Women as second-class (health) citizens

State policy

In some states with poor women’s health outcomes, efforts have been made in recent years to enact public health legislation to improve the situation, but many legislative proposals have failed to get off the ground.

In Oklahoma, for example, which saw some of the greatest declines in women’s life expectancy, Democratic state representative Jeannie McDaniel has introduced numerous public health bills over the past several years, few of which have been successful.

“I remember a few years ago when I learned that my granddaughters might live shorter lives than I will,” she said. “I am very cognizant that women are suffering especially in Oklahoma, but common sense legislation…that could really improve the lot of women doesn’t even get out of committee here.”

Last year, McDaniel introduced legislation to require that health education be taught at the middle school level, but the proposed bill failed to pass.

Oklahoma House Speaker Kris Steele, a Republican, said that while he had personally favored the measure, the Republican caucus in Oklahoma is loath to pass “unfunded mandates” on the school system. But Steele admitted that he, too, would be “very cautious” about raising taxes to make such a measure a “funded” one, even though he believed health education would be beneficial for both women and men in Oklahoma.

“In funding the various initiatives, it comes down to priorities,” Steele said. “We fund those things that are deemed as being vital or important.”

Steele himself introduced legislation in the last session that would have lifted a long-standing state prohibition on any local law to ban smoking in public places or to tax tobacco. Oklahoma is one of only two states that has such a prohibition, and the state itself does not currently have any regulations on the books concerning tobacco use. But Steele withdrew the legislation before the end of the session, because he was not sure that it could pass the State Senate. He is planning on reintroducing the measure in the next session.

“We recognize that we have to get our women’s smoking rates down, that they’re way too high,” he said. “I just thought we weren’t ready this year.”

Michael Brown, a state representative in Missouri, has had similar problems passing public health legislation in that state. Recognizing that obesity rates are higher in Missouri than the national average, Brown has repeatedly introduced legislation to establish a state agency to study obesity in Missouri and to be accountable for lowering obesity rates.

That bill has, likewise, gone nowhere.

“I can’t understand it,” Brown said. “This is such a small first step that we need to take, before we take a bunch of bigger steps, and we can’t even do it. When I say obesity in committee, people sneer at me,” completely unwilling to face the issue, he said.

In the Kentucky legislature, Health and Welfare Committee co-chair Tom Burch said that, several years ago, when he saw that women’s smoking rates were rising, he introduced legislation that would raise tobacco taxes. “It got referred to the ag[riculture] committee,” he said. “When I went there to talk about it, the chair lit up a cigarette.”

What needs to change?

Legislators, public health experts, and women’s advocates identified a number of barriers that they faced in gaining ground on women’s public health issues. McDaniel said that the number one issue she has faced is that many people in Oklahoma saw legislation intended to increase public health outcomes generally, and particularly for women, as an infringement into the “sanctity of the family.”

Burch echoed that sentiment. “We have folks in Kentucky who see their wives and daughters as property, and think their proper place is in the home, where the government has no right to go.”

Like others Remapping Debate spoke with, McDaniel emphasized the serious harm men suffer from the lack of priority accorded public health. Even so, she said, the societal status of women plays a large role in how frequently public health policy aiming to improve women’s outcomes is ignored.

“When women are treated as second-class citizens, then you don’t need to think about our needs as much,” she said, adding that by raising the status and recognition of women, it would become easier to make policy that affects them.

Lubetkin said that, in many parts of the country, measures to improve public health policy are seen, ironically, as “paternalism.”

“There’s always this conflict between individual rights and the collective good,” she said. “I don’t think gains will really be made until we realize that a little bit of paternalism can go a long way, and that might not happen until we accept that we are already paying for each others’ behavior.”

Many advocates stressed the importance of education, both in terms of raising the visibility of public health issues and also in terms of educating the public on the adverse effects unhealthy behavior.

“We have so much information, and we’re getting more and more all the time, and we need to keep finding better ways to get this information to legislatures and to the public,” said Waxman.