Woman Health
WOMEN¡¯S HEALTH ISSUES: AN OVERVIEW ( 1 )
By WOMEN¡¯S HEALTH ISSUES: AN OVERVIEW ( 1 )
Mar 17, 2006, 19:23

BACKGROUND

A woman¡¯s life expectancy has increased from 48.3 years in 1900 to 79.4 years in 1997. Today, our challenge is to make those extra years of life healthy and productive. Women represent 51 percent of the total U.S. population; 59 percent of the over-65 population; and 71 percent of Americans older than age 85, the fastest growing segment of the population. Women also constitute 46 percent of the nation¡¯s workforce. They make up 52 percent of the voting-age population, and they are more likely to vote in national elections than are men. In 1996, 55.5 percent of women voted in contrast to 52.8 percent of men.

A woman¡¯s health reflects both her individual biology and her sociocultural, economic, and physical environments. These factors affect both the duration and the quality of her life. For example, the average life expectancy for a woman varies considerably according to her race. In 1997, the average life expectancy for white women was 5 years longer than that of African American women (80 years versus 75 years). Women who live in poverty or have less than a high school education have shorter life spans; higher rates of illness, injury, disability, and death; and more limited access to high-quality health care services.

Historically, women have also been the primary health care providers and health decision-makers for their families. Nearly two-thirds of women polled in a recent national survey indicated that they alone were responsible for health care decisions within their family, and 83 percent had sole or shared responsibility for financial decisions regarding their family¡¯s health. Women are also the primary care givers for ill or disabled family members. Of the estimated 15 percent of Americans who are informal care givers, an estimated 72 percent are women¡ªmany of them sandwiched between caring for an ailing relative and caring for their own children.

BARRIERS TO WOMEN'S HEALTH CARE

MEDICAL RESEARCH

Until recently, medical research has largely ignored many health issues important to women, and women have long been under-represented in clinical trials. In the past, research on women¡¯s health focused on diseases that affect fertility and reproduction, while many studies on other diseases focused on men. At present, most women receive diagnoses and treatment based on what has worked for men. However, the efforts of women¡¯s health advocates and the unveiling of inequities in medical research have led to a broadened research agenda. This research is beginning to yield insights into the health-related similarities and differences between men and women.

BARRIERS TO WOMEN'S HEALTH CARE

HEALTH CARE PRACTICES

When women try to meet their needs for reproductive health care and other health care services, they often face a fragmentation in the health care system itself. Furthermore, women make more visits to the doctor than do men. Women are highly interested in, and informed about, health care issues. However, reliable information about health care has not been widely available. National studies have indicated that women may not be as satisfied with the information they receive from their health care providers as are men or with the level of communication with their provider.

Furthermore, several studies have found that health care providers treat women differently than they do men. Compared with the treatment given to men, health providers may give women less thorough evaluations for similar complaints, minimize their symptoms, provide fewer interventions for the same diagnoses, prescribe some types of medications more often, or provide less explanation in response to questions.

ACCESS TO HEALTH INSURANCE

Although the health of the American economy has never been better, more women than ever lack health insurance coverage. The proportion of uninsured women under age 65 rose from 14 percent in 1993 to 18 percent in 1998. More dramatic still, the proportion of women under 65 who lacked health insurance for all or part of 1998 was a staggering 26 percent, according to the 1998 Commonwealth Fund Survey of Women¡¯s Health.

The women who are most likely to have no health insurance are those who earn low or moderate incomes, women of color, and women with health problems. More than 8 in 10 uninsured women are employed or they are married to someone who is employed. Lack of insurance severely compromises both the accessibility and quality of health care.

Seventy percent of women under age 65 had private health insurance in 1997, and 12 percent were covered by Medicaid. Almost all Americans aged 65 and over are covered by the Medicare program, including 92 percent of those who also have private insurance.

PRIORITY WOMEN'S HEALTH ISSUES

HEART DISEASE

Heart disease is the number one killer of American women. Although it is typically viewed as a man¡¯s disease, more women actually die of heart disease each year than do men. On average, women develop heart disease later in life than do men. In addition, women are more likely to have other co-existing, chronic conditions that may mask their symptoms of heart disease than are men.

Symptoms of a heart attack in women may also differ from those in men, which can lead to a misdiagnosis of the disease in women. Women who recover from a heart attack are more likely to have a stroke or to have another heart attack than are men. In fact, 42 percent of women die within a year following a heart attack compared to 24 percent of men.

CANCER

Cancer is the second leading killer of American women. Since 1987, lung cancer has been the leading cause of cancer death among women in the United States, with an estimated 66,000 deaths in 1999. Over the past 10 years, the mortality rate from lung cancer has declined in men but has continued to rise in women. These alarming trends are under-recognized by women, and they are due almost exclusively to increased rates of cigarette smoking in women.

At present, breast cancer is the second leading cancer killer of American women, claiming the lives of 43,300 women in 1999. The incidence of breast cancer rose steadily from 1940 to 1990, then stabilized at approximately 110 cases per 100,000 women. With the increased use of mammography screening, breast cancers have increasingly been detected earlier in their development, when they are more treatable.

This earlier detection, coupled with improved treatment, has led to a decline in death rates from breast cancer. Between 1990 and 1994, breast cancer mortality decreased by 5.6 percent. This decline was more pronounced among white women (whose mortality rate dropped 6.1 percent) than among African American women (whose mortality rate dropped just 1 percent).

Colorectal cancer accounts for the third leading cause of cancer deaths in American women. Many cases are preventable with regular screening; regular exercise; and a diet low in fat and high in fruits, vegetables, and whole-grain foods. Nonetheless, colorectal cancer is expected to claim the lives of 28,800 women in 1999.

With the advent of the Pap smear, the early detection and prevention of cervical cancer has improved dramatically. Both the incidence and death rates from this disease have declined by 40 percent since the early 1970s. However, many elderly, low-income, and rural women remain at high risk for this disease because they are not obtaining regular Pap screenings. Other major risk factors include cigarette smoking and infection with certain types of the human papillomavirus (HPV).

An estimated 12,800 new cases of cervical cancer are expected to be diagnosed in 1999. It is also estimated that 4,800 persons will die from the disease that year.

The Pap smear and pelvic examination are only partially successful at detecting endometrial (uterine lining) cancer, which claimed an estimated 37,400 new cases in 1999 and led to 6,400 deaths. Although the incidence of ovarian cancer is lower, ovarian cancer is the most deadly of all the cancers of the female reproductive system. Symptoms often appear only in the very advanced stages of the disease. In 1999, there were nearly 25,200 ovarian cancer cases with over 14,500 deaths.

Melanoma¡ªthe most serious form of skin cancer¡ªis the most frequent cancer in women 25 to 29 years of age and the second most frequent (after breast cancer) in women ages 30 to 34. While men as a group are more likely to develop skin cancer than are women, women under the age of 40 comprise the fastest growing group of skin cancer patients. Furthermore, the rate of new melanoma cases is increasing. Since 1973, it has doubled from 6 cases per 100,000 persons to 13 cases per 100,000 persons in 1995.

STROKE

A stroke is usually caused by a clot that stops the flow of blood to an area of the brain. Stroke can cause paralysis, loss of speech, and poor memory. Stroke is the third leading cause of death for American women, and it kills more than twice as many women each year as breast cancer. It is the most common cause of adult disability in this country.

Women account for 43 percent (or 240,000) of the 550,000 strokes that occur each year and 61 percent of stroke deaths (97,227 of 159,791 annual deaths). Stroke occurs at a higher rate among African American and Hispanic women than among white women.

Taken together, stroke and heart disease kill nearly twice as many American women as do all types of cancer combined. More than one woman in five in this country has some form of major heart or blood vessel (cardiovascular) disease. However, in a 1997 national survey, only 8 percent of American women recognized heart disease and stroke as the leading cause of women¡¯s deaths.

CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD)

COPD includes chronic bronchitis, emphysema, and asthmatic bronchitis, all of which obstruct airflow from the lungs. In 1997, COPD was the fourth leading cause of death among women, claiming the lives of 53,045. The mortality rate from this disease was 17.7 deaths per 100,000 persons in 1997. While death rates from COPD are much higher in men than in women, the rates for women have nearly doubled since 1979. The most rapid increases have occurred in women ages 75 and older.

HIV/AIDS

Long considered a man¡¯s disease, HIV/AIDS is a public health problem among women. It is the fifth leading cause of death among women ages 25 to 44 and the third leading cause of death among African American women in this age group.

Between July 1998 and June 1999, 10,841 new AIDS cases among adult and adolescent women were reported. From 1985 to 1999, the proportion of AIDS cases reported among women increased from 7 percent to 23 percent. Among 13- to 19-year-olds, girls constituted 50 percent of all AIDS cases reported in 1998. By June of 1999, a total of 114,621 women were reported to have AIDS, and 77 percent of women diagnosed with AIDS were African Americans and Latinas.

Fortunately, increased screening for HIV among reproductive-age women and more effective therapies to reduce perinatal transmission of HIV have been quite effective. They have contributed to the 75 percent decline in the proportion of infants diagnosed with perinatally acquired AIDS since 1993.

The most common mode of HIV infection among adult and adolescent women is through heterosexual contact, followed by intravenous drug use. Significant gender differences are manifest throughout the course of the illness as well as in the mode of infection. These differences indicate the need for gender-sensitive treatment and prevention strategies to stem the spread of AIDS.

AUTOIMMUNE DISEASES

Autoimmune diseases arise when, for unknown reasons, a person¡¯s body declares war on itself, producing antibodies that attack healthy tissue. About 75 percent of autoimmune diseases occur in women, including systemic lupus erythematosus (SLE), Sjögren¡¯s syndrome, rheumatoid arthritis, scleroderma, diabetes Type I, multiple sclerosis, and autoimmune thyroid disease. When considered as individual conditions, autoimmune diseases are not very common. However, taken together as a group, they represent the fourth largest cause of disability among women in the United States. These diseases remain misunderstood and misdiagnosed.

MENTAL ILLNESS

One in 10 Americans experiences an episode of depression each year. Major depression and dysthymia (a less severe, more chronic form of depression) affect approximately twice as many women as men. An estimated 12 percent of women in the United States experience a major depression during their lifetimes, compared with 7 percent of men; and 4.2 percent of women have dysthymia.

Women are 2 to 3 times more likely to have certain types of anxiety disorders, including anxiety, panic, and phobic disorders. At least 90 percent of all cases of eating disorders occur in women. In addition, a high correlation appears to exist between eating disorders and depression and between eating disorders and substance abuse.

Untreated mental illness can be fatal. Suicide was the fifth leading cause of death among women ages 25 to 44 in 1994 and the fourth leading cause of death for young women ages 15 to 24. Women are more likely to attempt suicide than are men. However, women are far less likely to die from their attempt(s), largely because men are more likely to use a firearm.

SUBSTANCE ABUSE

The abuse of alcohol and other legal and illicit drugs is a serious and continuing problem among American women. Approximately 120,000 deaths are attributed to alcohol and drug use each year. In 1998, the health and societal costs of alcohol and substance abuse were estimated at $238 billion.

Nearly 4.1 million women in this country currently use illicit drugs, and over 1.2 million misuse prescription drugs for non-medical reasons. In 1997 and 1998, 4.5 million women ages 15 to 44 were current illicit drug users, including 1.6 million who had children living with them. Only 3.2 percent of pregnant women were current drug users. However, the rate increased to 6.2 percent among women who had a child under age 2 and who were not pregnant. Women account for an estimated 37 percent of illicit drug users in this country.

Women are less likely to use or abuse alcohol than are men. Death rates among female alcoholics, however, are 50 to 100 percent higher than those of their male counterparts. In 1998, 2.1 percent of American women were heavy drinkers; 8.6 percent were binge drinkers (more than five drinks at one time); and 45.1 percent of women had at least one alcoholic drink in the past month. Among teenage girls in 1997, 40 percent reported some alcohol consumption in the past month, and 29 percent reported binge drinking.

Heavy drinking during pregnancy has been clearly associated with severe birth defects, including mental retardation, nervous system disorders, abnormal features of the face and head, and retarded growth. The effects of moderate drinking (one to two drinks per day) are not well-established, so the only known safe level of drinking during pregnancy is total abstinence. In 1996, 16.1 percent of pregnant women reported any alcohol use; 1.3 percent reported binge drinking; and 0.5 percent reported heavy drinking (five or more drinks per day) in the past month.

Many women who abuse drugs or alcohol have histories of mental illness. Seventy percent report having been sexually abused before the age of 16, and more than 80 percent say they have a family member addicted to drugs or alcohol. These factors complicate the course of their illness and treatment planning. Women who abuse alcohol or drugs are also at higher risk for HIV/AIDS, tuberculosis, oral and pharyngeal cancer, injury, and sexually transmitted diseases (STDs).

SMOKING

Cigarette smoking is the leading preventable cause of death in this country, contributing substantially to deaths from cancer, lung disease, heart disease, stroke, and other causes. Smoking rates among women have decreased 35 percent since their peak in 1965. Nonetheless, 22.3 million adult women (or 22.1 percent of this population) were still current smokers in 1997. Unlike their adult counterparts, the rate of smoking among teenage girls has been increasing, rising from 27 percent in 1991 to 37 percent in 1997. In 1997, 70 percent of high school-aged girls had tried cigarette smoking.

Smoking during pregnancy substantially increases health risks to the developing fetus. It is the leading cause of premature births, and it greatly increases the risks of mental retardation, miscarriage, low birth weight, and other serious health conditions in infants. The 1997 National Household Survey on Drug Abuse indicated that 19.9 percent of pregnant women smoked cigarettes, with the highest rates among women in their first trimester of pregnancy and the lowest among those in their third trimester. The smoking rate among women with children under the age of 2 was 26.6 percent. This statistic indicates that some women may abstain from smoking during pregnancy, but resume smoking after their child is born.

Children who have been exposed to second-hand cigarette smoke are at increased risk of Sudden Infant Death Syndrome (SIDS); recurring ear infections; and severe respiratory illnesses such as bronchitis, pneumonia, and asthma.

VIOLENCE

Violence is a major public health problem for American women. More than 4.5 million women are victims of violence each year. Of these women, nearly two of every three are attacked by a relative or someone they know. Women are 6 times more likely to be abused by someone they know than are men and 10 times more likely to be victims of sexual assault. It is estimated that 10 to 20 percent (or one to two young women in 10) are the victims of sexual abuse.

In 1997, homicide was the second leading cause of death among women ages 15 to 24 and the sixth leading cause of death among women ages 25 to 44. It is the leading cause of occupational deaths in women.

Researchers are increasingly concerned that violence may also be an important hidden cause of maternal mortality. The prevalence of violence during pregnancy appears to range from 4 percent to 8 percent. Applying these percentages to the 3.9 million U.S. women who delivered live-born infants in 1995 yields the conclusion that 152,000 to 325,000 women experienced violence during their pregnancies. Thus, violence may be a more common problem for pregnant women than preeclampsia, gestational diabetes, or placenta previa.

REPRODUCTIVE HEALTH

Women¡¯s reproductive capacity plays an important role in shaping their lives and health experiences. Over 80 percent of all American women have had a child by the age of 45, and the average woman has 2.2 children.

While motherhood is a defining feature of adult life for many women, most spend the greater part of their reproductive years trying to avoid pregnancy. Sixty-four percent of women ages 15 to 44 use some form of contraception, up from 56 percent in 1982 and 60 percent in 1988. Women¡¯s use of contraception at first intercourse has risen from 64 percent in the late 1980s to 76 percent in 1995.

From 1987 to 1994, the rate of unintended pregnancy dropped 16 percent. This decline was due most likely to an increase in the use of contraceptives and the improved effectiveness of contraceptive methods. However, 49 percent of pregnancies in 1994 were unintended. Nearly half of all women who experienced an unplanned pregnancy in 1994 had been using some form of contraception.

The most commonly used contraceptive is female sterilization (10.7 million women), followed by birth control pills (10.4 million), the male condom (7.9 million) and male sterilization (4.2 million). In 1995, 2 percent of women used injectable hormones, 1 percent used hormonal implants, and less than 1 percent used the female condom for contraception.

Gynecological health is not only an important component of women¡¯s health during their reproductive years, but throughout the course of their lives. The average woman spends a third of her life beyond menopause. While many older women mistakenly believe that regular gynecological exams are no longer necessary, this is precisely the point in life when they are at higher risk for cancers of the reproductive system and other gynecological problems such as uterine prolapse.

Younger women are particularly at risk for reproductive health problems associated with sexually transmitted diseases (STDs). Two-thirds of all STD cases occur among individuals younger than 25 years, and one in four teenagers contracts an STD each year. Women are more susceptible biologically to becoming infected with STDs than are men, and younger women are more at risk than their older counterparts due to differences in their cervical anatomy.

Women are less likely than men to experience symptoms of STD infection. For example, chlamydia¡ªthe nation¡¯s most prevalent curable infectious disease¡ªproduces symptoms in 50 percent of men compared to only 25 percent of women. Left undetected, 20-40 percent of women infected with chlamydia and 10-40 percent of those infected with gonorrhea develop pelvic inflammatory disease (PID). In turn, PID leads to infertility in 20 percent of cases, chronic pelvic pain in 18 percent of cases, and ectopic pregnancy in 9 percent of cases. In addition to the direct health problems caused by STD infection, high rates of STD infection in adolescent women contribute to an increased susceptibility to HIV. In 1998, more than half a million new cases (501,128) of chlamydia were reported in American women. That same year, 179,651 new cases of gonorrhea were reported. (Young women ages 15 to 19 had the highest rates of gonorrhea infection.) In addition, 18,179 cases of syphilis were reported. Herpes simplex virus type 2 (HSV-2) infects about one in four women (or 25 percent of this population) and one in five men (or 20 percent of men).

Gynecological problems are common among women of reproductive age. More than 4.5 million women ages 18 to 50 report at least one chronic gynecological condition each year. Half of all women who menstruate experience some pain during menstruation, and 10 percent of them suffer from pain so severe (dysmenorrhea) that it interferes with their daily routine. Nearly two in five women between the ages of 14 and 50 experience some symptoms of premenstrual syndrome (PMS)¡ª10 percent with symptoms severe enough to disrupt their usual activities.

As many as 10 percent of American women have endometriosis, which can cause chronic pain and infertility. Between 10 and 20 percent of women have uterine fibroids (non-cancerous growths in the uterus). Together, endometriosis and fibroids are associated with half of the more than 580,000 hysterectomies performed in the United States each year. Other causes include cancer, excessive bleeding or pain, and uterine prolapse. One woman in three over the age of 60 has had a hysterectomy, and it is the second most commonly performed surgical procedure in the nation.

FERTILITY AND INFERTILITY

In 1997, there were 3,880,894 live births in the United States. From 1950 to 1997, the birth rate dropped from 24 live births per 1,000 population to 14.5 per 1,000. Most American women who bear children are between the ages of 20 and 29. However, the proportion of women in their thirties and forties who are having babies has increased throughout this decade. There were 483,220 births to teenage girls in 1997¡ªrepresenting a 16 percent drop since 1991.

Infertility affected 6.1 million women in 1997, up from 4.6 million in 1988¡ªan increase due in part to delayed childbearing and the aging of the baby boom generation. The causes of infertility are equally distributed among conditions affecting the male partner, the female partner, and both partners. Approximately one in four infertile couples are unable to conceive as a result of sexually transmitted diseases, according to the American Society for Reproductive Medicine.

Research has repeatedly indicated that timely and adequate prenatal care greatly enhances the chances for positive pregnancy outcomes. In 1997, more than 82.5 percent of all pregnant women received prenatal care in the first trimester of pregnancy¡ªreflecting a steady improvement since 1970. Still, 3.9 percent of pregnant women received prenatal care only in their third trimester or not at all.

The infant mortality rate reached a new low in 1997 of 7.2 deaths per 1,000 live births. Approximately one-third of that reduction is associated with an estimated 15 percent decline in Sudden Infant Death Syndrome (SIDS) between 1995 and 1996. In spite of these improvements, the infant mortality rate in the United States remains one of the highest in the industrialized world.

The maternal mortality rate has decreased more than tenfold since 1950. In 1997, there were 7.6 maternal deaths per 100,000 live births. However, new, improved data collection techniques suggest that the rate of maternal mortality associated with heart ailments, embolism, hemorrhage, high blood pressure, domestic violence, and infection may be higher than current measures indicate.

ENVIRONMENTAL HEALTH

Environmental factors contribute substantially to the cause of many diseases in women. Adverse environmental conditions range from water, air, and soil pollution to contamination through the workplace. Occupational hazards include exposure to lead, chemicals, pesticides, tobacco smoke, and continuous noise. Home and community environmental factors¡ªfrom radon, lead-based paints, electromagnetic fields, food, and cosmetics to heatstroke, hypothermia, and violence¡ªaffect women¡¯s health. The ways in which environmental factors may disrupt women¡¯s endocrine, reproductive, central nervous, and immune systems and cause specific diseases such as cancer, autoimmune diseases, endometriosis, and osteoporosis are only beginning to be understood.

CHRONIC DISABLING CONDITIONS

In part because they live longer than men, women are more likely to be affected by such chronic disabling conditions as diabetes, osteoporosis, osteoarthritis, obesity, urinary incontinence, Alzheimer¡¯s disease, fibromyalgia, and chronic fatigue syndrome. These conditions not only limit function, but over time they may be life-threatening. Each of these disorders is characterized by a long trajectory of increasing impairment.

Chronic illnesses exert an untoward effect not only upon the person experiencing them but also upon family members and other care givers. More research is needed to determine whether specific gender-related factors contribute to the increased incidence of these illnesses in women.

Diabetes mellitus. An estimated 16 million Americans have diabetes. However, only 10.3 million cases are diagnosed, of which 8.1 million are women. The prevalence of diabetes is 2 to 4 times higher among Black, Hispanic, American Indian, and Asian Pacific Islander women than among white women.

Diabetes can be controlled through a proper diet, weight loss, exercise, or the use of medications. Left untreated, diabetes can lead to severe vision loss, heart disease, stroke, kidney disease, amputation of the lower limbs, and even death. Diabetes is the fourth leading cause of death in African American, Native American, and Hispanic women; the sixth leading cause in Asian American women; and the seventh leading cause in white women.

Osteoporosis is a disorder characterized by the thinning and increasing brittleness of bones, a condition that can lead to bone fracture. It afflicts more than 25 million Americans, 80 percent of whom are women. More than half of all women over age 65 suffer from this condition.

Each year, osteoporosis causes 1.5 million fractures of the hip, wrist, vertebrae, and other bones. It accounts for 70 percent of all the fractures occurring every year annually in people over the age of 45. Twenty percent of the women who suffer a hip fracture die within one year of that event.

The annual costs associated with osteoporosis are estimated at over $10 billion, and it is a major cause of admission to nursing homes. Although osteoporosis is typically viewed as a geriatric concern, the prevention of osteoporosis spans the entire life course. Approximately 60 percent of a woman¡¯s final bone mass is acquired by the time she is 18, and peak bone density is achieved by age 35. To build and maintain healthy bones, girls and women of all ages need to consume calcium-rich foods, get regular exercise, and avoid tobacco and the excessive consumption of alcohol or caffeine. Further treatment strategies include the use of calcium and vitamin D supplements, estrogen replacement therapy at menopause, and nonhormonal medication to stem bone loss.

An estimated 4 million people in the United States suffer from Alzheimer¡¯s disease. In 1995, more than 13,600 women died from the disease. It is the most common cause of dementia for individuals over age 65. Alzheimer¡¯s disease places a heavy burden on society, costing an estimated $80 to $100 billion each year. It also takes a heavy toll on the individuals (primarily women) who take care of people with Alzheimer¡¯s.

Urinary incontinence (the unintentional loss of urine) affects 13 million Americans¡ª11 million of them women. Although half of all elderly people experience episodes of incontinence, it is not exclusively a problem among the elderly. In fact, one in four women ages 30 to 59 experiences urinary incontinence. Women are most likely to develop this problem during pregnancy, childbirth, and physical activity or after menopause due to weakened pelvic muscles or pelvic trauma.

Incontinence is treatable in 8 out of 10 cases. However, fewer than half of the people who experience this problem discuss it with a health care professional.

Since the 1970s, the rate of obesity among females has increased by more than one-fourth to a rate of 36 percent. The rate is particularly high among African American women (52.3 percent) and Mexican-American women (50.1 percent). Much of this rising rate is attributed to the increasing lack of physical activity and overeating. Being overweight increases women¡¯s risks of heart disease, diabetes, high blood pressure, arthritis, and some types of cancer.

Nearly 26.4 million of the 42.7 million Americans with arthritis are women. It is the most common and disabling chronic condition reported by women. An estimated 4.6 million American women (or 4.6 percent of this population) report that arthritis limits their daily activities. Higher rates are reported among African American (6.5 percent) and Native American women (6.9 percent) than among white women (4.2 percent).

The term arthritis commonly refers to a group of more than 100 diseases of the muscles, tendons, joints, bones, or nerves. These conditions range from mild to severe. Arthritis most commonly causes pain or stiffness in the joints of the hands, feet, knees, and hips. Risk factors including increasing age, injury, obesity, and genetic predisposition. Although arthritis is more common among the elderly, half of all Americans affected by the disease are under the age of 65. Treatment for arthritis includes medication, exercise, use of heat or cold on the affected area, weight control, and surgery.

Fibromyalgia. The American College of Rheumatology reports fibromyalgia affects 3 million to 6 million Americans. An estimated 80 percent of sufferers are women, most of whom are of childbearing age. Fibromyalgia is a common disorder characterized by widespread musculoskeletal pain; fatigue; and multiple tender points in the neck, spine, shoulders, and hips. People with fibromyalgia may also experience sleep disturbances, morning stiffness, irritable bowel syndrome, anxiety, and other symptoms.

Chronic Fatigue and Immune Dysfunction Syndrome (CFIDS) is characterized by persistent and debilitating fatigue and additional nonspecific symptoms such as sore throat, headache, tender muscles, joint pain, difficulty thinking, and loss of short-term memory. Estimates show that CFIDS affects as many as 500,000 persons in the United States. Approximately 80 percent of those diagnosed with the syndrome are women.

Most of the health care burden in the United States stems from chronic illness, more than half of which may be related to lifestyle and behavioral factors. An estimated 47 percent of premature deaths in the United States could be prevented by modifying lifestyle behaviors (including tobacco use, diet, physical activity, the use of helmets and seatbelts, sexual behavior, and alcohol and drug abuse). An estimated 20 percent of these premature deaths could be prevented by reducing environmental risks. Developing effective strategies to change behavior as well as women-focused programs that promote health are critical to improving the quality and length of life.