[EQ] Challenges to maternal and child health in the US, Health Policy 11-2008

Overcoming social and health inequalities among U.S. women of reproductive age
—Challenges to the nation's health in the 21st century

Shahul H. Ebrahim^{a, c, ,} John E. Anderson^{a, c}, Rosaly Correa-de-Araujo^{b, c}, Samuel F. Posner^{a, c} and Hani K. Atrash^{a, c}

^aCenters for Disease Control and Prevention, Atlanta, GA, USA
^bAgency for Healthcare Research and Quality, Rockville, MD, USA
^cUS Department of Health and Human Services, USA

Health Policy (2008), doi:10.1016/j.healthpol.2008.09.011
Available online 21 November 2008. Health Policy

To frame the discussion of the nation's health within the context of maternal and child health.
Methods We used national data or estimates to assess the burden of 46 determinants.

Results During 2002–2004, U.S. women of reproductive age experienced significant challenges from macrosocial determinants, to health care access, and to their individual health preservation. Two-thirds of women do not consume recommended levels of fruits and vegetables. Overall, 29% experienced income poverty, 16.3% were uninsured. About one in four women of reproductive age lived with poor social capital. Compared with white women of reproductive age, non-white women reported higher levels of dissatisfaction with the health care system and race-related discrimination. Among all U.S. women, chronic diseases contributed to the top nine leading causes of disability adjusted life years. About one-third of women had no prophylactic dental visits in the past year, or consumed alcohol at harmful levels and smoked tobacco. One in three women who had a child born recently did not breast feed their babies. Demographics of women who are at increased risk for the above indicators predominate among the socioeconomically disadvantaged.

Conclusions

At least three-fourths of the U.S. women of reproductive age were at risk for poor health of their own and their offspring. Social intermediation and health policy changes are needed to increase the benefits of available health and social sector interventions to women and thereby to their offspring.

“……..We have shown that both supply and demand obstacles and macrosocial issues overwhelm the efforts to improve health of women and children in the U.S. As a next step in evidence development, analysis of laboratory data on national prevalence of infectious and environmental challenges among women of childbearing age would be helpful.

At the supply level, preconception care is preventive medicine for maternal and child health, and increasing its universal availability should be a national priority.
At the individual level, healthy lifestyle messages may be more meaningful when presented with its intergenerational benefits and in a supportive social environment. Individual level efforts should begin in childhood, incorporated into the school curricula and school activities.
At the policy level, as has been suggested at the global level (http://www.who.int/entity/social_determinants/final_report/csdh_finalreport_2008.pdf ) greater emphasis should be given to macrosocial determinants of health also in the U.S. In summary, achieving further improvement in maternal and child health in the U.S. will be determined largely by how the nation reduces the barriers to health care, promote healthy lifestyles, and reduce disparities that women face in achieving optimal health……”

Article Outline

1. Introduction

2. Data and analyses

2.1. Data sources

2.2. Definitions of indicators

2.2.1. Reproductive health status of women

2.2.2. Burden of disease among women

2.2.3. Individual level risk factors and predictors of poor health

2.3. Health care access and uptake of prevention

2.3.1. Macrosocial determinants

2.4. Analyses

2.5. Data limitations

3. Results

3.1. Reproductive status of women

3.2. Burden of Disease among women

3.3. Individual level risk factors and predictors of poor health

3.4. Health care access and uptake of prevention

3.5. Macrosocial determinants

4. Discussion

5. Conclusions

Contributions

Conflicts of interest

References

 

 

 

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