SPECIAL POPULATIONS

MINORITY WOMEN

Many women of color continue to suffer disproportionately from premature death, disease, and disabilities. In 1997, life expectancy was 79.4 for white women, 74.9 for African American women, and 75.7 for all other minority women. Women of color also have greater prevalence of such chronic illnesses as cardiovascular disease, lupus, certain types of cancer, and diabetes as well as certain infectious diseases like hepatitis, tuberculosis, and AIDS. Infant mortality is highest among African American and Puerto Rican women, and maternal mortality is more frequent among African American, Hispanic, and American Indian/Alaskan Native women than among white women. African American and Hispanic women are also at greater risk of homicide and HIV/AIDS than are white women.

Women of color are more likely to live in poverty than are white women¡ªa factor which is strongly linked to a greater frequency and severity of illness and premature death. Limited access to health care and lower utilization rates for many preventive health services are more prevalent among women of color than among white women. These disparities are due to the legacies of discrimination; the dearth of minority health care providers; and the systemic, cultural, social, and economic barriers to health care that confront minority women.

ADOLESCENT GIRLS

Adolescence represents a dynamic, developmental period of life. Young women make important choices about lifestyle behaviors, including diet; physical activity; sexual activity; and the use of tobacco, alcohol, and other drugs. All of these decisions can influence their health and well-being throughout adulthood.

The leading cause of death among adolescent girls is unintentional injury. Physical and sexual abuse are experienced by more than one in five high school-age girls, and the proportion of these girls who show signs of depression is one in four. Surveys indicate that 28 percent of high school girls think they are overweight, 60 percent report trying to lose weight, and 8 percent regularly binge and purge. An estimated 37 percent of teen girls smoked in the last month, 48 percent report frequent drinking, and 15 percent rarely or never use a seat belt.

Youth and young adults under the age of 24 comprise the least medically served age group in this country. An estimated one in seven adolescents ages 10 to 18 years and 27 percent of those ages 19 to 24 have no health insurance. Many more lack access to affordable, comprehensive, and confidential services that are targeted to their needs.

OLDER WOMEN

Women live an average of seven years longer than men. Life expectancy is anticipated to continue to increase into the next century, with higher gains for women than for men. In 1998, there were 20.3 million women over age 65 and 14.3 million men. By the year 2030, the proportion of Americans over age 65 is expected to double, and the number of Americans over age 85 will triple. Projections indicate that 7 in 10 baby-boom wives will outlive their husbands, usually by 15 to 20 years.

Due to their greater longevity, women run a greater risk than men of suffering from the chronic disorders and disabilities that increase with age such as cancer, obesity, arthritis, osteoporosis, and heart disease.

Older women are also more likely to live in poverty than are older men. Nearly three-fourths of the nation¡¯s elderly poor are women. Moreover, women spend more of their disposable income¡ªas much as 25 percent¡ªon out-of-pocket health care expenses than do men. Two-thirds of older women do not use preventive screening services such as mammography because of the cost of these screenings or because they believe they do not need these services or because their physician does not recommend these screenings to them.

Promising trends are unfolding for the emerging population of older women. Disability rates are falling dramatically, and women are attaining greater education and economic independence. If women actively engage in healthy behaviors, the twenty-first century will see them enjoy lives that are not only longer, but indeed healthier.

INCARCERATED WOMEN

Although women account for only 6.5 percent of all prisoners nationwide, they are the fastest growing incarcerated population in the United States. During 1998, the number of women under the jurisdiction of state or federal prison authorities reached a total of 84,427, outpacing the rise in the number of men for the third consecutive year. In addition, 63,791 women were held daily in jails and 737,958 female juvenile arrests were made at midyear 1998.

Women in prison have different health care needs than that of male prisoners. These differences result from several factors: women¡¯s relatively complex reproductive systems, their status as pregnant women and mothers, their care giving responsibility for children who are minors, their increasingly high-risk illicit drug behavior, their increased rates of HIV positivity, and their history of physical and sexual abuse.