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Women have always considered many factors when voting, but this election, health care is top of mind. “I say it all the time now: ‘Vote health care, vote health care, vote health care,’” says Cindy Pearson, executive director of the National Women’s Health Network (NWHN), a nonprofit advocacy group in Washington, DC. So much of our health is affected by what our elected officials do: Getting affordable insurance, contraception, and screenings depends on this, as does having access to doctors who understand the unique ways in which conditions like heart disease affect women. Reproductive rights and racial disparities in the system are likewise on the ballot. “It’s more important than ever that women support people who prioritize women’s health,” says Congresswoman Nita Lowey, a rep from New York who is retiring after more than 30 years. “We cannot take that for granted.”
Legislating for Women’s Health
In some ways, the link between government and well-being is clear. Medicare and Medicaid are federal programs that help millions of women, and we know that the Affordable Care Act (ACA, a.k.a. Obamacare) expanded insurance coverage. “The ACA was particularly transformational for women,” says Congresswoman Rosa DeLauro, who represents the area around New Haven, CT. The law eliminated co-pays for birth control, mammograms, and annual visits; made it illegal to charge women higher premiums (as had been standard practice); and forced companies to cover preexisting conditions. “Those ‘conditions’ had included pregnancy, breast and ovarian cancer, osteoporosis, and more,” she says.
But a lot more is going on in government that concerns women’s bodies. For instance, Congress directs how much the National Institutes of Health (NIH) spends each year to research breast cancer, autoimmune disorders, reproductive health, and more, says Susan F. Wood, Ph.D., director of the Jacobs Institute of Women’s Health at the George Washington University School of Public Health. Sometimes elected officials make women’s health a priority, as they did in the 1990s, when hundreds of millions of dollars flowed into the Women’s Health Initiative (WHI), a 15-year study that examined how hormone replacement therapy, diet, and certain supplements impacted postmenopausal health. When legislators don’t focus on women’s needs, important research (such as on endometriosis, which affects one in 10 women but about which little is known) goes unfunded. And it’s the President who appoints the executives who run those agencies, as did George H.W. Bush when the WHI was started, and who nominates Supreme Court justices, who decide the fate of many health laws.
Choices like these that are made behind closed doors may feel distant, says Sarah Christopherson, policy advocacy director for the NWHN, “but the consequences can be life-or-death.” A recent study in Women’s Health Issues found that states that expanded Medicaid under the ACA had fewer maternal deaths than those that didn’t, with non-Hispanic Black mothers benefiting most. Maternal mortality is one of many areas in which Black women fare worse than white ones—something elected representatives could address by funding research to understand why, Wood says.
Maternal mortality is one of many areas in which Black women fare worse than white ones—something elected representatives could address by funding research to understand why.
Whom we vote for affects even how new drugs are tested. It was not until the early 1990s that women in Congress made sure clinical pharmaceutical trials included women as well as men—crucial, as women may metabolize drugs differently and require different dosages. “I remember when all the clinical trials were done on men—even the lab rats were male,” says Lowey, who worked with colleagues to insist that NIH trials include women. (Amazingly, scientists didn’t need to include female animals in government-funded research until 2016.) Even today, not all researchers follow the policy. A 2018 analysis, for example, found that women weren’t adequately included in drug trials for heart failure and coronary artery disease despite the fact that heart disease remains the number one killer of women.
Even a single politician at the local level can make a difference, says Pearson, who points to one female state senator in California who recently pushed through a requirement that hospital staff be trained in the implicit racial bias that harms women of color.
Having scientific evidence take a back seat to other considerations is not new. FDA officials appointed by George W. Bush, for example, prevented emergency contraception, known as Plan B, from being made available without a prescription despite evidence that it was safe. (It was finally allowed to be sold partially over the counter as of 2006.) “We shouldn’t have to worry that someone is influencing decisions based strictly on financial or political reasons,” says Wood.
But over the past decade, as partisan politics have grown even more divisive, some elected officials seem downright dismissive of science and facts, say health advocates. “There has been a trend toward discounting evidence and experts,” says Michael Fernandez, director of the Center for Scientific Evidence in Public Issues at the American Association for the Advancement of Science (AAAS), a nonprofit advocacy group in Washington, DC. The AAAS created the center in 2018, he says, because decision makers “too often ignore, misunderstand, or misuse relevant evidence.” Elected officials can disagree, for instance, about whether companies should be required to cover birth control, but they shouldn’t argue that contraception doesn’t reduce the risk of unintended pregnancy, as did the Trump administration. “It’s fine to have a political argument, but we should at least agree that certain things are true,” Fernandez says.
A willingness to dismiss science was particularly evident during the current administration’s response to COVID-19.
A willingness to dismiss science was particularly evident during the current administration’s response to COVID-19, DeLauro says. Officials first downplayed the reality of its rapid spread, then offered misinformation about treatments. By summer, the U.S. had the highest number of deaths in the world as other countries slowed the spread. Anti-science bias has also lurked behind other recent decisions. At the Environmental Protection Agency, for instance, a pending rule would allow staffers to ignore important scientific findings when crafting regulations that could impact our health, such as those affecting toxins in the air and water. “Voters have a responsibility to understand not only what kinds of decisions their leaders are making, but also how they’re making them and whether they’re appropriately incorporating scientific evidence into their decision-making processes,” Fernandez says.
If Congress Looked Different
While politicians who vote your values can be any gender, Pearson and others believe we would all benefit if more women were elected. Currently, only a quarter of U.S. House and Senate members are women. While not every female pol is a strong supporter of women’s health, most are, and their very presence changes the agenda, DeLauro says, in part because of their personal experience. DeLauro, for instance, survived ovarian cancer, while Iowa representative Abby Finkenauer, who suffers from endometriosis, is aiming to double funding for research on the disease. Illinois representative Lauren Underwood is a registered nurse who has seen health disparities firsthand and is pushing for expanded health care coverage.
Research has confirmed that women in Congress focus on health care issues (for women, children, and men) more than do their male counterparts, says Craig Volden, Ph.D., codirector of the Center for Effective Lawmaking at the University of Virginia in Charlottesville. His research found that 65% of congresswomen introduced bills on health, while only 48% of men did. He also found that women’s bills were less likely to become law, which he speculates is because most committees and subcommittees, through which agendas are set, are led by men. When Lowey took over as chair of the powerful House Appropriations Committee in 2019, its spending bills contained record funding for maternal health and cancer research.
So when you vote this November—and please do—think hard about the people you’re supporting. You’re making decisions that could directly determine the quality of health care for years to come—for your family and for you.
7 Questions to Ask Candidates
It doesn’t matter which side of the political fence you sit on—health care is on everyone’s mind for this election. In fact, a recent Gallup poll found that it was the number one concern among voters, above even the economy and national security. Before you vote, find out whether the candidates in your state are using science to inform their opinions by contacting their campaign offices and asking these questions:
How should the U.S. best prepare for current and future pandemics?
Do you believe contraceptives and reproductive health should
What can be done about the rising costs of health care?
Do you support the Affordable Care Act? If not, what would you replace it with?
How will you ensure that science doesn’t fall victim to partisan politics?
What are your plans to help fund research on women’s health?
How can the government ensure that clinical trials represent all genders and races?
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