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February 2, 2000

Critical Women's Health Issues in the 21st Century

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JAMA. 2000;283(5):667. doi:10.1001/jama.283.5.667-JMS0202-3-1

When my mother was diagnosed with cancer, more than 30 years ago, we could not say the word cancer out loud nor share her struggle with others. The only people specializing in women's health were obstetricians and gynecologists; no government offices and few resources were devoted to women's health. Less than 10%1 of entering medical students were women and there was a shortage of female leadership in the health professions. Professional education used the 180-pound male as the generic patient, and much research2 was conducted with men only. The results were then generalized to guide the treatment and prevention of disease in women.

Thankfully, much has changed. Since 1900, public health interventions have resulted in a 30-year increase3 in women's life expectancy. But this good news is tempered by the fact that while women are living longer, they have poorer health outcomes and suffer more chronic disability than do men.4 Today, more than 46% of entering medical students are women.1 And although there is still a dearth of women at the top of academic medicine, the emergence of women in leadership positions has helped bring women's health to the forefront of our health care agenda.

In recent years, the federal government has significantly increased funding for a broad spectrum of research and innovative programs on women's health, and a focus on these issues has been woven into all federal health agencies. The National Institutes of Health now requires women and minorities to be included in the research it supports, and the Food and Drug Administration encourages that women be included in drug and device testing. Regional women's health coordinators have been appointed to focus on inclusion at state and local levels. The National Women's Health Resource Center has been established, which provides easy access to women's health information by telephone and on the Internet.

Gaps in knowledge are being filled through the support of research on women's health across the lifespan and by examining gender differences in health and disease. Thus far, 18 National Centers of Excellence in Women's Health have been established to foster research, clinical services, and education on women's health issues, as well as to enhance the career development of women in academic medicine. Recommendations for medical education curricula5 have been disseminated to help ensure that future physicians are sensitive to gender differences in the etiology, treatment, and prevention of disease.

In the 21st century, improving women's health means addressing the social, biomedical, and environmental issues that will shape the health landscape of the future. Women now represent 60% of those over age 65 and 71% over age 85.1 By 2030, 20% of women will be over age 65,6 and as we age, the number of people with chronic conditions will increase. Therefore, priority must be given to improving health care research, services, and prevention programs for older women. Racial and ethnic disparities in health care must also be addressed.

Advances in medical research have largely eliminated some of the diseases that killed people at the beginning of the 20th century. The human genome will likely be mapped within the next 5 years, promising new treatment and prevention strategies; technology is revolutionizing our world and the practice of medicine. But as advances in medical diagnosis and treatment are developed, they need to be designed and evaluated with women in mind, and we must address the accompanying ethical and legal issues.

A top priority in the 21st century must be the prevention of disease and ensuring that national efforts target the unique needs of women. Prevention means developing new strategies to eliminate environmental hazards from women's lives. It also means safeguarding our nation's future by ensuring that every child has a healthy start and is protected from violence, tobacco, and drugs.

In the new century, we must work to provide access to health care for all Americans, and we must destigmatize mental illnesses. We must also adopt a global perspective on women's health. The spread of infectious diseases, tobacco and guns, the threat of bioterrorism, food and water supply safety, and violence against women do not recognize national borders. Finally, we must strive for economic and educational equity for all women, since socioeconomic status is one of the most powerful predictors of health.3 Marie Curie, who was never admitted to the all-male French Academy of Sciences, even after winning a second Nobel prize, once said, "I never see what has been done. I only see what remains to be done." Clearly, much progress has been made, yet much more must be accomplished if equity for women's health is to be achieved in the 21st century.

Association of American Medical Colleges, Women in US academic medicine statistics, 1998-1999. Available at: http://www.aamc.org/about/progemph/wommed/wimupdat/99fall.htm. Accessed December 12, 1999.
Blumenthal  SJ A new national focus on women's health. Epps  RStewart  SCeds.The Women's Complete Health Handbook. New York, NY Delacorte Press1995;3- 14
Centers for Disease Control and Prevention, Health, United States 1998 With Socioeconomic Status and Health Chartbook.  Hyattsville, Md US Dept of Health and Human Services1998;DHHS publication (PHS) 98-1232.
Office of Research on Women's Health, NIH, Report of the National Institutes of Health: Opportunities for Research on Women's Health.  Hunt Valley, Md US Dept of Health and Human Services1992;NIH publication 92-3457.
Not Available, Women's Health in the Medical School Curriculum: Report of a Survey and Recommendations.  Rockville, Md US Dept of Health and Human Services1997;Publication HRSA-A-OEA-96-1.
Day  JC Population Projections of the United States by Age, Sex, Race, and Hispanic Origin: 1995-2050.  Washington, DC US Bureau of the Census. Current Population Reports1996;25- 1130