A recently published, comprehensive review in the American Journal of Medicine (November 2008) sadly revealed that older women in above-average health are not screened for breast cancer or colon cancer, while the oldest women in below-average health are screened.
Regardless of health status, many older women do not receive immunizations from which they may benefit such as those for pneumonia or influenza. Meanwhile, many received Pap smears as a screen for cervical cancer, from which they are unlikely to benefit because of the low risk pool they are in. Exercise counseling, according to the research, is unfortunately uncommon but important to weight management, emotional well-being, and protection against fall prevention and bone fractures.
What a disappointing report card on primary care!
In December, the National Women's Health Resource Center published results of a national survey of women across all age groups from which it discovered nearly half of all women have begun to skip their screenings and preventive health care visits to providers, as a means of stretching diminished household income in a weakened economy.
The two sets of data are heading the entire female gender on a collision course. The U.S. already spends $2 trillion annually on health care, more than any other nation in the world and more than twice what every other industrialized country spends. Yet the WHO ranks U.S. health care today 37th among nations of the world in quality of care delivered. We are ranked last in the world in preventable mortality. In fact, the medical care costs of people with preventable chronic diseases such as Type II diabetes and cardiovascular problems associated with obesity, lack of exercise, and poor nutritional habits account for more than 75% of that $2 trillion tab and 70% of all deaths in the country.
What does it take to reverse the direction in which we're headed, particularly as women?
It's bad enough that all older women are not undergoing the screenings they need from their providers, not being directed for protective immunizations, and not being encouraged to engage in regular exercise. Now we are hearing about many women actually foregoing the checkups they need.
The economic stimulus bill working its way through the U. S. House of Representatives and the Senate includes $5.8 billion for "investment in evidence-based prevention activities." This includes monies earmarked for autoimmune disease prevention strategies, community wellness activities, HIV and STD prevention, immunizations for children and adults, electronic tracking and reporting key indicators of public health, public service announcements promoting healthy behaviors and health literacy, newborn screening, expansion of Prevention Research Centers, screening and education specifically for identifying pre-diabetes situations, smoking cessation, a pandemic influenza preparedness strategy, and funding for education and training of new entrants to the health professions, particularly to combat nursing shortages. While funding specified for measures such as fall prevention is unfortunately absent, the legislation represents a bold step in the right direction, both for infrastructure support of preventive healthcare and the economy.
