Health is complex. Women are complex. Women’s health is complex. So why does “women’s health” so often refer to reproductive issues alone?
The American Heart Association and the American College of Obsetricians and Gynecologists did something smart. They looked at the past few decades of progress in women’s cardiovascular health and asked “why are women still under-informed about their risk of heart disease. . . and why are we still not better at lowering risk?”
Those of us who practice primary care day-in, day-out could probably tell you a lot of reasons: competing priorities, limited time, siloed care— leaving a void for a big-picture assessment of health and health risks. This is a problem for all kind of patients and providers, but it’s particularly acute in women’s health, where issues of reproductive health often take center stage (especially in younger women). A well-woman visit is an opportunity for more than pap smears and birth control! This might be in a primary care practice or a gynecologist’s office (where many young women get their only care). What are we telling women when they come for a well woman visit, and what are they telling us? Are we communicating well, or are we checking boxes on the EHR and making sure we get reimbursed fully? I had a well woman visit myself this year, and I heard a lot about pap tests and nothing about blood pressure or depression. This is not unusual, but it’s not good.
There’s mounting evidence about sex (biological and physicological) and gender (sociocultural) influences on cardiovascular health and disease. Cardiovascular disease was first identified, studied, and treated in men. Our entire paradigm of the disease is based on men. Yet women’s disease is different, women’s response to disease is different, and the healthcare system’s treatment of women is different. Still, we too often fail to appreciate how these differences matter, and that undermines our efforts as health professionals to address risk.
The million dollar question: How do we identify, communicate, and mitigate women’s cardiovascular risk effectively?
One approach? Treat women’s health as a holistic issue rather than just focusing on the parts covered by a bikini.