Q: What are the most common health problems affecting women of color?

A: Women of color include Native, Hispanic, Black, and Asian American women. In the United States, cultural experiences, personal circumstances and their effects on life expectancies and illnesses differ greatly among the women included in any of the four groups. However, each ethnic group shares some health issues that differentiate it from other ethnic groups, including Euro-Americans. Historically, federal policies and social oppression have contributed to poverty and, consequently, poorer health for many members of the ethnic groups mentioned above. However, new federal initiatives are now in place to eliminate racial and ethnic disparities in health care and health risks for women.

Heart disease and cancer are the major killers among women of color, as they are among the rest of the population. African-American women experience high rates of death from HIV/AIDS, homicide and unintentional injuries. For Hispanic women, additional prominent causes of death are HIV/AIDS, especially among Puerto Rican women, and homicide and unintentional injuries. Homicide and unintentional injuries are also common causes of death for American Indian/ Alaska Native women, as well as alcohol-related diseases. The rate of tuberculosis among Asian-American women is four times the general population.

Besides the differences in the cause of death for women, there are also differences in less threatening health problems. And, women of color are disproportionately represented among the 15% of the total U.S. population without health insurance.

A: Heart disease and cancer are the leading causes of death among Asian-American women. Some other common health problems affecting Asian-American women are tuberculosis, Hepatitis B, and cervical cancer.

The rate of tuberculosis is highest among southeastern refugees from Vietnam, Laos, and Cambodia, where the rate of tuberculosis is six times that of the general population.

Hepatitis B, which affects the liver, is another significant problem facing Asian-American women. Of great concern to public health officials is the ability for Hepatitis B to transfer from mother to child during birth.

Although the overall cancer rates are lower among Asian populations, the number of cervical cancer cases among Asian-American women is higher than Caucasian women. Lack of knowledge, combined with an ethnocultural emphasis on modesty and humility, makes preventive care difficult. Despite the importance of preventative screenings, many Asian-American women, especially recent immigrants, are reluctant to have a Pap smear or breast exam. (See Affonso, p.85)

A: The health status of American Indian women is affected by the fact that rates of poverty and unemployment are higher among American Indians than those of other US ethnic populations: twenty-seven percent live in poverty.

The major health concern among American Indian women is heart disease. Although heart disease is the major cause of death for all US women, American Indian women are at an even higher risk due to their rates of obesity, diabetes and binge drinking. Sixty percent of American Indian women are overweight, have a sedentary lifestyle, eat relatively high-fat diets and experience cigarette and alcohol abuse.

Alcohol abuse is also a leading cause of death and hospitalization among American Indians, ages 45-54. Death due to alcoholism is ten times the rate of U.S. women of other ethnicities. Services for alcohol-related problems are one of the greatest unmet health care needs for American Indian Women.

Violence is reported in sixteen percent of all marital relationships.

End-stage renal disease, which is disease of the kidney, is 2.8 times higher among American Indians than whites.

Cervical cancer is another health concern among American Indian women and survival rates are the lowest of all the ethnic groups. (See Welty, pp.79-81)

A: The leading causes of death in African-American women are heart disease and cancer, followed by cerebrovascular disease, diabetes mellitus, unintentional injuries, pneumonia, influenza, AIDS, conditions related to pregnancy, childbearing, chronic obstructive pulmonary disease and homicide. In general, Blacks have more undetected diseases, higher disease and illness rates (from infectious conditions such as tuberculosis and sexually transmitted diseases), more chronic conditions (such as hypertension and diabetes), and shorter life expectancies than whites.

Morbidity and mortality rates for Blacks from many conditions (cancer, HIV/AIDS, pneumonia, and homicide) exceed those for whites. These findings exist even though black females are generally less likely than white females to report risk behaviors such as smoking cigarettes, consuming alcohol, or using other substances. In 1993, among women, blacks had the highest mortality rates from homicides and firearm-related events. In addition, the higher incidence of hypertension among African-Americans (approximately one in every three adults), obesity, high fat and cholesterol dietary intake, sedentary lifestyle and diabetes among African-Americans are likely major contributors to heart disease and stokes.

Fifty percent of African-American women are obese, a condition associated with diabetes, hypertension, as well as being an independent risk factor for cardiovascular disease. Diabetes is independently a major contributor to the death and disability of African-American women. The death rate for diabetes was two and a half times that of Euro-American women in 1993.

Additionally, Black American women have the highest incidences of both low-birth-weight (13 percent) and very-low-birth-weight (3 percent) infants. Infant mortality rates were the highest for the babies of black women-at seven deaths per thousand live births, more than double the rate of seven deaths per thousand live births to white mothers, and significantly greater than the rate for all mothers (nine deaths per thousand live births.)

In recent years, the incidence of AIDS has been increasing significantly faster among African-American women; the death rate from AIDS was nine times that of white women in 1993. Although not life threatening, uterine fibroid tumors are also more common in African-American women.

A: Like all other women, heart disease and cancer are the leading causes of death among Latinas, followed by cerebrovascular disease, diabetes mellitus, accidents and adverse effects, pneumonia and influenza, conditions originating in the perinatal period, chronic obstructive pulmonary diseases, including asthma, congenital anomalies and AIDS. Within some of these disease categories, there are differences in the incidence and severity among Latinas. Lung, cervical, colorectal and breast cancer are the most frequently reported types of cancer among Latinas. Although the incidence of breast cancer among Latinas is lower compared to white non-Latina women, Latinas are more likely to die of breast cancer than white women.

In addition, the diabetes mortality rate for Latinas is twice the rate for non- Latina whites. Mexican-Americans and Puerto Ricans experience up to 112% higher diabetes rates, compared to whites. The rate for Cuban-Americans ranges from fifty to sixty percent the rate for whites. Mexican-Americans and Puerto Ricans have a two to three times greater risk of non-insulin dependent diabetes than non- Latinas. Much of the diabetes in the Hispanic population is undiagnosed

Latina women are eight times more likely to acquire AIDS than non-Latino white women.   In December 1995, Latino women represented twenty percent of all accumulated AIDS cases among women in the U.S.

Some sexually transmitted diseases are more prevalent among Latinas than other women, too. In 1993, Latinas were five times as likely to contract primary and secondary syphilis as non-Latina whites, and three times more likely to contract gonorrhea.

Severe chronic depression is another problem that commonly affects Latinas; about one-half of Hispanic/Latina women reported severe chronic depression compared to thirty-seven percent of non-Hispanic white and forty-seven percent of non-Hispanic black women.

Finally, in 1995, among all Hispanics, thirty-three percent had no health insurance, while among poor Hispanics, this share was forty-one percent, the highest rates of non-coverage of any ethnic group.

A: Women’s health is finally been paid the attention it deserves, and the amount of information available on women’s health has exploded in recent years. However, getting information that is relevant to individual women remains a challenge; not all information is specific to women of various ethnic groups. In addition, not all information is valid or has women’s best interests in mind. Women should gather and compare information from various sources and consider the vested interests of the source before acting on the recommendations of any one source.

A: The best place to begin a search for medical information is your personal physician. It is often helpful to prepare for a session with your health care provider by writing down questions and concerns prior to your appointment. Women of color should ask if there has been sufficient research in their ethnic group to support recommendations for diagnosis and treatment of a particular condition.

A: The public library is also a wonderful source of information; many libraries have reference sections on women’s health. Our Bodies, Ourselves, published by the Boston Women’s Health Book Collective, is a classic women’s health book written in easy-to-read language by women, for women. The book is updated periodically to incorporate recent research findings and changes in the way some health conditions are managed, so be sure to look for a recent edition. Our Bodies, Ourselves recognizes that women are a diverse group and includes information on women of color. Recently published books such as Body & Soul: The Black Women’s Guide to Physical Health and Emotional Well-Being, offer general health information relevant to targeted populations. Body & Soul is published under the auspices of the National Black Women’s Health Project (NBWHP). The NBWHP, like the Boston Women’s Health Book Collective, believes that women are capable of making decisions about their own bodies, when given access to accurate information.

A: Women with computers can find a great deal of information on the Internet. However, a woman should remember that information on the Internet is not always complete or accurate. Critical assessment of the information is necessary. By using key words such as women’s health, women can learn of various agencies or organizations that could provide helpful information. Once on the Internet, you can learn of the latest books that have been published on women’s health (which sponsors this website) and can be purchased from your local bookstore or checked out at your local library. Organizations such as the American Medical Women’s Association, and the Office on Women's Health in the Department of Health and Human Services can provide a wealth of information, as well as direct you to other resources. Other sites such as the National Institutes of Health provide information on specific diseases or conditions that affect women and those they care for. The Office of Minority Health Resource Center at www.omhrc.gov is a nationwide service of the Office of Minority Health of the U. S. Public Health Service. It provides information on the activities of the Office of Minority Health, as well as listings of resources on specific diseases and conditions as they pertain to women of different ethnic groups.

A: For women without easy access to computer-based technology, information may be obtained from public service "spots" on local radio stations or television, printed materials provided by local health departments or local and regional offices of national health organizations such as the American Heart Association, American Cancer Society, or the American Diabetes Association. In addition, some organizations provide printed materials and assistance over the phone. The Office on Women's Health in the Department of Health and Human Services sponsors the National Women’s Health information Center, which has a toll-free health information and referral number: 1-800-994-WOMAN.

A: The National Women's Health Information Center has special sections on women of color on its website: http://www.4woman.gov.

The National Women’s Health Network provides up-to-date information on selected women's health issues for its members and the public. The Network seeks to protect the health of women by keeping them informed of the risks of certain medications, bringing to women's attention the latest research on cancer, birth control methods, and launching campaigns against harmful drugs and devices. The Network sponsored the first national conference on black women's health, which led to the creation of the National Black Women's Health Project. The Network maintains an extensive resource library and responds to health inquiries from individuals and health professionals. The National Women's Health Network has published pamphlets such as "Taking Hormones: Choices, Risks and Benefits," and fact sheets on breast cancer for women of different ethnic groups. The Network also publishes a bimonthly newsletter, which contains articles on women's health concerns for its members. For information, call (202) 347-1140.

The Office of Minority Health Resource Center has a toll free number, 1-800-444-6472. The center collects and distributes information on a wide variety of health topics, including substance abuse, cancer, heart disease, violence, diabetes, HIV/AIDS and infant mortality. Unlike a clearinghouse, OMH-RC offers customized database searches, publications, mailing lists, referrals, and more regarding American Indian and Alaska Native, African American, Asian American and Pacific Islander, and Hispanic populations. The Resource Center has trained information specialists who are available Monday through Friday between 9:00 a.m. and 5:00 p.m. eastern time to assist with your needs. For callers who prefer speaking Spanish, the Resource Center provides bilingual information specialists. For persons with hearing and speech disabilities, they provide a TDD line (301-589-0951).

The Native American Women's Health Education Resource Center offers health education information and activities for women. Education and information on the following subjects are provided: fetal alcohol syndrome; family planning; AIDS awareness; sexually transmitted diseases; nutrition; child development; domestic violence and self-help. The Native American Women's Health Education Resource Center publishes brochures and posters on AIDS and breast cancer. To contact the Center, call (605) 487-7072.

The National Asian Women’s Health Organization is a non-profit, community-based advocacy organization which strives to improve the health status of Asian-American women and families through research, education, leadership and public policy programs that empower women, and address broader social justice issues for under-served communities of the entire American population. You can access their educational materials on reproductive health, breast cancer, and cervical cancer through the internet at http://www.nawho.org  or by phone at (415) 989-9747.

The Organizacion Nacional de La Salud de La Mujer Latina (National Latina Health Organization) has been formed to raise Latina consciousness about health and health problems. The Organization brings together Latinas from all economical and educational backgrounds and represents Puerto Ricans, Chicanos, Mexicans, South Americans and Central Americans. All of the conferences, workshops, meetings, and documents are offered in Spanish as well as English. The organization publishes a quarterly newsletter with an emphasis on self- empowerment for Latina women in the community so that they may improve their own physical, mental, and emotional health. To contact the organization, call (510) 534-1362.

The National Black Women's Health Project has been organizing Black women in America to take an active role in maintaining their physical and mental health since 1984. In addition to being advocates for Black women on Capitol Hill and offering self-help tools to developing nations, NBWHP has over 4,000 members who participate in sixteen chapters and 150 local self-help groups all over the country. To improve the health of Black women, each self-help group not only serves as a support network for its members, but the members serve as advocates for Black women in their communities. Among the local initiatives in which many members of NBWHP also participate is the Walking for Wellness Program, where women make a commitment to walk together twice a week. Most recently, NBWHP organized Black women on eight college campuses to implement a youth substance abuse prevention program in their surrounding communities. NBWHP has developed extensive audio-visual and written materials for Black women, including, On Becoming a Woman: Mothers and Daughters Talking Together, which explores how mothers and daughters can talk about sexuality, motherhood, and birth control; Self-Help Developers Manual, to help women start self-help groups in their communities and Body & Soul: The Black Women’s Guide to Physical Health and Emotional Well-Being, a book on health information and self care guidelines. To contact the NBWHP, call
(202) 835-0117.

Contributions to this FAQ on Minority Women: Wake Forest University Baptist Medical Center, a National Center of Excellence in Women’s Health sponsored by the Office on Women's Health in the Department of Health and Human Services.