Sunday, October 19,2003

1:20-3:00 PM

Debbie Maiese: Well, good afternoon new leaders in Maternal and Child Health. I’m Debbie Maiese, the Director of the HRSA Office of Women’s Health, and when I say HRSA, the Health Resources and Services Administration, I always like to use our acronym HRSA to say it’s her service agency. So what I’m going to share with you today is sort of the depth and breadth of services that this agency offers to women, and one of the things I would challenge each of you to do is think about how your state organizes women’s health activities and how your table is set with people not only from Maternal and Child Health and Adolescent Health, but from WIC and other programs that serve women. So let me begin by sharing with you our guiding principle: our philosophy is that healthy women build healthy communities, and that theme is something that we use in our exhibits, in our materials, and with women to say that women are critical people to building healthy communities. What I do as the HRSA Women’s Health Director is to really coordinate across our more than 80 programs in health education and health policy in HRSA. The way I do that is to convene on a monthly basis a HRSA Women’s Health Coordinating Committee that has representatives from all the bureaus and offices in HRSA. This month, for example, we talked about our HIV/AIDS programs to women in prison, a joint project with the Centers for Disease Control and Prevention. So we feature a speaker so we can learn from each other about our programmatic activities and then we have round robins to share, as an example, Maribeth, with the grant programs the Maternal and Child Health Bureau is offering as well as activities that are coming up. For example, this being Domestic Violence Awareness Month, we’re planning activities for our own employees because, once again, what we do shouldn’t be all about other people’s health, but really start in our own offices in our own office buildings. And then Women’s Health is a much larger enterprise in the Department of Health and Human Services with Women’s Health Coordinators in each of our agencies, and we too meet on a monthly basis, sharing with each other our activities. So let me get into some of the statistics to really show how HRSA serves women, and I start with the uninsured, rural, migrant, and immigrant women. And looking at our Bureau of Primary Health Care, which sponsors the federally qualified health centers, we see that they serve more than 6.7 million women in any given year, and those people are at or below the 200 percent of the poverty level in 90 percent of the cases, this is for the year 2002. People living with HIV/AIDS, and here we see that through the end of 2001 there were 141,048 adolescent and adult women in the United States who’ve been reported as being HIV and AIDS positive. The numbers for HIV positive women are actually just catching up, as more and more states require HIV reporting. Our Ryan White CARE Act Program serves more than 157,000 women, so that is a real reach to women in the United States. I think we see about 25.8 percent of all cases now being among women in the United States, and unfortunately it’s a trajectory with an upward line. So, once again, we have a huge challenge in getting women tested and counseled and particularly we all know that healthy women have healthy children. In terms of women of reproductive age, the Maternal and Child Health Block Grant, Title V program, and if you don’t know the MCH data dot net website, please go online to see the summary of our statistics, that we serve more than 4.5 million women collectively, 2.2 million of whom were pregnant in the given year, essentially 54 percent of all pregnant women in the United States. So through your programs and through this network of Maternal and Child Health, we have the potential to really reach women. Another critical component to access in care is having women in the health professions training. And here what we’re using are statistics from Women’s Health USA 2003. If you haven’t gotten a copy they’re out here on the table. And from this document we have collected and summarized how women comprise nursing students, medical students, dental school students, public health students, and pharmacy students, and you can see that overwhelming numbers of women are nursing students, it’s 44.6 percent of first year medical students, 38.7 percent of dental school enrollees, and the overwhelming or more than two-thirds of public health school enrollees, and 65 percent of pharmacy students. So we can really see, and this data book gives us a comparison of 10 years ago to now, and it really shows that women are increasingly turning to alternative health careers beyond nursing. This pie chart comes from a report that we do on an annual basis to Congress, and think once again, you know, how is it that you portray your investments in women’s health in your state to your state legislator or to your governor? This happens to be something that’s called the Congressional Moyer Table. It’s named after a long gone congressman. It has reports not only on women’s health but on HIV, on rural health, but this one we’re focusing on the $1.5 billion in fiscal year 2002 in our women’s health investments, over half of which goes to our community health center programs, 39.9 percent to reproductive health, which includes not only the Title V Block Grant and the SPRANS grants, but it also includes the Title X family planning grants, because those are appropriated through HRSA to our office of population affairs to administer, and then the other slices reflect our HIV/AIDS investment, and then our training programs. Let me then turn to some of the projects that we’ve completed in HRSA Women’s Health, and I portray them as collaboration because we’re a very small office, there’s only four staff in the HRSA office of women’s health, but four people who really have a broader reach by virtue of the work we do with others. Women’s Health is a collaboration between the Division of Perinatal Systems and Women’s Health and our Office of Data and Information Management. If you haven’t looked through this document, I’d really encourage you to, particularly over these next three days, to give us your feedback about what you find useful in this data book and what you would like to see in future editions because we are at the point of planning the 2004 edition and one of the data rules that we established between the first and second editions was to say, if there’s no new data to update a particular subject matter, let’s just leave that first edition on the web accessible to everyone but make the second edition refreshed and renewed with new topics. So, for example, the first edition has osteoporosis, the second edition features arthritis, so we expand ourselves into new topics by virtue of that sort of statistical rule. But we’re really soul searching at the moment about what new topics should be covered and really looking hard at whether or not there are nationally representative data sources to enable us to continue to update these critical subjects in women’s health. And this, I’m sure you’ve heard from Michael Cogan today. Is a companion document to Child Health USA and so organized in the same way with a focus on health status and health service utilization as well as population characteristics. One of the other things that we do, and again, I’m sort of a hunter and gatherer in the agency, and we’ve produced, and they’re available on our website, a number of different fact sheets. There’s one about our HRSA women’s health activities collectively; there’s another that features and focuses on our domestic violence activities. Again, in terms of grants, in terms of publications, in terms of training opportunities, and so we sort of package our information in a digestible way for policymakers and our leadership to use in really saying, “Here’s what we’re doing with your tax payer dollars to invest in a critically important area.” Many of you may have seen that last week the Postmaster General released a new domestic violence stamp. The additional seven cents on that stamp will go and fund HHS activities in domestic violence. There is also a new initiative between HHS and the Department of Justice, again to insure homeland security at home so that women and their children are safe and free from domestic violence. So stay tuned to that grant opportunity as it unfolds. We also have invested and through our Bureau of Health Professions on women’s health and the curriculum of various schools. We’ve looked at women’s health in medical school, we’ve looked at women's health in dental school, and our most recent publication is on women's health in the baccalaureate nursing school curriculum. So it’s a way for us to, again, give resources to people who are training and educating our next generation of health professionals. We have GIS maps on our website that really show where our grants are and takes that pie chart to the level of grantee by state and community. In terms of some of our ongoing activities, I’ve talked already about our next edition of Women's Health USA. I’m really proud to say that we have two more women's health in the curriculum projects, one focused in pharmacy school, and for those of you who are interested in what a draft women's health curriculum looks like today, the American Association of Colleges of Pharmacy has on their website, AACP.org, this draft curriculum framework that has the input of the federal government along with the members of the schools of pharmacy and we’ve just started, in fact the first meeting is next week, with the Association of Schools of Public Health, to begin to look at the content of women's health in those schools. And we’re updating our GIS maps. We’re working on a videotape that takes the speakers we’ve had in our own workplace focusing on healthy pregnancy, on healthy heart, on bone health, to make those education resources available to you, not only in videotape form, but with brochures to accompany them. And the gateway to all of this information is our www.hrsa.gov/women's health. We really try to make that the link of grant opportunities as they arise in the agency as well as the, sort of, one stop shopping to get to other information in our agency. So that concludes my presentation, and I’d be happy to entertain your questions. Well, no questions; we’ll get on to the next speaker. Thank you very much.