Our Bodies, Ourselves (161 page)

CHAPTER 26
The Politics of Women's Health

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omen are healthier in places where policies promote equal access to health care and education; clean, safe neighborhoods and workplaces; fair and livable incomes; and the power to participate democratically in decisions that affect our lives. In fact, these markers of social and economic equality have significant influence over our health and longevity.
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This chapter provides an overview of economic and political trends that shape women's health. The first half looks at the health status of women in the United States, focusing on indicators of sexual and reproductive health. It also addresses U.S. health care reform and the brewing political storms over reproductive health and justice. The second half discusses the status of women's health from a global perspective and looks at
how U.S. policy affects women's reproductive and sexual health in developing countries.

© Earl Dotter/
www.EarlDotter.com

By many measures, the health of women in the United States has improved dramatically since the women's health movement began in the late 1960s. Many of the issues that the early women's health movement advocated for have become policy. Abortion is legal, and more research is directed toward women's health issues. Women are now more often health care professionals (accounting for 49 percent of medical school graduates in 2007, compared with 9 percent in 1970) and assertive patients.
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Women's participation in late-phase clinical trials of new drugs has improved; approximately 50 percent of enrollees are now women, and sex-based data analysis has also improved. We are living longer and enjoying higher incomes, more equal access to resources, and greater independence than earlier generations.

But our lives are still unevenly restricted by race, ethnicity, and class, as well as by gender, sexual orientation, and age. The global economic downturn has fallen most heavily on women, and the problem is compounded by the increasingly uneven distribution of wealth.

Although the United States spends more on health care per person than any other country, it has some of the worst statistics among developed countries for infant mortality, maternal health, unintended pregnancy, and sexually transmitted infections. Acts of harassment, including violence, increasingly obstruct access to family planning and abortion care. Americans are more likely to lack coverage for health care and are in worse health by several measures than citizens of other developed nations.

The Patient Protection and Affordable Care Act (PPACA)—the health care reform bill signed into law in 2010—begins to address some of the problems of inadequate coverage and a fragmented health care delivery system. However, the law limits immigrants' rights, and it places new restrictions on our rights to reproductive health care. These setbacks came as a rude shock to many who expected greater support from Democrats when they controlled Congress between 2008 and 2010. Conservative political campaigns continue to use reproductive health care as a divisive wedge issue, waging formidable and concerted attacks on access to family planning, including abortion and contraception.

The turbulent periods of social activism from the 1930s through the 1970s won important gains in income equality. But beginning with the Reagan administration in the 1980s, the divide between rich and poor became a chasm. Economic and social policies swung in favor of deregulating corporate practices, cutting public funding for social programs such as education and public health, and draining public reserves with tax breaks for the wealthy and spending on wars.

Between 1947 and 1973, income growth was distributed roughly equally across income classes, with the poorest 20 percent of families seeing income growth at least as fast as the richest 20 percent. But between 1979 and 2005, the trend reversed. Households at the bottom fifth of the income scale saw income growth of just $200 over the entire twenty-six-year period (adjusted for inflation). In contrast, household income grew by almost $6 million for a small number of households in the top 0.1 percent over that same period of time.
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In 2009, the bottom 20 percent of the population received only 3.4 percent of the aggregate income in the country, while the top 20 percent received a full 50.3 percent of the nation's income.
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The administration of George W. Bush manipulated concerns about national security to deflect attention from the virtual abandonment of government oversight and accountability. The global economic crash and the collapse of the U.S. financial sector followed in 2008, resulting in persistent high unemployment, record rates of home foreclosures and personal bankruptcies, and rising health care costs

The election of President Barack Obama in 2008 and the early days of the Obama administration in 2009 brought hope for the restoration of policies based on science and evidence and a new emphasis on equity in shaping economic and social policies that affect women's health. Congress passed the Lilly Ledbetter Fair Pay Act, and the administration's economic stimulus package promised some relief from the cratering economy. But the recession proved difficult to reverse.

Women traditionally have had less financial security than men. Our economic insecurity contributes to worse access to health care and worse health. The sharp economic downturn of 2008 compounded the damage as women lost jobs, income, and health care coverage. Women working full-time in 2009 were paid only 77 cents for every dollar paid to their male counterparts, earning a median salary of $36,278 versus $47,127 for men.
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Some of this disparity can be attributed to the disproportionate share of economically valuable but unpaid home tasks and child care carried out by women also working outside the home; however, sex discrimination in the workplace and fewer employment options also play critical roles, as does the fact that women on the whole receive lower rates of pay than men for the same work.

The poverty rate among women rose to 14 percent in 2009, the highest rate in fifteen years, versus 10.5 percent for men.
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The poverty rate is higher among women of color: 25 percent of African-American women were living below the poverty line in 2009, as were 24 percent of Hispanic women.

The recession has been marked by the greatest decline in the number and percent of fulltime jobs since 1969. From 2007 to 2010, the number of working women with earnings decreased by 1.3 million (from 74.3 million to 73.0 million). The number of working men with
earnings decreased by 2.5 million (from 84.5 million to 81.9 million).

A third of working mothers are the sole family wage earners either because they are single parents or because their spouse is unemployed or out of the labor force. In August 2010, unemployment among single women who head families was 13.4 percent—the highest in more than twenty-five years.

Households headed by single women are particularly vulnerable to poverty: Nearly four in ten single mothers (38.5 percent) lived in poverty in 2009. It is not surprising, therefore, that an increasing number of children are also now living in poverty. In 2009, 1.4 million children fell below the poverty line, bringing the number of poor children in the United States to 15.4 million. Over half of poor children lived with single mothers in 2009, and children now represent 35 percent of all those living in poverty in the United States.

There was one positive development during this period: The poverty rate declined for older Americans, including women sixty-five and older living alone. Poverty among older women living alone dropped to 17 percent in 2009 from 18.9 percent in 2008. This is where Social Security truly acted as a safety net: Without Social Security benefits, an additional 14 million older Americans would have fallen into poverty in 2009.
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There are differences in health status by race and ethnicity that cannot be explained based only on physical or genetic characteristics. These differences are influenced primarily by social and economic inequities and policies, including increased exposures to environmental toxins, lack of access to health care and to education, and residential segregation. Different treatment by health care providers can also play a role. These differences are referred to as disparities.

Health, United States
(cdc.gov/nchs/hus.htm) is the federal government's annual report on the population's health, including life expectancy, rates of illness, and major causes of death. It identifies numerous significant differences in health status by race and ethnicity. In most cases, women of color experience worse health than white women, though some aspects of cultures and communities may protect health (Latinas have a lower rate of low birth weight infants than whites, for example).
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A third of women self-identify as a member of a racial or ethnic minority group, and this share is estimated to increase to more than half by 2045.
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Some glaring health disparities based on race or ethnicity include:

• Life expectancy at birth increased for the population as a whole from 1970 to 2007. Life expectancy for black women increased more than that for white women but still consistently lags behind. White women's life expectancy was 80.8 years, up from 75.6, while black women's life expectancy was 76.8 years, up from 68.3.

• The infant death rate among African Americans is more than double that of whites; heart disease death rates are more than 40 percent higher; and the death rate for all cancers is 30 percent higher. African-American women have a higher death rate from breast cancer, despite having a mammography screening rate that is nearly the same as the rate for white women. The rate of new AIDS cases among black women is 55.7 per 100,000, compared with 3.8 for white women.
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• Hispanics living in the United States are almost twice as likely to die from diabetes as are non-Hispanic whites, and to have higher
rates of high blood pressure, obesity, and tuberculosis. There are a number of differences among Hispanic populations. For example, the rate of low-birth-weight infants is lower for all Hispanics than for whites, but for Puerto Ricans the low-birth-weight rate is 50 percent higher than the rate for whites.