Leadership in

Action:

Becoming Your

Best Health

Advocate

Magda G. Peck ScD Founding Dean and Professor

2015 Women Leaders ConferenceMarch 20, 2015

Magda G. Peck, ScDFounding Dean and ProfessorJoseph J. Zilber School of Public HealthUniversity of Wisconsin – Milwaukeempeck@uwm.edu414.227.3128 (w) 402.689.9413 (c)

CHALLENGESCHANGES

CHAMPIONS

…IN 75 MINUTES

z

TAKE THE QUIZ!

What are the Top 10 most common Causes of DEATHFor WOMEN in the U.S.?

Leading Causes of Death, 2011

WOMEN of All Ages, United States

1. Heart Disease (22.9)

2. Malignant Neoplasm – Cancer (21.8)

3. Cerebrovascular Disease – Stroke (6.1)

4. Chronic Lower Respiratory Disease (6.0)

5. Alzheimer’s Disease (4.7)

6. Unintentional Injuries – Accidents (3.7)

7. Diabetes Mellitus (2.8)

8. Influenza and Pneumonia (2.3)

9. Kidney Disease (1.8)

10.Septicemia (1.5) Source: CDC.gov (2015)

(%) N= 1,236,003

Leading Causes of Death, 2011

BLACK WOMEN of All Ages, U.S.

1. Heart Disease (23.4)

2. Malignant Neoplasm – Cancer (22.9)

3. Cerebrovascular Disease – Stroke (6.2)

4. Diabetes Mellitus (4.8)

5. Chronic Lower Respiratory Disease (3.1)

6. Kidney Disease (3.0)

7. Unintentional Injuries – Accidents (2.9)

8. Alzheimer’s Disease (2.7)

9. Septicemia (2.3)

10.Hypertension (2.0) Source: CDC.gov (2015)

Leading Causes of Death, 2011

HISPANIC WOMEN of All Ages, U.S.

1. Malignant Neoplasm – Cancer (22.4)

2. Heart Disease (20.5)

3. Cerebrovascular Disease – Stroke (5.9)

4. Diabetes Mellitus (4.9)

5. Unintentional Injuries – Accidents (4.5)

6. Alzheimer’s Disease (3.6)

7. Chronic Lower Respiratory Disease (3.1)

8. Influenza and Pneumonia (2.4)

9. Chronic Liver Disease (2.2)

10.Kidney Disease (2.1)

Actual Causes of Death in US

Actual causes of death in the United States, 2000.

JAMA. 2005 Jan 19;293(3):293-4.

1. Tobacco (435,000 deaths; 18.1% of total deaths)

2. Poor diet, physical inactivity

(365,000 deaths; 15.2%)

3. Alcohol consumption (85,000 deaths; 3.5%)

4. Microbial agents (75,000)

5. Toxic agents (55,000)

6. Motor vehicle crashes (43,000)

7. Firearms (29,000)

8. Sexual behaviors (20,000)

9. Illicit use of drugs (17,000)

Women’s Health (U.S.)

Number of U.S. women residents in 2011 : 158.3 million (Health U.S. 2012)

Percentage of women 18 years and older who are in fair or poor health: 14.2 (NHIS, 2011)

Percentage of adult women who are:

Obese 35.9

Currently smoke 17.3

Hypertensive 32.8

WISCONSIN Women

Number of women residents: 2.86 million

84% white, 7% non-Hispanic black

US Rankings:

Heart disease, Cancer, Stroke 20

Current smoking 29

Unintentional injury 30

Suicide 35

Binge drinking 51

Overweight and obesity among adults

NOTE: Overweight but not obese is body mass index (BMI) greater than or equal to 25 but less than 30; grade 1 obesity is BMI greater than or equal to 30 but less than 35; grade 2 obesity is BMI greater than or equal to 35 but less than 40; grade 3 obesity is BMI greater than or equal to 40. SOURCE: CDC/NCHS, Health, United States, 2012, Figure 11. Data from the National Health and Nutrition Examination Survey.

Current cigarette smoking

SOURCE: CDC/NCHS, Health, United States, 2012, Figure 8. Data from the National Health Interview Survey and the

National Institutes of Health/National Institute on Drug Abuse, Monitoring the Future Study.

WOMEN’S HEALTH CONDITIONS specific to women

are more common or more serious in women

have distinct causes or manifestations in women

have different outcomes or treatments in women

have high morbidity or mortality in women

Women’s Health Research:

Progress, Pitfalls, and ProgressInstitute of Medicine 2010

HONEY, WHAT ARE WE GOING TO DO ABOUT IT?

1. Is Women’s Health Research Studying the Most Appropriate and Relevant Determinants of Health?

Progress has been made in identifying behavioral determinants of women’s health, such as smoking, diet, and physical activity.

Inadequate attention paid to social and environmental factors; few studies have tested ways to modify these determinants in women or examined the effects of social and community factors in specific groups of women.

Women’s Health Research:

Progress, Pitfalls, and ProgressInstitute of Medicine 2010

2. Is Women’s Health Research Focused on the Most Appropriate and Relevant Conditions and Endpoints?

• Limited advances in depression, HIV/AIDS, and osteoporosis

• Few advances made in reducing unintended pregnancy, autoimmune diseases, maternal morbidity and mortality, alcohol and drug addiction, lung cancer, gynecological cancers other than cervical cancer, non-malignant gynecological disorders, and Alzheimer’s disease.

Women’s Health Research:

Progress, Pitfalls, and ProgressInstitute of Medicine 2010

(2010)

2. Is Women’s Health Research Focused on the Most Appropriate and Relevant Conditions and Endpoints?

Major progress in reducing mortality for women from breast cancer, cardiovascular disease, and cervical cancer.

Fewer advances in research investigating non-fatal diseases that result in major morbidity for women, despite the high value women place on quality of life as well as longevity.

The committee recommends that research include greater attention to assessing quality of life—for example, functional status or functionality, mobility, or pain—and promoting wellness.

Women’s Health Research:

Progress, Pitfalls, and Progress

www.iom.edu

cc

Women’s Health Amendment

Requires that all private health plans cover –with no cost sharing requirements for patients –a newly identified set of women’s preventive services

evidence-informed preventive care and screenings not otherwise addressed by current recommendations.

Women have longer life expectancies, a greater burden of chronic diseases and disability, reproductive and gender specific conditions …and women often have different treatment responses than men.

Clinical Preventive Services

for Women:

Closing the Gaps

Committee on Preventive Services for Women

Institute of Medicine, National Academy of Sciences

The National Academies Press, 2011

Released July 19, 2011

www.iom.edu

IOM Committee – Preventive Services for Women •Linda Rosenstock, M.D., M.P.H. (Chair) UCLA School of Public Health

•Alfred O. Berg, M.D., M.P.H.

•University of Washington

•Claire D. Brindis, Dr.P.H.

•University of California, San Francisco

•Angela Diaz, M.D., M.P.H.

•Mount Sinai Medical Center, NY

•Francisco Garcia, M.D., M.P.H.

•University of Arizona

•Kimberly Gregory, M.D., M.P.H.

•Cedars-Sinai Medical Center, Los Angeles

•Paula A. Johnson, M.D., M.P.H.

•Brigham and Women's Hospital, Boston

•Anthony Lo Sasso, Ph.D.

•University of Illinois at Chicago

Jeanette H. Magnus, M.D., Ph.D.

Tulane University

Heidi Nelson, M.D., M.P.H., FACP

Oregon Health and Science University

Roberta B. Ness, M.D., M.P.H.

University of Texas School of Public Health

Magda Peck, Sc.D.

University of Nebraska Medical Center

E. Albert Reece, M.D., Ph.D., M.B.A.

University of Maryland (Baltimore)

Alina Salganicoff, Ph.D.

Kaiser Family Foundation

Sally Vernon, Ph.D.

University of Texas School of Public Health

Carol S. Weisman, Ph.D.

Penn State College of Medicine

Recommendation 8

At least one well-woman preventive care visit annually for adult women to obtain the recommended preventive services, including preconception and prenatal care. The committee also recognizes that several visits may be needed to obtain all necessary recommended preventive services, depending on a woman’s health status, health needs, and other risk factors.

Supporting Evidence

Based on federal and state policies (such as included in Medicaid

and Medicare and the State of Massachusetts), clinical

professional guidelines (such as those from the AMA and AAFP,

and private health plan policies (such as Kaiser Permanente).

USPSTF Grade – Not Addressed

Note: well-child visits include adolescent girls under Bright Futures

…The inclusion of evidence-based

screenings, counseling and

procedures that address women’s

greater need for services over the

course of a women’s lifetime may

have a profound impact

for individuals

and the nation as a whole.”

THE BOTTOM LINE (IOM report brief July 2011)

ACA POLICY RELATED TO WOMEN

Insurers can no longer charge

women more just because

they’re women.

AND

All plans in the new marketplaces

must cover essential women’s health care like maternity care.

Source: Enroll America, used with permission, M Herrera Bortz

A Health Care System that is Better for Women

• Access to Free preventive services for women include: Well Woman Visits All FDA-approved contraception methods and

contraceptive counseling Mammograms Pap smears HIV and other sexually transmitted infection

screening and counseling Breastfeeding support, supplies, and counseling Domestic violence screening and counseling

• http://www.hrsa.gov/womensguidelines/

Thanks to

Enroll America

non-partisan technical assistancenational, state, local

empowers Americans with information about their health

coverage options under the Affordable Care Act (ACA)

Over 22 Million Enrolled in Coverage under the ACA

11.4 Million in Marketplace

Coverage for 2015

55% are

Women

Women are often the people who others turn to

when making important decisions about health

insurance.

Women make 80% of Health Care Decisions

What Enroll America Research Shows

Mothers

Sisters

Wives

Girlfriends

Partners

The Power of Women in Health Decisions

Too wide, too small, too soon…

Complications of Prematurity,

55.9%

Congenital Anomalies, 20.3%

SIDS, SUDI, accidental

suffocation, 15.4%

Homicide, 3.0%

Perinatal complications,

2.8%Infections, 1.9%

Other deaths, 0.8%

CAUSE OF INFANT DEATH 2008-2012 CITY OF MILWAUKEE DATA ANALYSIS

= “Unsafe Sleep”

Stillbirths Infant deaths

Total N=205 N=318

Average per year 68.3 106

Overall rate 6.5 10.6

White Non-Hispanic rate 3.7 5.2

Black Non-Hispanic rate 9.4 14.4

Hispanic rate 3.6 7.5

2009 – 2011: Stillbirths and Infant Deaths in Milwaukee 2011 data preliminary rate = deaths per 1000 live-births

10 Recommendations to Improve

Preconception Health and Health Care

1. Individual responsibility across the lifespan

2. Consumer awareness

3. Preventive visits

4. Interventions for identified risks

5. Interconception care6. Pre-pregnancy check ups

7. Coverage for low-income women

8. Public health programs & strategies

9. Research

10. Monitoring improvements

National Preconception Health and Health Care Initiative, October 2010

V-Up! for women’s health

Change our Vocabulary

the stock of words used by a particular group of persons

V-Up! for women’s health

Vigorous(vig-or-ous) adjective

strong, robust, energeticpowerful in action or effect

V-Up! for women’s health

Vivacious (vi-va-cious) adjective

lively, spirited, animatedhaving tenacity of life

V-Up! for women’s health

Vocal (vo-cal) adjective

Inclined to express oneself in words, insistently

V-Up! for women’s health

Veracious (ve-ra-cious) adjective

Habitually speaking the truth; honest, truthful

V-Up! for women’s health

Valiant(val-iant) adjective

Courageous, stout-hearted, worthy, excellent

Becoming

Women of Valor