Women's Health a Major Concern; Needs More Attention
By Rudi Williams
American Forces Press Service
WASHINGTON, June 21, 2000 Women's health is a major concern, but it hasn't received the kind of attention in clinical trials that it deserves, U.S. Surgeon General Dr. David Satcher recently told an audience here.
"We don't know as much as we need to know about the health of women," he said at a women's health issues seminar at the Women in Military Service for America Memorial at Arlington (Va.) National Cemetery. That's especially true for military women, whom the government sends into harm's way, he said. "We want them to be at their best and have the best ability to respond to different challenges to their health -- environmental or otherwise."
The surgeon general, who is also the deputy secretary of the Department of Health and Human Services, pointed out that women are stationed in some countries where diseases such as tuberculosis, malaria and AIDS, or acquired immune deficiency syndrome, are more widespread than in the United States. Therefore, before women leave the states, he said, they need instruction on protecting themselves.
Learning more about women's health is of paramount concern to Health and Human Services, Satcher said. Research is under way concerning the disproportionate incidence of osteoporosis in women to men, when calcium treatment is indicated to begin, and at what ages various kinds of hormonal therapy should start, he said.
He said these and other health issues are part of HHS Healthy People 2010 initiative, the third in a series of 10-year plans for the health of the American people. A summary, "Healthy People: Understanding and Improving Health," includes 10 leading health indicators.
The indicators are divided into lifestyle challenges and system enhancement challenges. The first five indicators are related to lifestyle -- physical activity, overweight and obesity, tobacco use, substance abuse and responsible sexual behavior. The system challenges are mental health, injury and violence, environmental quality, immunizations and access to health care.
Healthy People 2010 is an HHS initiative, but "collaboration has grown significantly with DoD and other agencies" in recent years, Satcher said. "We're working together in several areas. The Department of Defense is part of the environmental child health and safety task force and they're working with us on food safety. We take responsibility for it, but we asked for their support."
He said public health and science officials are working for a community health system that balances health promotion, disease prevention, early detection and universal access to health care. He envisions a program where communities across the nation invest, not just in treating people after they are sick and suffering, but in promoting health and preventing and detecting diseases as early as possible.
"We're continuing to make progress in decreasing deaths from cardiovascular diseases, motor vehicle crashes, cancer mortality and homicide. We've even decreased teen-aged pregnancy in the 1990s," Satcher said.
"That's movement in the right direction," he noted. "But there was also movement in the wrong direction, including an increase in diabetes, especially Type 2 diabetes." The increase in the diabetes cases is probably related to a significant increase in overweight and obesity among children and adults, Satcher speculated. That, he said, is probably caused by a decrease in physical activity among the American people.
"This is the most inactive generation of Americans in our history, including our children," he said. For example, he said only 25 percent of teen-agers take physical education in school. He said the benefits of physical activity are astronomical, because it decreases cardiovascular disease by 50 percent, lowers the onset of Type 2 diabetes by 30 percent, lowers the risk of breast cancer and high blood pressure, and increases muscle and bone strength.
Noting that older Americans suffer about 30,000 hip fractures per year, Satcher said people who are physically active, especially if they include strengthening exercises, are 40 to 50 percent less likely to suffer hip fractures.
He said a regular program of physical activity such as 30 minutes a day of walking, jogging, running, swimming, biking, aerobic dancing, gardening significantly reduces the onset of many diseases.
Jokingly saying that some surgeons generals get fired for talking about sex, Satcher said recent studies show physical activity significantly increases sexual potency and enjoyment.
"Even though some people believe in teaching abstinence, it's time to put the issue in the right perspective," he said. "We as a nation have a lot of trouble talking about sex.
"Sex is great; sex is beautiful," Satcher emphasized. "But it also carries responsibility to you and others. We need to get a message to our teen-agers that sex is great, but relationships don't start with sex. Relationships begin with communications, understanding, appreciation and caring."
He said sex takes place best in committed relationships where people have a real concern for each other. "When that happens, people protect each other," he said. "If we don't educate our children about sex, the only places they're going to learn about sex is dark alleys and vacant buildings."
Substance abuse is another leading indicator in the lifestyle area. "Obviously we're concerned about the use of heroin, marijuana, cocaine, but the major substance of abuse is alcohol," Satcher said. "About 12,000 people a year died from heroin, marijuana, cocaine, etc. But more than 100,000 died from alcohol - alcohol-related diseases, motor vehicle crashes, violence and other risk factors."
Turning to longevity, he said life expectancy in the past century has increased by 30 years from 47 to 77. Consequently, medical professionals have to focus on the quality of life, he said.
"We're an aging population. The fastest-growing group of people in this country is over 80 years of age, so the real issue is quality of life," he noted. "When we talk about quality, you have to be concerned about things like arthritis, osteoporosis, and management of chronic pain, aggressive diagnosis, and treatment of depression. Such things as visual and hearing disorders increase the number of objectives."
Calling breast cancer a major concern for women, Satcher pointed out 43,000 women die of breast cancer each year. White women are more prone to it, he said, but African American and Hispanic women have higher death rates.
"That's related to diagnosing breast cancer early," he said. Early diagnosis means a 97 percent chance of five-year survival, whereas late diagnosis means a five-year survival rate as low as 20 percent, he noted.
Breast cancer gets media attention, but "heart disease is a leading cause of death in this country in men and women," Satcher said. He put the annual death toll at 240,000 women.
He cautioned the audience about using food supplements and alternative medicine that haven't been approved by the federal Food and Drug Administration.
"We want to ensure that people are educated to be aware of the dangers of things on the market for treating any disease that don't require FDA approval, especially when you combine things," he said. "When you decide to try products, you're taking great risks."
More information about Healthy People 2010 is available at www.health.gov/healthypeople, while other Surgeon General initiatives are on the Internet at www.surgeongeneral.gov.