Transcript Women`s health

WOMEN’S HEALTH ISSUES
July 6, 2015
BIOPSYCHOSOCIAL MODEL HEALTH
 DISEASES UNIQUE TO WOMEN
Breast Cancer; Lupus (autoimmune)
 CULTURE AND SOCIETY
Violence Politics Economics Media
 WOMEN NOT HOMOGENEOUS
race, socioeconomic status, LGBT
 HEALTH DISPARITIES
low birth weight breast cancer
 BIOLOGAL DIFFERENCES
Alcohol heart disease
 ENVIRONMENTAL FACTORS
onset of puberty
 INTERNATIONAL
violence, reproductive, economics
girleffect.org
Leading Causes of Death in Females
United States, 2004 (CDC)
All Females, All Ages Percent*
1) Heart disease 27.2
2) Cancer 22.0
3) Stroke 7.5
4) Chronic lower respiratory diseases 5.2
5) Alzheimer's disease 3.9
6) Unintentional injuries 3.3
7) Diabetes 3.1
8) Influenza and pneumonia 2.7
9) Kidney disease 1.8
10) Septicemia 1.5
SEX (GENDER) BASED BIOLOGY
(biological differences between sexes)
Different symptoms for the same disease
 Drugs act differently
 Diseases that effect women more than
men
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GENDER BASED BIOLOGY
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MIGRAINE
BRAIN: concussions
AUTOIMMUNE
DISEASES
HEART DISEASE
OSTEOPOROSIS
ACL INJURIES
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STIs
DEPRESSION
MEDICATION
ALCOHOL
IRRITABLE BOWEL
CELIAC
Alcohol and Women
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Higher BAC than men:
body size, composition and metabolism
Sleep Aid and Women: Ambien
 Slower elimination/metabolism than men
 AM lack of alertness: FDA decreased dose
Health Disparity
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Disparity: differences in health or health care by:
race, social class, gender, sexual orientation
geographic location, disability
United States spends more money on health care
than any other country but does not have the
best health
Direct association between health and
socioeconomic status at every level
Racial minorities have higher rates of:
infant mortality, heart disease, stroke, diabetes,
HIV/AIDS, cancer
Women live longer than men but have greater
morbidity
Health Disparities: Why?
•Inadequate Access
to Care
health insurance; geographic; cultural; homophobia
lack of preventive care: immunizations, cancer screening
•Economic/Environmental
healthy foods (food deserts); exercise
•Behavior (may or may not be an inequity):
smoking; weight; breast cancer
•Racism (resulting in chronic stress with poor health outcomes)
infant mortality; low birth weight
•Biological
considerations
heart disease; colon and breast cancer; autoimmune
Disparities: LGBT youth
Harrassment, bullying, rejection lead to more
health risks and worse health outcomes
 LGB youth at increased risk for:
suicide ideation & attempts, substance use, risky
sexual behavior, disordered eating, victimization
 Transgendered youth: few data/research available
but also at health risks b/c of stigma attached
to their gender expression
 65% of LGB high school students had not
disclosed sexual orientation to their physician
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Health Disparity: Racism
Hypertension: 2 to 3x more in B than W women
results in: heart disease, stroke, renal disease
risk factors do not account for all the variation:
cigarettes, sedentary lifestyle; obesity; family hx
emerging research on psychosocial/environmental
 Racism as a chronic stress leading to high BP
studies done where the experience of racism leads
to a measureable increase in blood pressure
 Stress
immune response
inflammation
& depression
diabetes/cancer/CVD
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CYTOKINES
Racism: Infant Mortality
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Infant mortality: 13/1,000 B; 6/1,000 W
due to a high rate of very premature births
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Theory: well-being of mothers from the time they
were in womb, physical & mental
health; exposure to stress; and social ties
Disparity: Breast Cancer
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Black women have higher mortality rates
access to care for screening and treatment plays role
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Additional factor includes biology:
a. ‘triple negative’ breast cancer disproportionately affects African and
African-American women:
overall: 10 to 15% of breast cancers are triple negative
but it accounts for 39% of premenopausal diagnosis in black
women compared to 16% white & 14% post menopausal black
b. ‘triple negative’: cells without estrogen, progesterone or human
epidermal growth factor receptors; limiting treatment; e.g tamoxifen
Global Breast Cancer Disparity
Breast cancer most common malignancy in world
for women
 Age adjusted survival rate of breast cancer range:
32% in sub-Saharan Africa to 81% in the USA
 Why this disparity:
1. Biology (different cancers)
2. Access to screening
3. Treatment: expensive
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INTERNATIONAL HEALTH
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Lack of Education
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Sex selection and infanticide
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Maternal Mortality
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Obstetric Fistula
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Access to contraception
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Access to safe abortions
(Latin America: 5,000 deaths)
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HIV/AIDS (37% in Botswana)
India: 90% of HIV+ women married
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Early Marriage (child bride)
http://pulitzercenter.org/articles/child-marriage-brides-too-young-to-wedafghanistan-ethiopia-india-yemen
MISSING WOMEN
Natural sex ratio: 1/1
Infanticide & restricted access to food
Amartya Sen (1984): ‘missing women’
More than 100 million missing women
India: 10 million girls aborted last 20 years
932 girls for each 1,000 boys
(2001)
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1994: illegal to ultrasound for sex
 China: 120 boys for each 100 girls
results in trafficking of women
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International Health: violence
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GENITAL MUTILATION/CIRCUMCISION
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SEX FOR MONEY (trafficking: 700 million)
www.nytimes.com/ontheground
RAPE: 78% of Indian women
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BRIDE BURNING/MURDERS: 100,000/year India
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ACID thrown on a woman’s face
a. Afghanistan: group of girls going to school
b. Pakistan: for divorcing a husband
no prosecution
(Terrorism That’s Personal; Nicholas Kristof; nytimes; 11/30/08)
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Intimate Partner Violence as a cultural norm
35% of Indian woman experience IPV
Obstetric Fistula
global health disparity: maternal care
Complication of delivery without access
to emergency caesarian section
 2 movies:
A Walk to Beautiful (Ethiopia)
Love, labor, loss (Niger)
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