An Urgent Need to Prioritize Health Equity in Routine Women’s Medicine
By Jackson Novick, Master’s student in Public Health at GWU
As the Omicron variant surge subsides, we must examine the effects of the pandemic on health inequity and routine women’s medicine. The COVID-19 pandemic directly contributed to an increase in existing health disparities, especially in regard to disadvantaged populations accessing quality, preventative care. We must recognize that our healthcare system failed to allow all women to access the benefit of quality health care – which they ought to have a right – creating one of the starkest examples of health inequity in the developed world.
Consider cervical cancer. Once a leading cause of cancer deaths in American women, mortality rates have declined by more than 50% over the past 40 years thanks to the widespread adoption of the Pap test in 1941. Today, up to 93% of cervical cancers are preventable, according to the CDC. While this figure represents a monumental achievement, this phrasing – “up to” – is telling. There are still massive disparities in access to preventative screening for cervical cancer, and many other cancers – such as breast cancer – in the United States. The CDC states that individuals belonging to minority racial and ethnic populations have decreased access to preventative screening and treatment as a result of socioeconomic disadvantage, systemic racism, discrimination, lower educational attainment, and lack of access to housing and employment.
Lack of access to screening represents a particularly troubling public health concern, with marked disparities in both disease incidence and disease outcomes. The pandemic has not only amplified these disparities in health outcomes for women, but has laid bare the systemic health inequity that impacts nearly every measurable health indicator.
The CDC and CMS published guidelines during the first wave of the pandemic, including recommendations to postpone “elective and non-urgent procedures” since the healthcare system was overwhelmed. Women’s health procedures, unfortunately, are regularly classified as “elective.” As Dr. Ritu Salani of UCLA Medical Center explained in the LA Times, women’s health “is neither urgent nor emergent, but it truly isn’t something that’s optional, and that’s what it makes it sound like. It’s unfortunate terminology.”
Consequently, rates of routine women’s health preventative screenings dropped precipitously during the pandemic. Many postponed screening appointments; some due to fear of the virus, others because of lack of appropriate communication in minority languages, and lack of access. Crucially, this drop in screening rates may exert a disproportionate effect on incidence of preventable disease in Black, Latina, and American Indian and Alaskan Native (AIAN) women, who already suffered from disproportionately higher rates of many categories of preventable disease and negative health outcomes than white women nationwide. Due to the slow recognition of these systemic factors, there remains a possibility that the return of screening rates to a normal baseline after the pandemic may be slower in these populations.
As we begin to imagine life returning to a “new normal,” it is critical that organizations take steps to address these decreases in vital preventative measures and work to minimize health disparities to ensure equitable access to life-saving services. Organizations can work to guarantee access to preventative screening and prevent decreases in screening rates by following the recommendations of the CDC National Breast and Cervical Cancer Early Detection Program (NBCCEDP). Making health equity a priority by utilizing inclusive terminology; tailoring strategies to meet the needs of target populations; and investing in diversity, health equity, and inclusion training are excellent steps. The social determinants of a population’s health (and their unique effects on members of that population) must be prioritized in developing strategies to expand access to care.
Providing outreach and education to disadvantaged communities, partnering with community leaders and local health experts, and employing individuals familiar with communities in need of resources can help. One CDC-funded organization in Los Angeles County, California, Every Woman Counts, implements these strategies, and provides free breast and cervical cancer screenings, as well as educational materials and workshops in minority languages, to women in need.
It is up to us – students, policymakers, healthcare providers, community leaders, and so many more – to rewrite and rebuild our systems to provide all women and all citizens the care that they need, and which is their right.
Resources:
Centers for Disease Control and Prevention. (2020, September 3). HPV-associated cervical cancer rates by race and ethnicity. Centers for Disease Control and Prevention. https://www.cdc.gov/cancer/hpv/statistics/cervical.htm.
California Department of Health Care Services. (n.d.). Every woman counts. Every Woman Counts.
https://www.dhcs.ca.gov/services/cancer/EWC
Centers for Disease Control and Prevention. (2022, February 15). National Breast and Cervical Cancer Early Detection Program. Centers for Disease Control and Prevention. https://www.cdc.gov/cancer/nbccedp/index.htm
Centers for Disease Control and Prevention (2019, March 14). Levine S, Malone E, Lekiachvili A, Briss P. Health Care Industry Insights: Why the Use of Preventive Services Is Still Low. Prev Chronic Dis 2019;16:180625. https://www.cdc.gov/pcd/issues/2019/18_0625.htm
Smith, H. (2021, February 22). ‘Just Living with Pain’: Women’s Healthcare Waylaid by COVID-19 Pandemic. Los Angeles Times. Retrieved December 12, 2021, https://www.latimes.com/california/story/2021-02-22/covid-19-pandemic-womens-wellne ss-effects.