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

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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 IWPR.

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 JAMA.

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 U.S.Census Bureau.

World Health Organization (2008). Violence against women: Fact Sheet No. 239. Retrieved September 27, 2009, from WHO.