences among
racial and ethnic groups, and treatments for PPD and encourages ORWH to
seek opportunities to collaborate on this issue with NIMH and NICHD.
In closing, the American Psychological Association would like to thank
you for the opportunity to share our comments related to women’s
health. We appreciate the NIH’s ongoing commitment to women’s
health and look forward to serving as a resource and partner as you work
on this and other important issues affecting women’s physical and
psychological well-being.
References
Alexander, L. L., LaRosa, J. H., Bader, H., & Garfield, S. (2007). New
dimensions in women’s health (4th ed.). Sudbury, MA: Jones and Bartlett.
Andrulis, D. P. (1998). Access to care is the centerpiece in the elimination
of socioeconomic disparities in health. Annals of Internal Medicine, 129, 412-416.
Astbury, J. (2006). Violence against women and girls: Mapping the health consequences.
International Congress Series, 1287, 49-53.
Institute for Women’s Policy Research (2009). Fact Sheet: The gender
wage gap 2008. Retrieved September 27, 2009, from http://www.iwpr.org/pdf/C350.pdf
Institute of Medicine. (2002). Unequal treatment: Confronting racial and ethnic
disparities in health care. Washington, DC: National Academies Press.
Institute of Medicine. (2004). Health literacy: A prescription to end confusion.
Washington, DC: National Academies Press.
Parrot, A., & Cummings, N. (2008). Sexual enslavement of girls and women
worldwide. Westport, CT: Praeger.
Torpy, J. M. (2006). Women’s Health: Theme issue. Retrieved September
28, 2009, from http:/jama.ama-assn.org/cgi/content/full/295/12/1474
U.S. Census Bureau. (2004). Press release: Census Bureau projects tripling
of Hispanic and Asian populations in 50 years; non-Hispanic Whites may
drop to half of total population. Retrieved September 27, 2009, from http://www.census.gov/Press-Release/www/releases/archives/population/001720.html
World Health Organization (2008). Violence against women: Fact Sheet
No. 239. Retrieved September 27, 2009, from http://www.who.int/mediacentre/factsheets/fs239/en/
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