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The Women's Health Data Book: A profile of women's health in the United States
ELSEVIER
BOOK REVIEW The Women’s Health Data Book A Profile of Women’s Health in the United States Second Edition, 1995,The Jacobs Institute of Women’s Health, 176 pp. Edited by Jacqueline A. Horton, ScD. ISBN # O-444- 10002-4 We’ve come a long way baby! With national attention recently focused on the topic of women’s health, the initiative of a diverse group of professionals to establish Women’s Health as a unique discipline is impressive. Clinical centers devoted to the delivery of health care to women have emerged across the country. Part G of Title IV of the Public Health Service Act was amended (Section 492B) in 1993 to ensure that women and minority groups were included in clinical research supported by the National Institutes of Health. An office of Research on Women’s Health was established within the Oflice of the NIH Director. Training programs dedicated to Women’s Health are evolving in Schools of Public Health and in postgraduate training programs in medicine. 7% Women’s Health Data Book is an important contribution to this new field during a critical stage of its development. The Duta Book provides timely and accurate information on a wide range of health issues as they affect women in the United States today. The second edition also documents the health experiences of women from diverse racial and ethnic backgrounds. The book is organized into seven chapters: reproductive health; infectious disease; chronic disease; mental health; use of alcohol, drugs, andcigarettes; violence against women; and women’s access to the health care system. Topics are introduced by a brief description of the significance of the health problem; morbidity and mortality data follow. Numerous tables and figures highlight data by age, race, and ethnicity. An extensive list of references follows each chapter, and an appendix summarizes sources and limitations of data, explains demographic classification, and provides a glossary. The target audience is broad. As a physician, epidemiologist, and program director, I found the Data Book useful on several levels. Students and professors of undergraduate and graduate courses covering topics in women’s health will find this volume an excellent source of information. Readers unfamiliar with the types of rates frequently used in epidemiology will find the glossary very handy. Investigators may refer to the Data Book for a number of reasons, including assessment of cohort effects, sample size estimations, and
Ann
Epidemical
1996;6:89-90
0 1996 by Elsevier Science Inc. 655 Avenue of rhe Americas, New York,
NY 10010
documentation of women’s specific health care patterns. Program planners and policymakers will find this edition a unique resource that identifies the major health issues of American women and prioritizes these issues within racial and ethnic groups. The information provided in the Data Book will be valuable as we project health care needs and design delivery systems targeted at American women. The style is direct, clear, and factual. It is refreshing that the authors present the data in a balanced and unbiased fashion. They appear to be deliberately avoiding the speculation or hypothesis generation that might naturally ensue from publication of such an enormous amount of data. This approach lends credibility to the book; however, the reader may feel frustrated when attempting to tie it all together. Each fact appears more striking than the previous one, and it is difficult to place the major topics into perspective because each issue is discussed independently. One exception is the chapter on chronic disease, which affords comparisons between major causes of mortality in women. Whereas the book is intended to be descriptive and is clearly not solution oriented, it would be more powerful if the authors made suggestions for prioritizing women’s health care issues and proposed initial directions. The book would also benefit from a summary chapter. As one might expect from a book seeking to address the vast issue of women’s health, the breadth of topics limits to some extent the depth of coverage. For example, the opening chapter on reproductive health pR!SenKS natality statistics, trends in the use of contraception, abortion and adoption patterns, and pregnancy and infertility data. However, no data on patterns of cessation of reproductive function are included. One brief paragraph in the chapter on chronic disease mentions that menopause is associated with an increased risk of cardiovascular disease, whereas in the chapter on mental health, there is a discussion of the influence of menopause on depression. Since, for women, menopause is as inevitable as death and taxes, this is an important omission of data. Information on rates of hormone replacement therapy by ethnic group would also be valuable. The last chapter, on women’s access to the health care system, covers women’s use of prevennve health care services. However, few data are presented tJn the efficacy of these programs. The chapter on infectious disease highlights the impact of immunization programs on disease prevention. However, minimal data are cited on the prevalence of lifestyle risk factors and their relation to chronic disease prevention. An exception is a summary of smoking-related morbidity and mortality and a section on osteoporosis, which concludes with a useful discussion of rhe role of cxercise in reducing bone fractures. 1 would prefer to see this 10-W.27W/Y6/$15.UU SSDJ 1~~4i-7’:‘~7(95)00100-x
90
MOSGI
BOOK REVIEW
format followed more consistently throughout the book. Differences in the use of medical interventions by women and men are briefly discussed, with minimal data presented. Because the field of health services research identifies important gender differences in both usage and outcomes related to interventions, it would be interesting to include such data in future editions. The Data Book is a valuable resource for its concise compilation of data concerning women’s diverse health issues as well as its particularly useful appendix. The authors have abstracted a list of government and nongovernment sources of data with a general overview of each, including information about methods of data collection, reliability, validity, and numbers of records contained in each study. An expla-
AEP Vol. 6, No. 1 January J996: 89-90
nation of the variability of these data collection systems aids the reader in understanding the limitations of data presented in the book. In summary, the Data Book is a comprehensive and timely publication of information pertinent to the health status of American women. The second edition contributes significantly to our understanding of women’s health care issues within the context ofrace and ethnicity. I highly recommend adding this book to your reference library. Lori Mosca, M.D., M.P.H. The University of Michigan Preventive Cardiology Program Ann Arbor, MI
BOOK REVIEW The Women’s Health Data Book A Profile of Women’s Health in the United States Second Edition, 1995,The Jacobs Institute of Women’s Health, 176 pp. Edited by Jacqueline A. Horton, ScD. ISBN # O-444- 10002-4 We’ve come a long way baby! With national attention recently focused on the topic of women’s health, the initiative of a diverse group of professionals to establish Women’s Health as a unique discipline is impressive. Clinical centers devoted to the delivery of health care to women have emerged across the country. Part G of Title IV of the Public Health Service Act was amended (Section 492B) in 1993 to ensure that women and minority groups were included in clinical research supported by the National Institutes of Health. An office of Research on Women’s Health was established within the Oflice of the NIH Director. Training programs dedicated to Women’s Health are evolving in Schools of Public Health and in postgraduate training programs in medicine. 7% Women’s Health Data Book is an important contribution to this new field during a critical stage of its development. The Duta Book provides timely and accurate information on a wide range of health issues as they affect women in the United States today. The second edition also documents the health experiences of women from diverse racial and ethnic backgrounds. The book is organized into seven chapters: reproductive health; infectious disease; chronic disease; mental health; use of alcohol, drugs, andcigarettes; violence against women; and women’s access to the health care system. Topics are introduced by a brief description of the significance of the health problem; morbidity and mortality data follow. Numerous tables and figures highlight data by age, race, and ethnicity. An extensive list of references follows each chapter, and an appendix summarizes sources and limitations of data, explains demographic classification, and provides a glossary. The target audience is broad. As a physician, epidemiologist, and program director, I found the Data Book useful on several levels. Students and professors of undergraduate and graduate courses covering topics in women’s health will find this volume an excellent source of information. Readers unfamiliar with the types of rates frequently used in epidemiology will find the glossary very handy. Investigators may refer to the Data Book for a number of reasons, including assessment of cohort effects, sample size estimations, and
Ann
Epidemical
1996;6:89-90
0 1996 by Elsevier Science Inc. 655 Avenue of rhe Americas, New York,
NY 10010
documentation of women’s specific health care patterns. Program planners and policymakers will find this edition a unique resource that identifies the major health issues of American women and prioritizes these issues within racial and ethnic groups. The information provided in the Data Book will be valuable as we project health care needs and design delivery systems targeted at American women. The style is direct, clear, and factual. It is refreshing that the authors present the data in a balanced and unbiased fashion. They appear to be deliberately avoiding the speculation or hypothesis generation that might naturally ensue from publication of such an enormous amount of data. This approach lends credibility to the book; however, the reader may feel frustrated when attempting to tie it all together. Each fact appears more striking than the previous one, and it is difficult to place the major topics into perspective because each issue is discussed independently. One exception is the chapter on chronic disease, which affords comparisons between major causes of mortality in women. Whereas the book is intended to be descriptive and is clearly not solution oriented, it would be more powerful if the authors made suggestions for prioritizing women’s health care issues and proposed initial directions. The book would also benefit from a summary chapter. As one might expect from a book seeking to address the vast issue of women’s health, the breadth of topics limits to some extent the depth of coverage. For example, the opening chapter on reproductive health pR!SenKS natality statistics, trends in the use of contraception, abortion and adoption patterns, and pregnancy and infertility data. However, no data on patterns of cessation of reproductive function are included. One brief paragraph in the chapter on chronic disease mentions that menopause is associated with an increased risk of cardiovascular disease, whereas in the chapter on mental health, there is a discussion of the influence of menopause on depression. Since, for women, menopause is as inevitable as death and taxes, this is an important omission of data. Information on rates of hormone replacement therapy by ethnic group would also be valuable. The last chapter, on women’s access to the health care system, covers women’s use of prevennve health care services. However, few data are presented tJn the efficacy of these programs. The chapter on infectious disease highlights the impact of immunization programs on disease prevention. However, minimal data are cited on the prevalence of lifestyle risk factors and their relation to chronic disease prevention. An exception is a summary of smoking-related morbidity and mortality and a section on osteoporosis, which concludes with a useful discussion of rhe role of cxercise in reducing bone fractures. 1 would prefer to see this 10-W.27W/Y6/$15.UU SSDJ 1~~4i-7’:‘~7(95)00100-x
90
MOSGI
BOOK REVIEW
format followed more consistently throughout the book. Differences in the use of medical interventions by women and men are briefly discussed, with minimal data presented. Because the field of health services research identifies important gender differences in both usage and outcomes related to interventions, it would be interesting to include such data in future editions. The Data Book is a valuable resource for its concise compilation of data concerning women’s diverse health issues as well as its particularly useful appendix. The authors have abstracted a list of government and nongovernment sources of data with a general overview of each, including information about methods of data collection, reliability, validity, and numbers of records contained in each study. An expla-
AEP Vol. 6, No. 1 January J996: 89-90
nation of the variability of these data collection systems aids the reader in understanding the limitations of data presented in the book. In summary, the Data Book is a comprehensive and timely publication of information pertinent to the health status of American women. The second edition contributes significantly to our understanding of women’s health care issues within the context ofrace and ethnicity. I highly recommend adding this book to your reference library. Lori Mosca, M.D., M.P.H. The University of Michigan Preventive Cardiology Program Ann Arbor, MI