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	Woman in Charge By Nancy Glick

As the primary coordinators of family healthcare, women shoulder most of the responsibility for the care provided to their children, spouses/ partners, and elder relatives. Of equal importance, today's woman is becoming increasingly savvy about her own body and recognizes that she is in charge when it comes to medical practice and new therapies.
I am woman, hear me roar
In numbers too big to ignore
And I know too much to go back
and pretend

When Helen Reddy made these lyrics famous in her 1972 hit song "I Am Woman," she could not have known that almost 35 years later, these words could be used to describe the dominant role that American women now play as the decision makers in healthcare.

Numbers Too Big To Ignore

According to the U.S. Census Bureau, women now represent 51 percent of the total U.S. population, which translates into more than 153 million people. Women also make up a significant portion of the labor market. According to the U.S. Department of Labor, Women's Bureau:

• Women constitute 46 percent of the total workforce, and this number is projected to climb to 48 percent by 2008.
• Almost two-thirds of married women (62 percent) with a spouse present, 65 percent of women with an absent spouse, 67 percent of never married women, and 75 percent of divorced women are participating in the workforce.
• In 2000, 72 percent of women with children younger than 18 were working. This included 55 percent of women with infant children and 65 percent of women with children under age 6.
• Women also represent 25 percent of all part-time workers and 53 percent of those engaged in contingent work or temporary employment.

Besides women being a major part of the workforce, the Center for Women's Business Research reports that nearly half (48 percent) of all privately-held U.S. firms are 50 percent or more women owned. This means that 10.6 million firms are at least half owned by a woman or women. These firms employ 19.1 million people and generate nearly $2.5 trillion in sales.

As more women enter the workplace or start their own businesses, their earning power continues to escalate. As just one example, a February 2002 study of 400 women commissioned by Prudential Financial found that 37 percent live in households with incomes of $50,000 to $100,000 and 12 percent live in households with more than $100,000 in annual income.

Taken together, these statistics document this undeniable fact: women represent an economic powerhouse, making over 85 percent of the consumer purchases in the U.S. and influencing over 95 percent of total goods and services sold (source: Competitive Edge Magazine and EPM's Marketing to Women). This translates into an estimated $3.7 trillion a year that women spend on consumer purchases, including those in traditional "male" categories, such as automobiles, consumer electronics and PCs (source: Women's Market). Moreover, women now make about $1.5 trillion worth of all decisions regarding business expenses (source: Women's Market) and, according to a new report by the Center for Women's Business Research, are equally likely to rely on facts and information (47 percent) as they are on intuition, values and the quality of the relationship (53 percent) when making a decision.

Women as Health

Managers for the Family The role of women as consumers of goods and services gives them far-reaching possibilities to affect change, and nowhere is this more apparent than when it comes to the healthcare marketplace. In fact, the National Women's Health Resource Center (NWHRC) concludes that American women have taken on the role of "health manager" for their family and make the bulk of the health-related decisions for their children, their spouses, and their parents. According to "Women Talk," NWHRC's first annual national women's health survey issued in May 2005, women place a greater priority on the health of their family than their own personal health.

This survey of 1,005 women aged 18 and over reveals that:

- Women's perceptions of being healthy are defined by their family's health. In fact, the top priority for women (96 percent) is having a healthy family, ahead of their own health (95 percent), being financially secure (72 percent) or having close friends (66 percent).

- Women see rewards in taking care of others. A near majority (48 percent) says that taking care of others has a positive impact on their physical health and 57 percent say that taking care of others has a positive impact on their mental health.

- Women make the vast majority of healthcare decisions for the family, such as selecting a health care professional and choosing when to go to the doctor. Only 19 percent of those surveyed reported making their decisions jointly with their spouse/partner while another 71 percent said they acted alone.

- Women see healthcare professionals with great frequency (92 percent in the last year) and are the most likely to engage in a dialogue with physicians about a health issue.

Building on these important findings is the research conducted by the Kaiser Family Foundation, which examines the role that women play in their families' health, including the decisions they make on behalf of their children. In a report called "Women and Health Care: A National Profile," the Kaiser Family Foundation finds that 80 percent of mothers shoulder the main responsibility in the family for selecting their children's doctors, taking them to doctor's appointments, and arranging for their children's follow-up care. Decisions about children's health insurance coverage are more likely to be a joint responsibility with a spouse, but still a majority of women (57 percent) assume the primary responsibility in this area also.

On the other end of the spectrum, women predominate among the family caregivers who now provide unpaid services valued at $306 billion a year, an amount comparable to Medicare spending in 2004. Seminal research on family caregiving commissioned by Ruder Finn's client Johnson & Johnson Consumer Products Company reveals that women represent 56 percent of the estimated 120 million adult Americans who either are or have been family caregivers. Many of these individuals provide care for several years. In the Johnson & Johnson Consumer Products Company survey, twothirds of family caregivers (63 percent) reported providing care for a year or more; 37 percent said they provided care for 1 to 4 years while another 26 percent have been caregivers for more than 4 years.

As caregivers, women often have multiple roles, including juggling work and childrearing along with their caregiving responsibilities. Just how much juggling is involved can be seen by research conducted by the Ravazzin Center for Social Work Research in Aging at Fordham University, which finds that 40 percent of caregivers in 2000 were raising their own families and two-thirds were working, mostly full time. At the same time, women caregivers must now deal with complicated medical equipment and procedures, administer multiple medications properly, and keep track of the drugs prescribed by different physicians. Moreover, when women care for a family member, they are increasingly functioning as the patient's healthcare advocate, juggling conflicting advice about health care and social services from different providers and government agencies.

How do women feel about being family caregivers? According to the Johnson & Johnson Consumer Products Company survey, the overwhelming majority are willing to make significant changes in their lives to ensure that an adult family member or friend gets the care he or she needs. This is because Americans — and especially women — believe that caring for a family member is an important value that improves the quality of their lives.

Women as Health Managers for Themselves

When it comes to taking care of themselves, American women are becoming increasingly savvy about the range of issues affecting their health — from their family medical history and screening guidelines to new therapies that can improve their health status. In the 2005 survey conducted for the National Women's Health Resource Center, nearly two-thirds of the women polled said they are very familiar with their family medical history and most are familiar with screening guidelines. As a result, broad majorities of women accurately reported needing annual preventative screening, such as Pap smears (86 percent), pelvic exams (81 percent) and teeth cleanings (90 percent). Further, the NWHRC survey found increasing awareness among older women about the need for frequent screenings, such as mammograms (81 percent among women over 40), cholesterol tests (84 percent among women over 50), and bone density tests (39 percent among women over 50).

But despite this progress, women's health groups are not standing on their laurels. Research continues to find that many women do not know about major differences in their biology and physiology that cause them to react differently to some medications, make them more vulnerable to some diseases, and produce different symptoms than men.

These differences are the essence of sexbased biology, the study of biological and physiological differences between men and women. Documented in an April 2001 Institute of Medicine (IOM) report, "Exploring the Biological Contributions to Human Health," these differences between the sexes are significant and are translating into improved medical practice and therapies. Moreover, organizations like the Society for Women's Health Research are focusing on the need to raise awareness about the crucial biological and physiological differences between men and women. According to the society, there are ten major areas where biology makes a significant difference:

Heart Disease - which kills 500,000 American women each year - over 50,000 more women than men - and strikes women, on average, 10 years later than men.

Depression - where women are two-to-three times more likely than men to suffer from depression in part because women's brains make less of the hormone serotonin.

Osteoporosis - where women comprise 80 percent of the patient population.

Smoking - which has a more negative effect on cardiovascular health than in men. Women are also less successful quitting smoking and have more severe withdrawal symptoms.

STDs - where women are two times more likely than men to contract a sexually transmitted disease, and more likely to experience significant drops in body weight, which can lead to wasting syndrome.

Anesthesia - because women tend to wake up from anesthesia more quickly than men - an average of seven minutes for women and 11 minutes for men.

Drug Reactions - where even common drugs like antihistamines and antibiotic drugs can cause different reactions and side effects in women and men.

Autoimmune Disease - because women represent three out of four people suffering from autoimmune diseases, such as multiple sclerosis and rheumatoid arthritis.

Alcohol - because women produce less of the gastric enzyme that breaks down ethanol in the stomach and therefore metabolize alcohol differently.

Pain - because some pain medications (known as kappa-opiates) are far more effective in relieving pain in women than in men.

Women's health groups are also concentrating on closing the gap between awareness and behavior change, which is especially important when it comes to lifestyle issues, such as exercising and losing weight. Time constraints, inadequate financial resources and cultural differences among women are largely responsible for this lack of action. Increasing data finds that women, in particular those under age 65, feel pressure from competing responsibilities of work and home life that restrict their time and energy and keep them from making lifestyle changes that would improve their health.

Reaching Women With Health Information

As the health managers for the American family, it is essential to know how to reach women who are at the nexus of most decisions regarding healthcare. Thus, increasing attention is being given to understanding where women get their health information and which sources they trust the most. Among the many groups studying this question is the National Women's Health Resource Center, which finds that an overwhelming majority of women (67 percent) trust the information provided by healthcare professionals more than any other source. This is because women, more than any other demographic group, have an ongoing relationship with physicians, either for their own care or for the care of their children and adult family members.

This established relationship between women and healthcare professionals underscores the need to promote a better dialogue between women and physicians, nurses and pharmacists about diagnostic screenings, diagnosing conditions, treatment options, and medicine compliance - all factors essential for better patient care. This can include communications tools that will prepare women to ask questions of the clinician and consumer-oriented information provided in doctors' waiting rooms. According to the NWHRC survey, 57 percent of the women polled said that they get healthcare information from the professional's waiting room.

But increasing research finds that despite the frequent interaction between women and clinicians, information about specific issues is still limited. For example, research conducted by the Kaiser Family Foundation finds that counseling on sexual health topics is infrequent, even during women's reproductive years.

In a survey commissioned by the foundation, fewer than one in three women aged 18 to 44 reported having a discussion with their doctor about their sexual history (31 percent), sexually transmitted diseases (28 percent), or HIV/AIDS (31 percent). Moreover, an important report issued by the Society for Women's Health Research documented a breakdown in communications between breast cancer patients and their clinicians over the risk of recurrence of their disease. However, approximately one-third of women with estrogen receptor-positive early breast cancer experience a recurrence and over half of those recurrences occur more than five years after surgery.

To address this lack of communication, Ruder Finn worked with the society to launch "Life After Early Breast Cancer: Improving Your Chance of Staying Cancer Free (Life ABC)," an educational campaign initiated by the society and supported by Novartis Oncology. A key part of this program was the widespread distribution of the Life ABC Checklist with simple steps that women can take to remain cancer-free and a list of questions to ask the doctor about preventing a cancer recurrence.

To reach women with these tools, health educators often rely on the Internet, because the Web is increasing in importance as an information resource for women. According to the U.S. Census in 2000, women became a slight majority of Web users for the first time in history (51 percent women and 49 percent men). Moreover, the Pew Internet and American Life Project reported that 82 percent of women who are online use the Internet to search out information about specific health issues. Based on a 2004 poll, Pew found that the most-searched topics include:

• Information about a specific disease or medical problem - 66 percent
• Information about a specific medical treatment or procedure - 51 percent
• Diet and nutrition - 51 percent
• Exercise or fitness - 42 percent
• Prescription or over-the-counter drugs - 40 percent
• Health insurance - 31 percent
• Experimental treatments - 23 percent
• Vaccinations - 16 percent
• Sexual health information - 11 percent
• Problems with drugs or alcohol - 8 percent

When women are searching online, they are looking for solid health information that is easy to use, solutions-oriented and simple in design. Surveys also find that on the whole, women do not respond well to gender-oriented pastel print ads or websites unless the subject is specific to a women's health concern, such as breast cancer.

But women rely on other, more conventional communications channels for their health information, such as magazines, community newspapers, drive-time radio and local morning television news programs. In addition, cable networks and special women's programming on television remain a potent force for addressing women's issues and concerns. According to a recent Nielsen report, nearly 80 percent of working women spend an hour watching television on the average weekday.

Because of the reach and impact of these media channels, communications programs that utilize these touch points can be effective in raising awareness about health issues. But these outlets also require considerable frequency or exposure over time, which is why health educators must utilize a mix of media channels, including materials in waiting rooms and pharmacies and customized materials available through the Web.

Harnessing the Power of Women

Freud famously pondered "What does a woman want?" and didn't find the answer. But when it comes to the health of themselves and their loved ones, what women want is not elusive: it is easy access to information that is actionable and solutions- oriented. Women also trust in doctors and want to be able to ask questions and get simple answers that will guide their decision making.

Ultimately, what women want is what Aretha Franklin sings about — respect. Because women are the health managers for their families, marketers and educators that recognize the increasing role of women as decision makers and respond accordingly will be successful in driving awareness and behavior change. A lot still needs to be done, and the women are waiting...