Improving Women’s Health: 
An Integral Component to Advancing Population Health

By Dr. Janine A. Clayton

Dr. Clayton headshot

November observances provide significant reminders of enduring health disparities that we must address together to improve the health of all people. Women play essential roles in society including as professionals, leaders, and decision-makers, as well as mothers, providers, and caregivers. Caring for those who provide care to others is a thoughtful way to express gratitude in November. Women’s health and well-being are central to the health and well-being of society. Seeing as women make 80% of families’ health care decisions, working to improve the health of women will contribute to enhancing population health. 

November is National Family Caregivers Month. In 2020, AARP released the comprehensive Caregiving in the U.S. report, detailing caregiving statistics and demographic information. Partly because women live longer than men do on average, women live more years with disability than men do. Women are also more likely to provide unpaid caregiving to family members. Both disability and caregiving responsibilities can limit women’s full participation in the workforce. Over 20% of Americans are caregivers, and importantly, women constitute 61% of caregivers. Providing care for a family member or loved one can be rewarding, but caregivers face mental and physical health challenges, too. 

As you might expect, primary caregivers are most often women, with 67% of female caregivers identifying as the primary caregiver, compared with 59% of male caregivers. Between 2015 and 2020, the percentage of women caregivers self-rating their health as “excellent” or “very good” declined from 48% to 40%. Regarding stress, 39% of female caregivers report experiencing high emotional stress, compared with 33% of male caregivers. Also, 27% of female caregivers provide care for two or more adults, compared with 20% of male caregivers.

The National Institute on Aging provides resources for caregivers to support their own well-being, in addition to that of their loved ones. Remarkably, unpaid caregiving would represent a $470 billion industry if the caregivers were financially compensated for the essential services they provide. However, there can be benefits associated with caregiving, such as increased self-confidence and fulfillment from helping others, starting or adding to social networks of friendships, and learning and developing new skills.

Another important observance in November is Native American Heritage Month. Since the formation of the Union, the United States has recognized American Indian Tribes as sovereign nations, and there are unique government-to-government relationships between Tribes and the Federal Government. Regarding maternal mortality, a recent Centers for Disease Control and Prevention (CDC) report highlights the need to address and improve the American Indian/Alaska Native (AI/AN) pregnancy-related death rate. For example, using the CDC Hear Her campaign’s framework, the National Indian Health Board and CDC are working together to support healthy pregnancies and postpartum health in AI/AN communities. 

Research supported by the National Institute on Minority Health and Health Disparities (NIMHD) elucidates intragroup AI/AN health disparities between tribally enrolled and non–tribally enrolled subpopulations. Overall, both the incidence and the prevalence of risk factors for chronic diseases—such as type 2 diabetes, asthma, obesity, and heart disease—are higher among the AI/AN tribally enrolled subpopulation than for the AI/AN non–tribally enrolled subpopulation. It remains unknown why these disparities exist between tribally enrolled and non–tribally enrolled AI/AN people, highlighting the importance of expanding data collection and research to understand health outcomes of underserved racial and ethnic groups. 

Critically, COVID-19 is a leading cause of death for AI/AN populations, along with heart disease, cancer, and suicide. Research supported by the National Institute of General Medical Sciences (NIGMS) examined hospitalizations of AI/AN, Black, and White adult patients between March and December 2020. AI/AN patients were significantly more likely to die of COVID-19 while hospitalized than Black or White patients even though AI/AN patients in the study had lower comorbidity risks compared with the study’s overall patient population. Possible explanations for this disparity in hospitalized COVID-19 deaths may be factors such as AI/AN discrimination, marginalization, inability to see preferred clinicians, and underfunding of the Indian Health Service. 

To address health disparities among AI/AN populations, ORWH collaborates with NIH institutes to support the grants highlighted below.

To address the myriad health disparities of women in populations that are understudied, underrepresented, and underreported (U3) in biomedical research, ORWH developed the U3 Interdisciplinary Research program. ORWH seeks to draw attention to the lack of research on persistent disparities in women’s health and health care and to support research and evidence-based programs to address this gap. ORWH also offers a U3 administrative supplement to support NIH researchers from various disciplines who are committed to advancing health equity by bringing women of U3 populations into focus within the research lens. 

It’s been a busy fall for ORWH as we work together and across disciplines to improve the health of women. To tackle the maternal health crisis, NIH launched the Implementing a Maternal health and PRegnancy Outcomes Vision for Everyone (IMPROVE) initiative in 2020 to support research on how to mitigate preventable maternal mortality, decrease severe maternal morbidity, and promote health equity. To learn more about the components of the IMPROVE initiative, please follow the links below:

  • Maternal Health Research Centers of Excellence: These centers work collaboratively to design and implement research projects to address the biological, behavioral, environmental, sociocultural, and structural factors that affect maternal morbidity and mortality in populations that experience health disparities.
  • Rapid Acceleration of Diagnostics (RADx®) Tech for Maternal Health Challenge: This challenge seeks to innovate point-of-care and home-based diagnostics that predict/diagnose risk of severe maternal morbidity and maternal mortality for postpartum individuals.
  • Connectathon: This aims to identify, create, and standardize maternal health–related data elements to advance care delivery and prenatal, birth, and postpartum research.
  • Community Implementation Program: This program consists of community-engaged implementation projects for evidence-based interventions in disproportionately affected populations and maternity care deserts.
  • Notice of Special Interest (NOSI): Implementation Science to Advance Maternal Health and Maternal Health Equity for the IMPROVE initiative: This is a funding opportunity to gather evidence-based findings related to maternal health, with emphasis on strategies for populations with health disparities.
  • Connecting the Community for Maternal Health Challenge: This challenge will reward nonprofit community-based and advocacy organizations for developing research capabilities and infrastructure to pursue maternal health research projects.

On October 26, ORWH hosted the “Gender and Health: Impacts of Structural Sexism, Gender Norms, Relational Power Dynamics, and Gender Inequities” workshop. This was the first NIH workshop focused specifically on the domains of gender and resulting health consequences. The workshop featured excellent presentations and panel discussions from over 15 researchers who focus on gender and health outcomes. One example illustrating how societal structures result in health consequences is that women who experience sexual assault and harassment are more likely to develop higher blood pressure. I look forward to continuing research to understand how gender affects women’s health and encourage you to read Drs. Elizabeth Barr and Sarah Temkin’s recent guest post on my blog, “Gender as a Social and Cultural Variable and Health,” which details the differences between sex and gender and explains how gender is a meaningful variable to enhance health and reduce illness and disability.

In early November, ORWH hosted two important annual meetings. On November 1, the Specialized Centers of Research Excellence on Sex Differences (SCORE) 2022 Annual Meeting’s keynote address featured Cara Tannenbaum, M.D., M.Sc., Scientific Director of the Institute of Gender and Health at the Canadian Institutes of Health Research. You can access the videocast of the keynote speech here. And on November 2, our Careers Section hosted the Building Interdisciplinary Research Careers in Women’s Health (BIRCWH) 2022 Annual Meeting. This was a gathering of senior and junior faculty with a shared interest in women’s health research, aiming to advance science. More information on the BIRCWH program is available here. You can watch the videocast of this virtual event here.

With events and scientific meetings all year long, ORWH continues to strive to improve the health of women. Promoting women’s health and well-being is a win for everyone. It is important to continue to recognize that risk factors for disease may be different for women, understand how to diagnose and treat disease early, and maintain awareness of sex and gender differences while conducting research and providing care. Women’s family health care decisions, women’s contributions to the workforce, and the roles women play in the community context all affect the well-being of the people around them. Improving women’s health is an integral component to advancing population health.

This Director’s Message will be the final blog post for 2022. I want to sincerely thank everyone at ORWH and beyond who works tirelessly to progress the health of women and women’s health research. I look forward to continuing the charge in 2023, and I hope everyone has a safe and healthy start to the new year!