Reframing the View of Women?s Health in the United States: Ideas from a Multidisciplinary National Center of Excellence in Women?s Health Demonstration Project

Abstract

U.S. women's health has only recently received concerted attention, reflecting a historic lack of information about how to serve female clients in health care settings, and understanding the components of holistic approaches to women's health [1-3]. Women's health care has traditionally focused on reproductive health, with little emphasis on other areas such as cardiovascular, environmental, financial, and mental health, social connectedness, and consideration for spiritual and intellectual pursuits [3-6]. To remedy these deficits, the U.S. Department of Health and Human Services' Office on Women's Health launched in 1996 the National Centers of Excellence in Women's Health initiative. These multidisciplinary programs involved academic, clinical community, and rural frontier Centers [4]. In each Center, the five initiative principles were similar: advancing women's health by providing efficient, effective and comprehensive clinical care, promoting education and championing women's health research, providing outreach to underserved women, and endorsing women's health leadership development. The University of Utah became a contributing member to this CoE network in 2005 as a National Center of Excellence in Women's Health Demonstration Project (CoEDP) for U.S. Region VIII. Our CoEDP adopted an inclusive philosophy, involving the entire University Health Sciences Center, including the School of Medicine, the Colleges of Nursing, Pharmacy and Health, and the Eccles Health Sciences Library (EHSL). Our CoEDP emphasized the inclusion of faculty and students on the university's main campus, notably from the College of Social Work, to conduct research on, and teach content relative to, women's health. Our core group consisted of committee chairs on clinical care, professional education, outreach, research and leadership development plus key members from all the aforementioned academic units. Early on we established a vision statement clarifying the work we would embark on together: "Connecting Women to Wellness". In addition, we conceptualized a generalized approach to health based on a holistic and multifaceted perspective-all aspects of women's lives are connected and are linked to health in the broadest sense possible. It became clear in developing this statement that we needed a multidisciplinary definition of "health and wellness". Although the concepts of wellness and wellbeing are quite common in the literature on social development, much of the discussion about these concepts is quite narrow and not as encompassing as the ideas we were attempting to identify and implement though the CoEDP. For example, White [7] notes that "wellbeing is viewed as a social process with material, relational and subjective dimensions "which can be assessed at individual and collective levels". This view of wellbeing was not broad enough from our view. Thus we explored the idea of "360 degree screening" (a "Circle of Health") view of women's health (Figure 1). Since we all acknowledged that women are not just their reproductive body parts, we considered those aspects of health that would promote clinical experience, educational offerings, research opportunities, and community outreach efforts. We wanted to highlight women's health in multi-faceted dimensions and across disciplines. In identifying and reviewing the literature about women's health, we explored the clinical, research, and educational literature to determine what was being discussed from a multidisciplinary and transdisciplinary view about women's health. This search was a challenge since much of the scholarly literature examines women's health in terms of silo-either physical