On the list of countries with the best women’s health outcomes across five predictive dimensions, the U.S. isn’t even in the top 25. Here’s why.
About six months before the Covid-19 pandemic broke out in 2020, Hologic, a breakthrough diagnostic and medical imaging solutions company committed to improving health outcomes for all women, teamed up with Gallup to carry out a comprehensive international assessment of women’s health. Even when the pandemic began limiting travel and access around the globe, the team at Hologic managed to interview 60,000 women and girls, aged 15 or older, from 116 countries and territories in 140 languages about their personal health experiences over the past year.
The results of this research, which represent the feelings and actions of approximately 2.5 billion women and girls 15 years of age and over globally, is known as the Hologic Global Women’s Health Index. Its findings vary between the expected and the downright alarming. But Hologic found that five key factors, which they call the five dimensions of health, account for more than 80 percent of the variance in female life expectancy across the globe. The five dimensions are Preventive Care, Emotional Health, Opinions of Health and Safety, Basic Needs, and Individual Health.
While you might imagine that a developed country like the U.S. would fare quite well in a study like this, it in fact ranked only 26 out of 116 countries overall, even though America spends more on healthcare than any other nation. A few things from the Hologic Global Women’s Health Index are glaringly apparent when it comes to the U.S.’s less-than-stellar performance:
Many American women are missing their annual screenings, teen pregnancy (particularly among Black women and women with secondary school education or less) is astronomically high when compared to other developed countries, and there is a very high maternal mortality rate. While all this evidence may seem disheartening, Susan Harvey, MD, VP of global medical affairs, breast and skeletal health at Hologic, helped to put these findings into perspective: “We now have the hard evidence. The time has come to stop ignoring these issues.”
Preventive Care
Of the five dimensions of health, the one that women living in wealthy countries have the most control over is preventive care. Yet, according to Dr. Harvey, only 25 percent of women in the United States aged 40 to 74 had any kind of cancer screening in the past year, including many women who are insured. “It is really puzzling when you consider the potential lifesaving benefits of health screenings,” says Dr. Harvey, “but many people view a screening as an action that requires immediate time and energy without considering the long-term benefits. If you get your breast cancer screening today, you may avoid a potentially fatal late-stage diagnosis in the future. Unfortunately we don’t do a great job of linking those things as humans.”
Dr. Harvey suggests that one way to encourage women to prioritize their screenings is to consider the impact they have beyond the individual. She likens health screenings to vaccinations: “We get vaccinated for personal health, but also for the health and wellbeing of our family and our communities. We should look at preventive care in a similar light. There are people in your life who need you. Your children need you, your friends and family need you. If you’re not willing to do it for yourself, consider the impact it will have on the people who are important to you.”
The importance of regular screenings is personal to Dr. Harvey, who is living with a stage four lung cancer diagnosis. Dr. Harvey explains, “There is no screening for lung cancer, but man alive, I wish there was. I had never smoked in my life, and I took action as soon as I became symptomatic, but I now have a terminal diagnosis. If I had cancer that could have been screened for, there may have been a chance to save myself and my family from what’s happened to us, but I didn’t. So that’s what I tell other women: don’t take that chance for early detection away from yourself and from your family.”
Pregnancy
In addition to missed screenings, another major factor contributing to the U.S.’s mediocre performance in the Hologic Global Women’s Health Index is the average age of first pregnancy. The study found that 33 percent of U.S. mothers were first pregnant before the age of 19, a percentage that is shockingly high when compared to other high-income countries (around eight percent for most). When accounting only for Black women or women who have a high school degree or less education in the U.S., that number jumps up to 50 percent. Dr. Harvey explains, “Black women and women with less education are not getting adequate care when compared to white educated women. If we take the time to listen to these women, we may begin to understand how to address these issues.”
Teen pregnancy has a negative correlation with life expectancy for several reasons. There are the immediate health risks, like a higher likelihood for preeclampsia, but Dr. Harvey explains that teen pregnancy often leads to extreme disadvantages in the long-term: “If a teen mother doesn’t go back to complete high school, that will impact her long-term earning potential. That either keeps her in poverty, plunges her deeper into poverty, or makes poverty more likely. Then basic needs like access to food or adequate shelter are impacted, and that can in turn take a huge toll on a woman’s emotional health.”
Then, there is the shocking issue of maternal mortality. Maternal deaths are double in the U.S. when compared to other high-income countries, and four times higher for Black American women. Although the study does not delve into the nuanced reasons why the U.S. maternal mortality rate is so high, one thing is clear, says Dr. Harvey: “Our pregnancy care services are failing women, especially Black women.”
What can we do?
The evidence collected by Hologic in its Global Women’s Health Index poses a challenge for all of us: what can we do to improve the future of health for women? The best place to start, says Dr. Harvey, is in your own community: “Be accountable for your own health, and encourage other women to do the same.” This means staying on top of your screenings and making sure your friends and family do as well. It means doing your best to advocate for yourself in the healthcare system, but it also means encouraging healthcare workers to make sure their patients understand their options. Maybe it means organizing a local food drive to address the basic needs of those in your community or lobbying the government to rehaul sex education programs in schools or provide easier access to continued education for teen mothers.
Regardless of what resonates most with each individual from these study results, Dr. Harvey says that simply knowing these disparities exist is crucial. “Being aware of these issues means acknowledging that something has to change. This might pressure our government, policy makers, and even private citizens to figure out why these disparities in women’s health exist and attempt to close the gaps. Knowledge is power. As our CEO loves to say, if you don’t measure something, then you can’t manage it or improve it.”
