We now know that men and women have very unique health risks and outcomes, but that wasn't the case 20 years ago, when most health research was done on men.
“Women were vulnerable to harm from undertreatment, overtreatment and mistreatment due to the lack of rigorous research on women's unique experience of health and disease,” says Nancy Milliken, MD, who was a professor in the Department of Obstetrics, Gynecology and Reproductive Sciences at the time. “Women's health was predominantly viewed as limited to reproductive health.”
Milliken was a member of a small group at UC San Francisco and in the local community who believed they could transform women's health across the lifespan. They drafted a proposal that resulted in UCSF being designated in 1996 as one of the nation's first six National Centers of Excellence in Women's Health, sponsored by the Office on Women's Health in the U.S. Department of Health and Human Services.
Including women in studies to uncover the sex and gender differences in the causes, treatment and prevention of disease was one but not the only motivation behind the establishment of these centers. As Dixie Horning, executive director of the UCSF National Center for Excellence in Women’s Health since 2000, points out: “We know we can't just change research and expect it to quickly get into care.”
In recognition of the interconnected processes needed to improve women's health, the center has integrated its pursuits along five main pillars:
- Promoting sex and gender research as essential for understanding women's (and men's) health and disease;
- Encouraging the development of multidisciplinary clinical care organized around the needs and preferences of women and based upon the emerging evidence;
- Educating the future generations of clinicians and researchers in sex and gender inquiry and knowledge;
- Supporting leadership roles for women at UCSF; and
- Filling the pipeline with diverse young women.
Core to the center’s vision is that advancing women’s health and transforming women’s lives can only be done partnership with our community. As part of that community participation, the center hosted a street fair on Saturday to celebrate its 20th anniversary.
Changes in Care, Research Over 20 Years
Much has changed in those two decades since the UCSF National Center for Excellence in Women’s Health was launched.
With its sister centers nationally, the UCSF center has witnessed a sea change in women’s health in its first two decades of existence.
Heart disease and HIV now are recognized as presenting differently in women and men and requiring different strategies of prevention, diagnosis and treatment. Targeted screening for breast and cervical based upon risk and new markers are resulting in less testing and fewer false positives. Postmenopausal hormone therapy is not the preventive panacea it was once thought to be but still has variable benefits and harms specific to individual women. Social determinants of health, such as interpersonal violence and poverty, affect women in different ways than men.
Incredible progress also has been made in the realm of clinical care, notes Milliken, who has directed the Women’s Health Center at Mount Zion for its entire existence. Collaboration and coordination of primary and specialty care for women at UCSF has been enhanced, reduced fragmentation of care has been designed into the Women’s Health Center, the UCSF Betty Irene Moore Women’s Hospital at Mission Bay and multiple other practices.
The centers have worked on women's health curriculum and implementing new programs and training opportunities for professional students, and "community partnerships have developed and enhanced research, clinical care and programs beyond the walls of UCSF,” Milliken adds.
More Work Remains for Equality
However, the directors agree, there is still much work to be done.
Case in point: bringing equal numbers of women as men to leadership positions. “We have women entering medical school at a rate of around 50 percent, and yet why aren’t half of the deans women?” Horning poses. “The center has invested in studying this pipeline breakdown, and how to get women – and also communities of culture and color – into leadership roles and remain there.”
The center has established community outreach and multiple educational and mentoring programs that are starting to fill the training pipeline with future health care providers, researchers and educators that have a passion for women’s health. Their Young Women’s Health Conferences, designed by and for young women to empower them to take control of their health and lives, have touched the lives of more than 10,000 teenage girls.
Looking to the future, Horning wants to see more of the same. “I would like to see us continue to work on getting diverse populations in leadership roles within our institution so that the populations they are serving are being seen by people who look like them,” says Horning.
There is a lot to look forward to in the coming decades, especially given that it can take 15 to 20 years for research findings to be incorporated into clinical practice.
“My dream would be that the need for UCSF National Center of Excellence in Women’s Health would be eliminated because sex and gender approaches to research, clinical care, education are in the DNA of UCSF, and inform health care and policy across our nation and the world,” says Milliken.
In that future vision, she hopes that men’s symptoms would no longer be called “typical” and women’s “atypical,” as is the case with chest pain today. Researchers and clinicians would automatically ask “Are there differences between women and men?”, gender and other social determinants of health would be included in health care decisions and policy and mutually beneficial partnerships with the community would abound.
How to get to that point? “We need to invest in the deep thinkers and visionary women and men of the next generation who are committed to this task which will transform not just women’s health but all of human health,” she says.