Preventative Care - Welcome to the 21st Century

By Melissa Sandgren, WAPPP summer intern
Posted August 1, 2012

Today I joined a call with the White House and HHS officials to discuss the incredible things that are taking place -- for women -- as part of the ACA. Guess when these great new services start? Oh, that's right. Today.

Here was the line-up to discuss Women's Preventative Health Services:

• Valerie Jarrett, Senior Advisor & Chair of the White House Council on Women & Girls
• Kathleen Sebelius, Secretary of the U.S. Department of Health & Human Services
• Dr. Regina Benjamin, U.S. Surgeon General
• Dr. Nadine Gracia, Deputy Assistant Secretary for MINORITY Health (acting)
• Mayra Alvarez, Director of Public Health Policy, Office of Health Reform

Most of what they discussed centred around the new services available to women, the disproportionate impact of health disparities on minority communities, and the importance of preventative care across race, creed and class. The main point -- these things start today. That's right, as of August 1st, all new insurance policies are required to cover preventative care to women without absurd co-pays. As someone who represents one of the 1 in 4 women in the United States who have used Planned Parenthood for a preventative screening either because of expense, lack of insurance or convenience -- it's pretty incredible. The need is so strong.

I also want to share just a few excerpts from the op-ed in USA Today from Congresswoman Pelosi and HHS Secretary Sebelius: A new day for women's preventive care

• Starting Wednesday, thanks to the Affordable Care Act, all new insurance policies will be required to cover the vital care women need to stay healthy without charging a fee to the patient. ... before Wednesday, many plans didn't even cover basic women's preventive care....In total, more than half of women delayed or avoided necessary care because of its cost. 

• Beginning Wednesday, all new insurance plans will be required to cover additional services and screenings for women without cost to the patient. .. [including] FDA-approved contraception, breastfeeding support and supplies, gestational diabetes screening, HPV testing, sexually transmitted infection counseling, and HIV screening.

• In the past, insurance companies could deny women coverage ... [or] charge women up to 50% more than men just for being women, even though the plans often didn't cover basic women's health care such as maternity care. One study found that this discrimination cost women $1 billion a year. 

• In 2014, it will be illegal to charge women more than men just because they're women. In other words, being a woman will no longer be a pre-existing condition. 

The downside? Well, there are plenty. These guidelines above only currently apply to insurance companies, not Medicaid or Medicare. It also means it doesn't apply to those who are uninsured. Or to those whose insurance seem to have some type of temporary grandfather policy (this, of course, was very grey). Regardless, even with all of this, it is a step forward, and the US seems to slowly, albeit almost reluctantly, actually be entering the 21st century in terms of health care.

Get the full list of 22 covered preventive services for women (also includes children and all adults).

....And just for fun, the photo on the right was courtesy of a fantastic WAPPP gathering earlier this year where Ms. Jarrett was the guest of honor. Man I love WAPPP. 

How to Transform a Global Health System

The Woman: Paula Johnson, Chief, Division of Women's Health, Brigham and Women's Hospital; Associate Professor of Medicine, Harvard Medical School

The Talk: Women's Health and Health System Reform: The Route to Transformational Development?

The Question: How do we transform a global health system that neglects gender?

As women continue to lag behind men in health and preventative care, the need for a health system transformation could not be greater. Yet, health access for women also requires recognition of the intricate relationship between politics, economics, education and current health systems. Fundamentally, the advancement of women hinges on improving their state of health and similarly, better outcomes for global health call for a gender-focused approach.

Women as mothers, individuals, and citizens

Dr. Johnson started her lecture with an overlooked angle to the question about improving health. As women, who are we and how do our multiple identities factor into global health? As mothers, Johnson says, women’s health needs will be neo-natal and maternal health services. As individuals, girls and women require reproductive and general health education catered to them. Women often act as family caregivers, providing “about 80 percent of the home health care”.

According to Johnson, health care systems must also treat women as citizens, who have risk for different kinds of diseases than men and who disproportionately bear the burden of disease. For example, women have a higher incidence of chronic diseases and a higher likelihood to suffer from anxiety and depression. Upper respiratory illness, often from exposure in kitchen spaces, also impacts more women around the world.

The roles of women and their distinctive health needs reinforce why health care changes must have targeted programs for women. The equity argument set aside, improving health circumstances for women can have a ripple effect. Johnson cites how Turkey and Sri Lanka developed female-focused health programs that may have resulted in higher national income, lower poverty rates, and increased global competitiveness.

Accountability in programs and public discourse

How do we create better health care access for women? Johnson answer: “data”. Policies such as the U.S. Affordable Care Act require a “mechanism to ensure that the policies do what they are supposed to do.” This means collecting data that is aggregated by gender and race, program monitoring with data analysis, and framing debate the about health policies with numbers.

Public discourse and political debate are key to reforms. Yet, at least for the United States, “Political divisions limit the conversation to abortion and contraception, making it extremely difficult to elevate other issues.” Johnson suggests “setting aside advocacy and the ideological arguments” for those based on numbered reasoning. She reminisced about a previous visit to the Kennedy School, where a debate on controversial topics in health took place. Ideology controlled, both sides were asked how they would improve women’s health.

Brooke Davis is a MPP1 at the Harvard Kennedy School and a State Department foreign affairs fellow.