Women caught in the multi‐causal web: A gendered analysis of Healthy People 2010

Abstract

This essay is a gendered analysis of the U.S. Department of Health and Human Service’s Healthy People 2010 initiative (HP 2010). HP 2010 sets national health goals and priorities for public health agencies throughout the nation with a stated goal to “reduce health disparities” (p. 2), including disparities based on “gender, race, education or income, disability, geographic location, or sexual orientation” (p. 11). Given the focus on women’s medical research since the 1990s and the continued presence of gendered health disparities, it is important to investigate how public health policy defines, depicts, and prioritizes issues related to women’s health, particularly poor and minority women. A close reading of three sets of chapters related to physical disease, health care services, and sexual health issues from the perspective of women suggests that despite renewed promises, the “multi‐causal web” approach to public health does not promote conditions that would empower marginalized groups because it fails to address sex differences in health advice and prioritize economic and political changes necessary for marginalized groups. Underlying these issues is a lack of consideration for the role of socially constructed gender roles along with race and class in health status and inequities.

Keywords:

• Healthy People 2010
• Women’s Health
• Multi‐causal Web
• Public Health and Gender
• Health Communication

Notes

Heather M. Zoller (Ph.D. Purdue University) is an Assistant Professor in the Department of Communication at the University of Cincinnati. This paper was presented at the 2003 Conference of the Organization for the Study of Communication, Language and Gender. The author wishes to thank Cynthia Berryman‐Fink and Lyn Kathlene for comments on drafts of this essay.

The leading health indicators are chosen through interagency work and collaboration from public partners, and public input. The DHHS states that these indicators “reflect the major public health concerns in the United States and were chosen based on their ability to motivate action, the availability of data to measure their progress, and their relevance as broad public health issues” (p. 24). These indicators are, in order, physical activity, overweight and obesity, tobacco use, substance abuse, responsible sexual behavior, mental health, injury and violence, environmental quality, immunization, and access to health care (p. 24). The accompanying text says that income and education underlie these indicators.

The introduction notes that gays and lesbians face discrimination that results in mental health burdens.

The heart disease issue also commofidied women’s health—Eckman argues that it focused public attention on menopause, an issue industry saw as profitable.

HIV/AIDS can be contracted through drug use and blood transfusion, and for this reason may not fit best in a category related to sexual politics. However, the overlap in the content in these sections makes it easiest to analyze as a group. Additionally, heterosexual contact is the fastest growing transmission source for women (NIAID, 2004).

This statement reflects a criticism from Petersen and Lupton (1996), that government public health initiatives often treat “race” as a fixed, “real,” and unproblematic category.

For example, research suggests that physicians treat women with cardiovascular disease less aggressively than they do men, and are more likely to refer female patients than male ones to psychologists for anxiety rather than for a cardiovascular exam (“New Red Flags are Raised,” 2004).

Research suggests, for example, that women receive very little information from physicians about mental issues such as panic and anxiety (Watkins & Whaley, 2000).

In 2004, this number has grown to 26% (NIAID, 2004)

According to the text, women under the age of 20, the poor, and African Americans are more likely to have unintended pregnancies. Poor women are less likely to have access to family planning clinics; indeed, half of women who need public subsidy in this area do not receive it.

Additional information

Notes on contributors

Heather M. Zoller

Heather M. Zoller (Ph.D. Purdue University) is an Assistant Professor in the Department of Communication at the University of Cincinnati. This paper was presented at the 2003 Conference of the Organization for the Study of Communication, Language and Gender. The author wishes to thank Cynthia Berryman‐Fink and Lyn Kathlene for comments on drafts of this essay.