The Disparities of Women in Terms of Health in America Essay

The Disparities of Women in Terms of Health in America Essay

The problem of women’s health disparities is determined by objective and subjective factors. For example, the socioeconomic factor is the subjective factor determined by current policies and overall position of women in society, whereas there are objective factors, such as specificities of women’s health. Women face some health issues that are unique for them. Today, the problem of the effective prevention of breast cancer among females is one of the major challenges to the national health care system. However, the effective prevention of breast cancer should start at the local level and the first step to the prevention of breast cancer is the close collaboration between nurses, health care professionals and individuals, who are in the risk group. Nurses working in hospitals should help patients from the risk group to undergo regular examinations to find out first signs and symptoms of breast cancer and to start the treatment as soon as possible, if the disease is diagnosed. Unfortunately, today, health care professionals fail to maintain the close and effective communication with client and local communities that leads to the emergence of cases of breast cancer, especially among women after 40.The Disparities of Women in Terms of Health in America Essay

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Breast cancer is a serious disease that affects the health and life of patients. At the same time, causes of breast cancer are not always clear, while some researchers (Rajaram & Rashidi, 1998) believe that inheritance plays an important part in the development of breast cancer. On the other hand, the development of breast cancer can be provoked by the lifestyle and environment of individuals. In this regard, women above the age of 40 are at a particularly high risk of the development of breast cancer. Therefore, they have to undergo regular examinations to examine their conditions and to diagnose breast cancer at the early stage of its development because the earlier the disease is diagnosed the easier the treatment will be.

Today, breast cancer is one of the most dangerous diseases with the high mortality rate. However, the contemporary equipment and methods of treatment allow health care professionals to treat patients with breast cancer successfully, but the key condition of the successful treatment of breast cancer is the early diagnosis of the disease. Hence, the intervention program should be the priority because it helps to educate the target population and expand their knowledge not only of breast cancer but also of effective ways of its prevention. In addition, the prevention program encourages the target population to regular examinations, especially for women after 40, who are in the greatest risk of the development of breast cancer. Thus, the intervention program will help to prevent the development of breast cancer, to encourage regular examinations and, therefore, early diagnosis of breast cancer that will increase chances of the successful treatment of the disease substantially.The Disparities of Women in Terms of Health in America Essay

Intervention programs are very effective in terms of survival in breast cancer patients. One of the studies has revealed the fact that participants of the intervention program, which taught strategies to reduce stress, improve mood and alter health behaviors, also reduced the risk of breast cancer recurrence by 45 percent (Andersen, 2008). Patients participating in an intervention program reduced their risk of dying of breast cancer by 56 percent after an average of 11 years (Andersen, 2008).

Studies conducted by many researchers (Smith, et al, 2003) have revealed the fact that the survival rate of patients with breast cancer increases, if the disease is diagnosed at the early stage

The intervention program aims at educating the target population, providing them with expertise knowledge of prevention of breast cancer, its symptoms signs and treatment. Moreover, the intervention program will encourage patients to conduct regular examinations and will support the target population in need to get access to examination and treatment of breast cancer.The Disparities of Women in Terms of Health in America Essay
The intervention program that addresses the problem of breast cancer as the distinct feature of women’s health, should be implemented at three levels: community, nursing care and health care. The women’s health intervention program should focus on the prevention of breast cancer in the local community and promote the threat of the risk cancer at the community level. Community members, mainly females above 40 are at the high risk of the development of breast cancer. In such a way, the rise of awareness of the target population about the risk of the development of breast cancer is the first and major step to the prevention of the health problem because, if women are aware of the problem, they are more likely to undergo regular examinations to detect the disease at the early stage of its development, in contrast to unaware women, who fail to have regular examinations.The Disparities of Women in Terms of Health in America Essay

The involvement of nurses into the intervention program is particularly important because they spend more time with patients than other health care professionals. Nurses should communicate the importance of regular examinations to community members and attract women to hospitals, where they can undergo examination to diagnose breast cancer. Nurses spend more time with patients than any other health care professionals. They communicate with physicians and they should become mediators between patients, who have the risk of the development of breast cancer and physicians.

Physicians, in their turn, should provide patients with examination and diagnosis of breast cancer. Regular examinations of women after their 40 is the major condition of the effective prevention of the progress of breast cancer and lethal outcomes in patients. The early diagnosis helps to detect the disease and allows patients to recover fast and successfully. Physicians should maintain close communication with nurses to help them to complete the intervention and to improve the public health through promotion of regular examinations and prevention of breast cancer. As health care professionals provide information and conduct examination of the target female population, they reduce the risk of the progress of breast cancer and minimize its negative effects in the population affected by the disease.The Disparities of Women in Terms of Health in America Essay

Thus, the intervention program is essential for the successful prevention and treatment of breast cancer. The intervention program involves education of the target population (women at all ages, especially women at the age of 40 and above) of the risk of breast cancer, ways of its prevention, symptoms, diagnosis and treatment. The program will encourage the target population to conduct regular examination to diagnose breast cancer at the early stage

The early diagnosis of breast cancer will increase the effectiveness of treatment of the disease and, thus, improve the public health in the community. Moreover, the effective prevention of breast cancer and the enhancement of intervention programs can help to eliminate women’s health disparities concerning the higher risk of the development of breast cancer which affects predominantly female population.

This dissertation is the culmination of six years of graduate education and
research in the fields of sociology and demography at the University of Pennsylvania.The Disparities of Women in Terms of Health in America Essay
Although this project is my own, the success of my work would not have been possible
without the advice from several faculty members and students at the University, as well
as the never-ending support of my family. First and foremost, I want to acknowledge
Jerry A. Jacobs, my advisor and dissertation committee chair. Jerry has been an
exceptionally supportive mentor, and his feedback and advice throughout the process of
researching and writing my dissertation has been indispensable. Sam Preston and Jason
Schnittker, the other members of my dissertation committee, have also provided helpful
theoretical, methodological, and editorial advice. My entire dissertation committee was
wonderful, and I feel fortunate to have worked with such knowledgeable and supportive
scholars in my field.
The first chapter of my dissertation was published in the International Journal of
Comparative Sociology. I would like to thank my coauthor, Virginia W. Chang, for her
hard work and dedication in getting this chapter published. In addition, the editor of IJCS,
David A. Smith, as well as the reviewers, provided insightful comments that strengthened
the paper.
Other faculty members at the University of Pennsylvania whose advice
contributed to my research include Paul Allison, Herb Smith, Kristen Harknett, HansPeter Kohler, Janis Madden, and Robin Leidner. I am also very appreciative of the
iv
advice and support I received from my fellow sociology and demography students,
including Ruth Burke, Andy Fenelon, Vitor Miranda, Allison Sullivan, Sabrina
Danielsen, Junhow Wei, Whitney Schott, and Arielle Kuperberg. I would especially like
to thank Julie Szymczak, a dear friend and indispensable asset to me throughout my
tenure in graduate school. In addition to the faculty and students, I would like to
acknowledge the incredibly helpful staff in sociology, demography, and in the Population
Studies Center library, including Audra Rogers, Carolanne Saunders, Yuni Thorton, John
McCabe, Nancy Bolinski, Aline Rowens, Karen Cooke, Shellie Copp, Addie Métivier,
and Nykia Perez Kibler.
I would not have been able to write this dissertation without the unrelenting
support from my family. Special thanks to my mom, Deborah Medalia, who has
encouraged and supported me throughout my life, and particularly in the past six years. I
am also tremendously grateful to have such a loving partner and fiancé, Drew Dallas,The Disparities of Women in Terms of Health in America Essay
who has always has my back and helps me keep my cool. Thanks also to my dad,
Anthony Phillips, and his wife, Maureen Smith, and everyone else in my family for their
love and encouragement. I would also like to acknowledge the inspiration of my Papa,
Dr. Avrom Medalia, who passed away in 2002; ever since I was eight years old I wanted
to get a PhD like him.
Finally, I dedicate this dissertation to my Nana, Judy Medalia, who motivated me
to finish this dissertation even when it felt impossible to do so. Although she passed
away in May 2011, her encouragement has stayed with me and continued to help me
v
through the process of completing my PhD. One message she reiterated when I felt
overwhelmed with school was that “If it were easy to get a PhD, everyone would do it.”
This message may sound simple, but has reminded me that it was OK that writing a
dissertation was hard. It certainly was difficult to write this dissertation, but I am so glad
that I saw it through to the end.
vi
ABSTRACT
ESSAYS ON GENDER AND HEALTH
Carla Medalia
Jerry A. Jacobs
The relationship between gender and health is complex. Although women live longer
than men in almost every country throughout the world, women also tend to be sicker
than men. While biological sex differences likely contribute to sex gaps in health, crossnational, historical, and life course variation suggest that social factors also play a role.
This dissertation is composed of three chapters which examine social explanations for
gender gaps in mortality and morbidity. The first chapter looks at the relationship
between gender equality in the public sphere, and sex gaps in life expectancy throughout
the world. I find that influence of gender equality on the sex gap in life expectancy
depends on the level of economic development. The second chapter takes an historical
perspective to examine the trend in the sex gap in depression in the United States
between 1971 and 2008. In examining this trend, I find that the sex gap in depression has
decreased over the past forty years, due to a decrease in depression among women that is
primarily attributable to an increase in women’s labor force participation and attachment.
In the third chapter, I examine the relationship between gender, aging, and depression
using longitudinal data for the population over age fifty in the United States. In doing so,
I find that age does not increase depression until age 75, after which point depression
vii
increases for both sexes, but particularly for men, leading to a reversal in the sex gap in
depression at the end of the lifespan. Furthermore, while the majority of the age effect on
depression is explained by social and health changes, I conclude that there is a net effect
of age per se on depression after age 75.The Disparities of Women in Terms of Health in America Essay

At various times, federal health policy has taken aim at reducing the
role of racism and patriarchy in health and health care. For the most
part, it has done so by treating racism and patriarchy as separate targets.
Until recently, most federal initiatives that have addressed the health
needs of women of color have done so incidentally, not expressly.
Women of color, in other words, have not figured significantly on the
federal health agenda.
In broad terms, the health arenas that racism and patriarchy mediate
include biomedical research, health care access, and quality of care.
Federal initiatives have sought to intervene in each of these arenas. For
example, federal efforts have required the inclusion of women in clinical
trials, conditioned federal funding on racial desegregation of hospitals,
and, more recently, provided guidelines for culturally and linguistically
appropriate services in health care. Each of these arenas, in turn, has
implications for health status. The state of one’s health, or one’s group’s
health, is partly a function of the availability of biomedical knowledge,
access to health care, and the quality of care received.
Critical Race Feminism’s two most basic insights tell us that antiracist
and feminist projects that fail to explicitly examine the synergistic effects
of racism and patriarchy tend to default to androcentrism and white
privilege, respectively, and that any gains these projects achieve fail to
trickle down to women of color. In the context of health care, the core
failure — inattention to the intersections of categories used for social
ordering — leaves the particular ways that racialized patriarchy allocates
health risks to women of color out of sight and out of mind. In practice,
the inattention means that health needs particular to women who are
African American, Latina, Native American, Native Alaskan, Pacific
Islander, and Asian American will receive less attention and fewer
resources than other members of society.The Disparities of Women in Terms of Health in America Essay
Tracking the history of the federal government’s efforts to intervene in
the operation of racism and patriarchy in health care shows that these
efforts were limited and very much of their times. Each period’s
initiatives used the then-dominant antidiscrimination paradigm. For
example, antiracist efforts in the 1960s focused on racial desegregation, a
key goal of that era’s fight for civil rights. More importantly, for
purposes of this analysis, the history shows that federal initiatives to
reduce the role of racism and patriarchy have been almost wholly
1026 University of California, Davis [Vol. 39:1023
separate and that the health needs of women of color have, in fact,
remained largely out of sight and out of mind.
In the 1990s, the federal government launched a series of initiatives
aimed at “health disparities,” or population-based differences in health
status and health care. The health disparities initiatives ostensibly aimed
to reduce differences by “race, ethnicity, gender, education or income,
disability, geographic location, and sexual orientation.”1
Many hoped
that the multi-axis approach to disparities would prompt a deep
examination of how sociopolitical differences allocate health risks among
us, and that the examination would yield an understanding of how those
differences operate as markers “for differential exposure to multiple
disease-producing social factors” both inside and outside the health
system.The Disparities of Women in Terms of Health in America Essay
That kind of critical approach would place women of color, as
well as many other groups, on the federal health agenda.
The historical examination and a critical analysis of the disparities
approach show that three limitations have thus far stymied the promise
of developing a multi-axis approach to health disparities. In the 1990s,
the disparities approach focused on data-based differences in health
status by race and gender. There was relatively little effort to gather data
on other potential sociopolitical bases for health disparities, or to
examine the role of discrimination as a contributing factor to health
disparities. As a result, other explanations, such as biological race,
socioeconomic status, and “lifestyle” became the prevailing explanations
for statistical differences in morbidity and mortality among racial
groups. Even less effort was made to account for health disparities
particular to women of color because they appeared primarily as a
statistical subcategory of race. More recently, policy makers have
recognized that racism is a significant contributor to health disparities
among racial groups. At the same time, however, the scope of the
inquiry into health disparities seems to be narrowing. Race is becoming
the sole focal point. The narrowing scope of the health disparities
inquiry threatens to constrain the understanding of health, as well as to
push the health needs of women of color and others back into the
shadows.The Disparities of Women in Terms of Health in America Essay
Finally, to the extent that the disparities efforts acknowledge racism’s
1
See 1 U.S. DEP’T OF HEALTH AND HUMAN SERVS., HEALTHY PEOPLE 2010, 11 (2000),
available at http://www.healthypeople.gov/document/tableofcontents.htm [hereinafter
HEALTHY PEOPLE 2010]. 2
David R. Williams & Pamela Braboy Jackson, Social Sources of Racial Disparities in
Health, 24 HEALTH AFF. 325, 325 (2005).
2006] In the Shadow of Race 1027
role in creating health disparities, the understanding of how racism
operates and the proposals to reduce health disparities have been
primarily structuralist. They focus on organizational structures,
practices, and the formal and informal rules of health care institutions.
Accounts of how racism affects health care access and quality of care
acknowledge the complex, interactive nature of stereotyping and lead to
proposals for organizational change, such as affirmative action, to
eliminate the problems. While structuralist analysis is good at
identifying opportunities for legal intervention, an exclusive focus on
health care organizations and practices fails to fully account for how
orders of power formed by racialized patriarchy can persist despite the
dismantling of specific institutional structures and practices.
Critical analysis of cultural formation sheds light on this phenomenon.
As many others have shown, critical cultural inquiry is sensitive to
multi-axis difference, differential subordination, and the fact that
ideology, including racialized patriarchy, adapts quickly to structural
change. Critical theory’s attention to ideology allows for a more
nuanced and complicated understanding of how inequality becomes
embedded in our understanding of “health.”The Disparities of Women in Terms of Health in America Essay

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In Part I, I track the federal government’s initiatives to reduce the role
of racism and patriarchy in health care from the 1940s to the 1970s. I
focus on the ways in which race and gender differences have been
framed within federal health policy and the resulting inattention to the
health needs of women of color. In Part II, I describe the federal
government’s return to examining the role of difference in health care in
the mid-1980s and the subsequent emergence of a “health disparities”
approach to that work. The new disparities paradigm focused on
quantifiable health status differences among sociopolitical population
groups. I argue that the tendency to decontextualize the data de-linked
race from racism and thus precluded that work from providing a
substantial account of health disparities. In addition, while the
disparities approach held the potential to develop a multi-axis approach
to the role of difference in health care, the commitment to examining
anything other than the role of race wavered. As a result, women’s
health initiatives and minority health initiatives have remained largely
separate endeavors. Part III tracks the most recent shift from an
understanding of “disparities,” in which racism and patriarchy received
little attention as explanations, to an emerging understanding which
recognizes racism as a significant contributor to health disparities. I
argue that despite the necessity of re-linking race and racism in
1028 University of California, Davis [Vol. 39:1023
disparities research, the disparities work is still hampered by the past.
The analysis of racism remains primarily structuralist, and race seems to
be the only axis of difference at issue in disparities research. I describe
the resulting proposals for institutional change and argue that the
resulting structuralist discourse, as well as the near-exclusive focus on
race, may inhibit efforts to place the health needs of those not privileged
in the categories of “race” and “gender” on the national health agenda.
In Part IV, I sketch an analytical approach that combines the strengths of
structuralism and critical cultural inquiry. This approach holds greater
potential than structuralism alone to deepen understanding of the roles
that difference plays in health and health care, and to move beyond the
traditional race-only civil rights analysis in health care.
I. THE FEDERAL GOVERNMENT’S ROLE IN ADDRESSING RACISM AND
PATRIARCHY IN HEALTH CARE: 1940S-1970S
Federal efforts to address the role of racism and patriarchy in health
care have been sporadic, limited, and largely separate. From the 1940s to
the late 1960s, the Truman, Kennedy, and Johnson administrations took
steps to end de jure racial segregation, including racial segregation in
health care. In the 1970s, the women’s health movement became an
influential component in the women’s rights movement, but did not
succeed in putting women’s health on the federal health agenda.
Neither the efforts to desegregate health care nor the women’s health
movement substantially addressed the status or the health needs of
women of color.The Disparities of Women in Terms of Health in America Essay
A. The Federal Government’s Influence
The federal government is the most significant actor in the nationallevel effort to reduce inequalities in health care.3
State governments and
nongovernmental participants, including insurers, can do much to
reduce inequalities that impair health care.4
Yet, a combination of
3
See also Nicole Lurie, Minna Jung & Risa Lavizzo-Mourey, Disparities and Quality
Improvement: Federal Policy Levers, 24 HEALTH AFF. 354, 354 (2005) (advocating for use of
quality improvement framework, implemented by Department of Health and Human
Services and related agencies, to reduce racial and ethnic health care disparities). 4
See Marsha Lillie-Blanton & Catherine Hoffman, The Role of Health Insurance Coverage
in Reducing Racial/Ethnic Disparities in Health Care, 24 HEALTH AFF. 398, 406 (2005); David R.
Nerenz, Health Care Organizations’ Use of Race/Ethnicity Data to Address Quality Disparities, 24
HEALTH AFF. 409, 410 (2005); Amal N. Trivedi et al., Creating a State Minority Health Policy
2006] In the Shadow of Race 1029
funding and regulatory power enhances the federal government’s direct
and indirect influence on health care. The federal government is the
biggest payer of health care services.5
These services include programs
that provide care for half of the nation’s racial minorities.6
The
Department of Health and Human Services and related agencies provide
oversight for much of the access to and quality of health care in the
United States.The Disparities of Women in Terms of Health in America Essay
The federal government is a major funding source for
biomedical research and has the accompanying regulatory authority
over health care access and quality. In addition, history shows that the
government has experience in addressing inequality in health care. As a
result, the federal government has unparalleled direct and indirect
influence over health care policy and practice.
B. Racism in Health Care: The Civil Rights Era8
In the mid-twentieth century, the dominant framework for addressing
racism was desegregation of society’s most essential institutions,
including health care facilities. The Truman, Kennedy, and Johnson
administrations made serious efforts to desegregate health care. Their
efforts, like most efforts in the civil rights movement of that time, aimed
at race- and class-based exclusions, but paid little attention to the
particularized experiences of women of color. By the late 1960s, the
federal government had pulled back from its efforts to desegregate
health care.
Federal efforts to end racially segregated health care date back to the
1940s. The Hill-Burton Act and Title VI of the Civil Rights Act of 1964
were key tools in those efforts. Congress enacted the Hill-Burton Act to
provide federal funding for hospital construction. The law mandated
nondiscrimination by providing that a “hospital or addition . . . will be
made available to all persons residing in the territorial area of the
applicant without discrimination on account of race, creed, or color.”9

However, a provision immediately following the nondiscrimination
Report Card, 24 HEALTH AFF. 388, 393 (2005). 5
See Medicare and Medicaid Programs: Hospice Conditions of Participation, 70 Fed.The Disparities of Women in Terms of Health in America Essay
Reg. 30,840 (May 27, 2005) (to be codified at 42 C.F.R. pt. 418). 6
Lurie, Jung & Lavizzo-Mourey, supra note 3, at 356. 7
See id. 8
For a detailed account and analysis of the role of racial segregation in health care,
see DAVID BARTON SMITH, HEALTH CARE DIVIDED: RACE AND HEALING A NATION (1999). 9
Hospital Survey and Construction Act, Pub. L. No. 79-725, § 622(f), 60 Stat. 1040,
1043 (1946) (codified as amended at 42 U.S.C. § 291e).
1030 University of California, Davis [Vol. 39:1023
mandate made “an exception . . . in cases where separate hospital
facilities are provided for separate population groups, if the plan makes
equitable provision on the basis of need for facilities and services of like
quality for each such group.”10 Thus, the Hill-Burton Act funded and
thereby enabled racially segregated facilities. Hospitals, particularly
those in the South, took advantage of the separate but equal provision by
maintaining racially segregated facilities.11 In 1948, President Truman
took a much less ambivalent stance on desegregation. He issued
executive orders12 that most associate with desegregating the military.
The same orders forced federal health facilities, including the Veterans
Administration, to desegregate.13 Because the vast majority of United
States residents did not use federal health facilities, these orders had
more political significance than direct impact on health care. The federal
government played its most significant role in reducing inequality in
health care in the 1960s. In 1963, the Fourth Circuit held the “separate
but equal” provision of the Hill-Burton Act unconstitutional in Simkins v.
Moses H. Cone Memorial Hospital.
14 In the spring of 1964, the Department
of Health Education and Welfare revised the Hill-Burton regulations
according to the Simkins holding.15 During the summer of 1964,
Congress enacted both a five-year extension of the Hill-Burton Act
without the “separate but equal” provision16 and Title VI of the 1964
Civil Rights Act, which prohibited racial discrimination by facilities that
accept federal money and established the Office of Equal Health
Opportunity to carry out Title VI’s mandates.17
Initially, Title VI proved to be a weak tool for desegregating health
care because relatively few facilities received federal money.18 Then, in
1966, President Johnson insisted that no hospital could enroll in the thennew Medicare program unless the hospital provided assurance of
10 Id.The Disparities of Women in Terms of Health in America Essay
11 SMITH, supra note 8, at 47. 12 Exec. Order No. 9981, 13 Fed. Reg. 4313 (July 26, 1948); Exec. Order No. 9980, 13 Fed.
Reg. 4311 (July 26, 1948). 13 For a broader account of Executive Orders 9980 and 9981, see MICHAEL R. GARDNER,
HARRY TRUMAN AND CIVIL RIGHTS: MORAL COURAGE AND POLITICAL RISKS 105-21 (2002). 14 Simkins v. Moses H. Cone Mem’l Hosp., 323 F.2d 959, 969 (4th Cir. 1963).
15 SMITH, supra note 8, at 106-07. 16 Id. at 107. 17 See id. at 143-59. 18 Sidney D. Watson, Race, Ethnicity and Quality of Care: Inequalities and Incentives, 27
AM. J.L. & MED. 203, 214 (2001).
2006] In the Shadow of Race 1031
compliance with Title VI.19 A substantial percentage of the U.S. hospitals
had been racially segregated, particularly in the South.20 By July 1, 1966,
the launch date for Medicare, 92% of hospitals in the United States had
officially desegregated.21
President Johnson’s insistence on using Medicare funding as leverage
to desegregate hospitals did substantially reduce the most obvious form
of racism in health care. It did not eliminate racism in health care.22 It
did not even eliminate segregated health care facilities.23 From the late
1960s, however, the government began what health care scholar David
Barton Smith has characterized as “the federal retreat” from civil rights
enforcement in health care.24 This happened despite the best efforts of
the Office of Equal Health Opportunity staff. In the absence of federal
initiative, the burden of reducing racial inequities in health care fell
primarily on civil rights organizations such as the NAACP,25 public
health advocates,26 and individual providers.27 Efforts to eliminate racist The Disparities of Women in Terms of Health in America Essay

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