ACTIONS BY THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES (DHHS) TO PROMOTE WOMEN'S HEALTH

As part of its overall mission to promote and protect the nation¡¯s health and to provide essential human services, DHHS is pursuing a comprehensive agenda to improve women¡¯s health. Through its agencies and offices, and in coordination with other governmental, national, and international organizations, DHHS

• promotes the health of women across the lifespan,
• empowers women to make informed choices about their health, and
• translates policy decisions into effective women¡¯s health programs.

DHHS funding for women¡¯s health totaled just under $5 billion in FY 1999, an increase of more than $2 billion in just five years. These funds support health care services for women, the development of innovative educational programs for the public and health care professionals, intensified research, and other specific initiatives targeted to women.

OFFICE ON WOMEN¡¯S HEALTH

The Office on Women¡¯s Health (OWH) serves as the focal point for women¡¯s health within the Department of Health and Human Services (DHHS). OWH is pursuing a comprehensive agenda to ensure that women¡¯s health is a top national health priority. OWH was established in 1991 to improve the health of American women of all ages, races, and ethnicities by advancing and coordinating a comprehensive women¡¯s health agenda throughout DHHS and by working with other federal and public organizations, consumer groups, and associations of health care professionals. OWH focuses on critical health issues affecting women¡¯s lives today. OWH has implemented a number of important initiatives to improve the health of women in the United States and abroad.

NEW RESEARCH STUDIES

Research on women¡¯s health has increased substantially since the beginning of the 1990s. Basic, clinical, epidemiological, and health services research are supported by the National Institutes of Health (NIH), the Agency for Health Care Policy and Research (AHCPR), and the Centers for Disease Control and Prevention (CDC). These organizations are focusing on the causes, treatment, and prevention of a broad spectrum of diseases and health concerns affecting women across the lifespan, including heart disease, breast and ovarian cancers, mental and addictive disorders, osteoporosis, autoimmune disorders, gynecologic disorders, and AIDS.

Major longitudinal studies are under way to examine adolescent and mid-life behaviors and their effect on future health, disease, and disability.

• Ensuring Inclusion of Women in Clinical Trials. New policies ensure that women and minorities are included as subjects in government-supported research and in the evaluation of drugs and medical devices.

• The National Longitudinal Study on Adolescent Health is based on a survey of 90,000 students in grades 7 through 12 across the country. This study is sponsored by the National Institute of Child Health and Human Development. A recent analysis of interview data found that family and school contexts as well as individual characteristics were associated with healthy and risky behaviors (such as the use of alcohol and drugs and early sexual activity). Study findings will be analyzed over the next decade.

• Health of Mid-Life Women. The National Institute on Aging is sponsoring the Study of Women¡¯s Health Across the Nation (SWAN). SWAN, a large-scale study, examines the health of women in their forties and fifties and how their health during those years affects their health in later life. SWAN focuses on the physical, psychological, and social changes that take place at mid-life and how these changes affect health over the long term. The study looks at factors such as body composition; bone density; cardiovascular function; sexuality; menstrual patterns; diet; physical activity; stress; social support; use of health care services; relationships with families and friends; and other information related to health, function, and overall well-being.

• The NIH Women¡¯s Health Initiative. The Women¡¯s Health Initiative (WHI) is investigating the risk factors for major diseases, death, and disability among older women: heart disease, cancer, Alzheimer¡¯s disease, and osteoporosis. This multi-year study, carried out in more than 40 centers across the country, is the largest prevention-oriented clinical trial in U.S. history. It attempts to redress the inequities in research on older women and to provide practical information to older women and their physicians about the effectiveness of hormone replacement therapy and behavioral interventions, including diet and exercise.

The Women¡¯s Health Initiative has three components: 1) a randomized, controlled clinical trial approach to prevention; 2) an observational study to identify predictors of disease; and 3) a study of community approaches to developing healthful behaviors. The latter component is being conducted in collaboration with the Centers for Disease Control and Prevention (CDC).

IMPROVEMENTS IN EARLY DETECTION OF DISEASES

• Identification of Genes for Diseases. Researchers, supported by NIH, have identified genes that may increase susceptibility to diseases, including breast, ovarian, and colon cancer and Alzheimer¡¯s disease. The isolation of these genes may lead to new treatment and prevention strategies.

• New Imaging Technologies. Imaging technologies from the defense, space, and intelligence communities are being adapted to detect breast cancer and other diseases in women earlier and with greater accuracy. This project was launched by DHHS¡¯ Office on Women¡¯s Health to foster innovative partnerships with other federal agencies¡ªincluding the National Aeronautics and Space Administration, the Department of Defense, the Central Intelligence Agency, and the National Cancer Institute¡ªas well as private-sector organizations. Novel imaging techniques, including MRI, PET, and ultrasound, are being tested as improved methods to detect and diagnose disease in women.

• Tumor Markers. The National Cancer Institute is conducting a large-scale study that includes evaluating whether a test to detect CA 125¡ªa protein whose levels may rise in women with ovarian cancer¡ªwill reduce the number of deaths from ovarian cancer among women ages 55 to 74.

HEALTH CARE SERVICE DELIVERY

A priority for DHHS is to ensure the availability of health care services for women. The Department has established a variety of initiatives to improve the delivery of health care services to women. A number of these efforts are described below.

• Nationwide Breast and Cervical Cancer Screening. The Centers for Disease Control and Prevention (CDC) National Breast and Cervical Cancer Early Detection Program (NBCCEDP) provides free or low-cost mammograms and Pap tests to women with low incomes and women of racial and ethnic minority groups in all 50 states, six U.S. territories, the District of Columbia, and 12 American Indian/Alaska Native Organizations. Women can locate screening services in their area by calling 1-888-842-6355.

• Preventing Sexually Transmitted Diseases (STDs) and Infertility. DHHS supports the implementation of the National Infertility Prevention Program to prevent and treat STDs, particularly chlamydia. This program is a collaborative effort between the Centers for Disease Control and Prevention and the PHS Office of Population Affairs. Partnerships among the following programs have been developed: family planning, STD, and primary health care.

• The Mammography Quality Standards Act. In October 1994, the Food and Drug Administration (FDA) implemented a certification and inspection program for mammography facilities in the United States. This program was established to ensure that these facilities meet high-quality standards for equipment, personnel, record-keeping, and quality control. Women can find a certified mammography facility by calling 1-800-4-CANCER.

• Promoting Mammography Use by Older Women. In May 1995, First Lady Hillary Rodham Clinton joined DHHS in an educational campaign to convince women over the age of 65 that mammography saves lives and to encourage them to use their Medicare mammography benefit.

• Community Health Centers. Through the Health Resources and Services Administration (HRSA), community health centers serve the poor and uninsured, migrant workers, homeless people, and residents of public housing.

• Indian Health Service. The Indian Health Service (IHS) provides health care services and assistance to Native American and Alaska Native women. IHS addresses reproductive health, cancer, diabetes, maternal-infant health, substance abuse, child/sexual abuse, family violence, behavioral health issues, and teenage pregnancy. Pap smear registries (including a tracking system) and mammography screening services have been made available in all IHS areas.

• Ryan White CARE Act. Through the authority of the Ryan White CARE Act, HRSA provides comprehensive health care and support services for women living with HIV/AIDS.

• Counseling Pregnant Women To Prevent HIV Transmission. Physicians are being urged to counsel all pregnant women on the benefit of HIV testing to prevent the transmission of HIV to their infants. Evidence has shown that treating HIV-positive pregnant women with the drug AZT will reduce the risk of transmitting HIV from mother to infant from 25 percent to 8 percent. In response to this news, the Centers for Disease Control and Prevention has produced new guidelines and educational material for women and health care providers.

• Enhanced Alcohol, Drug Abuse, and Mental Health Services. The Substance Abuse and Mental Health Services Administration (SAMHSA) supports demonstration programs for substance abuse prevention among adolescent women and women with dependent children. In FY 1996, SAMHSA directed about $127 million to women¡¯s substance abuse and mental health activities.

New educational initiatives are under way to enhance women¡¯s knowledge of health issues and to improve the care women receive. These efforts help ensure that health care professionals have up-to-date information and training on women¡¯s health issues. The following educational programs/initiatives have been instituted:

• National Women¡¯s Health Information Center. This comprehensive information resource center was established by the Office on Women¡¯s Health (OWH) to provide the public, health care professionals, and researchers with a single point-of-entry to state-of-the-art federal and private-sector information about women¡¯s health via a toll-free telephone number (1-800-994-9662; 1-888-220-5446, TDD line for the hearing impaired) and on the Internet (www.womenshealth.gov).

• Domestic Violence Hotline. A federally supported, nationwide, 24-hour domestic violence hotline (1-800-799-SAFE; 1-800-787-3224, TDD line for the hearing impaired) provides immediate crisis information and assistance, counseling, and referrals to local shelters to women across the country.

• Mental Health and Substance Abuse Resource Center. The Substance Abuse and Mental Health Services Administration¡¯s National Women¡¯s Resource Center provides information and referral services (1-800-354-8824). These services address the prevention and treatment of both mental illness and substance abuse. This Center also provides information dissemination services on women¡¯s substance abuse prevention and treatment as well as on mental health services issues throughout the life cycle.

• Cancer Information Service (CIS). The CIS toll-free number, 1-800-4-CANCER, provides rapid access to the latest information on cancer for the general public, patients/family members, and health professionals in both English and Spanish. This free and confidential service provides information on cancer prevention, detection/diagnosis, causes and risk factors, state-of-the-art treatment, and cancer research. The CIS also provides referral to clinical trials and to community resources and services; free publications; and professional consultation for nurses, nutritionists, and physicians.

• Health Education for Mid-Life and Older Women. The Food and Drug Administration¡¯s new Take Time to Care program is encouraging women to use medicine wisely. The program is designed to reach women ages 45 and older, particularly those who are medically underserved. The program is a collaboration among government agencies, national health and consumer organizations, women¡¯s groups, and health care providers and health institutions.

  FDA: 1-800-532-4440
  www.fda.gov

• Mental Health Education Campaigns. The National Institute of Mental Health (NIMH) runs three major educational programs and information resource services: (1) the Depression Awareness, Recognition, and Treatment Program (1-800-421-4211); (2) the Anxiety Disorders Education Program (1-888-8-ANXIETY); and (3) the Panic Disorder Education Program (1-800-64-PANIC). These programs provide information to the public and health care professionals about symptoms and treatment of these diseases as well as referrals to other organizations for further information.

• HIV/AIDS Information Clearinghouses. Educational campaigns spearheaded by DHHS are under way to inform health care professionals and to counsel pregnant women about HIV testing and treatments, so the rate of HIV transmission from mother to child can be reduced. Free information is available through the HIV/AIDS Treatment Information Service by calling toll-free 1-800-448-0440 or 1-800-243-7012 (TTY for the hearing impaired). Other DHHS information services on HIV/AIDS are the CDC¡¯s National AIDS Clearinghouse (1-800-458-5231) and the AIDS Clinical Trials Information Service (1-800-874-2572).

• Office of Minority Health Resource Center (OMH-RC). The OMH-RC (1-800-444-6472) serves as a national resource and referral service on minority health issues. It collects and distributes information on health topics, including substance abuse, cancer, heart disease, violence, diabetes, HIV/AIDS, and infant mortality. Other resources include customized database searches, mailing lists, referrals, and specific information on health issues affecting Native American and Alaska Native, African American, Asian American and Pacific Islander, and Hispanic populations.

• HealthFinder. In April 1997, DHHS launched HealthFinder, a Web site that would serve as a gateway for consumers who are searching for health and human services information. HealthFinder (www.healthfinder.gov) leads users to selected online publications, clearinghouses, databases, Web sites, and support and self-help groups, as well as government agencies and not-for-profit organizations that produce reliable information for the public.

• HRSA, in partnership with the Chronic Fatigue and Immune Dysfunction Syndrome Association of America, is educating health professionals, students, and health workers about CFIDS and how to manage this chronic illness through its Area Health Education Centers Programs.

• Medical School Education. Recommendations for a model medical school curriculum on women¡¯s health issues have been developed and widely disseminated by the Health Resources and Services Administration (HRSA), the National Institutes of Health (NIH), and the Office on Women¡¯s Health (OWH), in collaboration with private-sector organizations.

As part of a study and report by the NIH Office of Research on Women¡¯s Health and HRSA, with the American Association of Dental Schools, OWH has also prepared and widely disseminated a first-of-its-kind directory of women¡¯s health residency and fellowship opportunities in medicine.

A comprehensive national mentoring program is needed to encourage women¡¯s careers in the medical professions and scientific careers. OWH is exploring the establishment of such a mentoring program to address women¡¯s needs at all stages of their academic and professional careers.
HRSA: 301-443-2086 - www.hrsa.gov
NIH: 301-496-4461 - www.nih.gov

CROSS-CUTTING WOMEN¡¯S HEALTH INITIATIVES

• National Centers of Excellence in Women¡¯s Health (CoEs). The Office on Women¡¯s Health (OWH) supports CoEs in academic health centers across the United States and Puerto Rico. The CoEs combine the latest advances in women¡¯s health research and teaching with community outreach and clinical service delivery to promote new standards of excellence in women¡¯s health. The CoEs also promote the career advancement of women, including minority women in the health sciences. An important focus of the CoE program is to address racial and ethnic disparities in women¡¯s health.

  OWH: 1-800-994-WOMAN - (1-800-994-9662); 1-888-220-5446, TDD www.womenshealth.gov/coe/

• National Community Centers of Excellence in Women¡¯s Health (CCOEs). In 2000, the DHHS Office on Women¡¯s Health (OWH), the Office of Minority and Women¡¯s Health in HRSA¡¯s Bureau of Primary Health Care (BPHC), and the DHHS Office of Minority Health created and funded the nation¡¯s first model community health centers for women. The CCOE program is designed to integrate health services with research and public outreach. The CCOEs will work with women in communities to reduce the fragmentation of health care services and the barriers to accessing and receiving high-quality care that too many women encounter. This program is part of the department¡¯s goal to eliminate racial, ethnic, and gender disparities in health status.
  OWH: 1-800-994-WOMAN
  (1-800-994-9662); 1-888-220-5446, TDD
  www.womenshealth.gov/owh/CCOE/

• The National Action Plan on Breast Cancer. In October 1993, President Clinton directed the establishment of a National Action Plan on Breast Cancer (NAPBC), an innovative public-private partnership that would coordinate a national strategy to catalyze new action in research, service delivery, and education about this disease. The NAPBC focused on six areas: (1) to facilitate communication among scientists, consumers, and health care professionals and enhance information dissemination; (2) to establish national biological resource banks to enhance research capacity; (3) to ensure consumer involvement in the development of health programs and research relating to breast cancer; (4) to increase knowledge about the causes of breast cancer, especially environmental factors; (5) to broaden the opportunities for women to participate in breast cancer clinical trials; and (6) to implement a comprehensive plan to address the health needs and ethical, legal, and policy issues related to breast cancer susceptibility genes. NAPBC: The work of the NAPBC can be seen at www.womenshealth.gov/napbc

• Federal Interagency Breast Cancer Coordinating Committee. This committee mobilizes all departments of the federal government in the fight against breast cancer by sharing information and fostering collaborations on breast cancer across government agencies.

• Reducing Teen Pregnancy. A National Campaign to Reduce Teen Pregnancy involves a group of prominent Americans to bring the message to youth across the nation. DHHS efforts to reduce teen pregnancy include abstinence-focused demonstration programs as well as support for community-wide coalitions to test innovative approaches. DHHS has published a community guidebook entitled "Preventing Teen Pregnancy: Promoting Promising Strategies."

• Microbicide Initiative. This DHHS effort, which includes a $100-million commitment for research and development, is focused on developing safe and effective topical microbicides to help women protect themselves against HIV infection.

• Initiative on Older Women. Launched in 1994 by the Administration on Aging, this initiative is creating partnerships designed to address the needs of older women and the capacity of women to contribute significantly to society throughout their lives.

• Minority Women¡¯s Health. In 1994, DHHS co-sponsored the first National Minority Women¡¯s Conference on the Status of Health and, in collaboration with the Indian Health Service, convened a National American Indian and Alaska Native Conference on the Status of Women¡¯s Health. Health education projects for women of color have also been sponsored in several regions.