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Lifelong Partnership-Based Approach to Healthcare

Access and Equality

Integrative Medicine and Holistic Care

The State of Women’s Health Recalibrate the Present & Redefine the Future

#SWH2015 Outcomes Report

Innovative Programs and Policies


Introduction: The State of Women’s Health Dr. Martin Luther King, Jr. said “Of all the forms of inequality, injustice in healthcare is the most shocking and inhumane.” Last summer, over 260 of us gathered at The Union League to address one of the most pressing issues in healthcare today: The State of Women’s Health. Everyone in attendance, regardless of age or background or profession, came together to generate ideas for how to combat inequality and provide the greatest access to, and highest quality of, healthcare. We are incredibly fortunate to live in one of the wealthiest countries in the world, and yet our provision of healthcare is not on par with comparable countries. The United States spends far more on healthcare than every country in the world– over 17% of our gross domestic product. The next highest spending Western country spends 11.6%. Yet despite our off-the-charts expenditure, our health outcomes, quality, and efficiency are significantly lower than other countries. On nearly all indicators of mortality, survival, and life expectancy, the U.S. ranks at or near the bottom among high income countries. Looking at public policy, we also sadly stand alone on measures that negatively impact women’s and family health. For example, the U.S. is the only Western country - and one of perhaps only three countries in the world - that does not provide any paid maternity leave.

deaths, poor mental health, and more – Pennsylvania ranks in the bottom half of U.S. states. The number of women living in poverty is also unacceptable, and those hit hardest are women and families of color. We know we can do better. That’s why we created our State of Women’s Health forum, and that’s why we and our partners have generated this Outcomes Report, derived from the interactive discourse from the symposium. And that’s why we are already planning for next year’s symposium-- Save the Date for #SWH2016: September 14! Whether you were able to join us at the first forum or not, please add your voice now. Join us as a practitioner, a consumer, a policymaker, an advocate, a healthcare administrator, or anyone who cares about health issues facing us today. Help us identify innovative and effective approaches, programs, and policies for advancing care, and together, let’s maximize our ability to greatly improve health outcomes for women and families! Many thanks for all you do! Kathryn Boockvar, JD Executive Director Lifecycle WomanCare

On the state level, we in Pennsylvania are at high risk on far too many health indicators. On smoking, obesity, low birthweight babies, infant mortality, diabetes, drug

Despite the United States spending far more on healthcare per capita than every other country in the world, our health outcomes, quality, and efficiency are significantly lower than other countries. On nearly all indicators of mortality, survival, and life expectancy, the U.S ranks at or near the bottom among high income countries. Comparative Health Outcomes by Country

Healthcare Spending Per Capita by Country

(higher rates=poorer outcomes)

Total Healthcare Expenditures per capita in U.S. dollars (2013)

U.S. Health Care from a Global Perspective: Spending, Use of Services, Prices, and Health in 13 Countries, The Commonwealth Fund, October 2015.

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United Kingdom









United States

In the grand Lincoln Hall of The Union League of Philadelphia, the #SWH2015 panelists and audience deliberate critical issues relating to women’s health.

Highlights from #SWH2015

Panelists Brenda Shelton-Dunston, MPH, Kay Kinsey, PhD, RN, FAAN, Julie Cristol, CNM, and Lois Evans, PhD, RN, FAAN share a few moments before #SWH2015.

I wanted to participate in this very important event to get across the message of the significance of women’s health issues for the Department of Health and the Wolf administration. I thought that the event was wonderful. . . . Lifecycle WomanCare did a fantastic job in organizing the conference and arranging the speakers. The setting was magnificent and the technology was very innovative. . . . Having all those people, all of those experts as well as the audience’s participation about issues of women’s health highlighted the significance of... important public health topics [such as] health disparities, behavioral health, the importance of midwives, aging and end of life issues, public policy issues, LGBTQ issues.... I thought that the event was inspiring. Rachel Levine, MD Commonwealth of Pennsylvania Physician General

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The State of Women’s Health aired in its entirety on the Pennsylvania Cable Network (PCN) as well as portions on KYW-CBS and WPVI-ABC.

Click to see the short video of #SWH2015

#SWH2015 Recap Many thanks to all who participated in our inaugural State of Women’s Health panel symposium– it was a tremendous success! Held at the picturesque Union League, #SWH2015 was a sold-out event – with attendees representing the spectrum of stakeholders in women’s healthcare: policy-makers, nonprofit leaders, medical providers, hospital administrators, advocates, students, and more. Our keynote speaker, Pennsylvania Physician General Dr. Rachel Levine, was unanimously confirmed by the Pennsylvania legislature the night before, making #SWH2015 her first event in her fully official capacity. From Dr. Levine’s thought-provoking keynote, to our expert panelists, to the use of, the live-polling platform that allowed for audience participation in real-time, it was a dynamic, engaging event. The discourse included such critical areas as health disparities, maternal mortality, integrative healthcare, poverty, addiction, and the need for political action. The depth of interest in collaborating to improve our healthcare system was evident, and we are

excited as we begin planning #SWH2016, to continue the collaboration across sectors to enact real change for women and families. #SWH2015 also prompted critical discussions outside the walls of the Union League, and we were very thankful for the coverage received on these important subjects. The Philadelphia Business Journal, NewsWorks and PhillyVoice all highlighted disquieting maternal mortality data discussed at the symposium, and referenced important work by Philadelphia DPH’s Maternal Mortality Review (see charts below). The Philly Tribune and Main Line Times covered the effect of poverty on family health, the disproportionate amount of older women in need of empowering elder care, and the alarming data on opioid addiction and advances to combat it. The program in its entirety was also aired on the Pennsylvania Cable Network (PCN) as well as portions on KYW-CBS and WPVI-ABC. All links to #SWH2015 media coverage can be found at:

Philadelphia Department of Public Health’s Maternal Mortality Review: pie charts compare race/ethnicity and insurance status of pregnancy-related deaths in Philadelphia between 2010-2012 Race/Ethnicity of Pregnancy-Related Deaths (n=19)

Insurance Status of Pregnancy-Related Deaths (n=19)

Maternal Mortality in Philadelphia 2010-2012, Philadelphia Department of Public Health Maternal Mortality Review, May 2015.

Page 3 Live Polling The charts below are the results of our Live Polling platform – attendees were able to weigh-in in real-time and thereby shaped the direction of our program – making the morning a truly interactive, dynamic experience, involving everyone in the room. These three charts represent several questions presented to the panelists and the audience’s actual responses at #SWH2015. Learn below what current issues regarding the state of women’s health mattered most to our attendees.

Attendees cast their votes using

What do you think are the most critical healthcare issues facing women and families today? Mental health and trauma issues

Maternal mortality


Lack of attention to aging issues

Lack of integrative care and services


Lack of long term holistic care

LGBTQ concerns

Health disparities


What steps do you think would be most critical to reduce gaps/barriers to effective care? Improve funding and insurance reimbursement Expand integrative/collaborative models of care and services Increase public health education and initiatives Improve training on cultural differences and biases Increase representation by and research on women Improve provider training for treatment of older women Improve addiction treatment

If you could snap your fingers and make any public policy in the realm of women’s health become law, what policy would you choose? Insurance reimbursement model supporting holistic care Require a living wage and income equality Paid family leave High quality affordable childcare Workplace accommodation of pregnancy and breastfeeding LGBTQ nondiscrimination Required provider screening for evidence of mistreatment and mental health issues in mid-life and older women Access to training for caregivers of older women Page 4

Panelists Brenda Shelton-Dunston, MPH, and Julie Cristol, CNM, relate effective examples of long-term, holistic, and collaborative healthcare programs and practices.

Disparities in Women’s Health and Healthcare Women of color are disproportionately affected by health conditions and risk factors that are directly influenced and compounded by Social Determinants of Health. Social Determinants of Health are conditions in the places where we live, learn, work, and play. These conditions include poverty, unemployment, inferior education systems, polluted environments, lead infused housing, and food deserts. According to the 2013 U.S. Census, Philadelphia had the highest rate of deep poverty of any of the nation’s 10 most populous cities. Research and data have substantiated the relationship between each of these factors and racism, as well as racism’s impact on health outcomes and disparate healthcare conditions for women of color. The differences are striking. African American women are 1.6 times as likely as non-Hispanic White women to have high blood pressure, and African Americans are 30 percent more likely to die from heart disease. The mortality rates for Black women with diabetes or cancer are staggeringly higher than the mortality rates for White women. And babies born to Black mothers are more than twice as likely to die before their first birthday than babies born to White women.

healthcare system and impedes our efforts to eradicate health disparities. Let’s challenge our governmental institutions in Pennsylvania and Philadelphia to develop a commission to focus on developing and implementing strategies to eradicate racism and bias in our healthcare system, and justly work to improve health outcomes for all.

Brenda Shelton-Dunston, MPH Executive Director Black Women’s Health Alliance

Disparities in Women’s Health & Healthcare in Pennsylvania

Our children are developing friendships with children of all ethnic backgrounds openly without bias, fear, preconceptions and racism. It is time for us as adults, as a nation, to do the same. We must commit to working on the conscious and unconscious biases that are a part of who we are based on the history of slavery, power, and economics that our forefathers shared. We must openly acknowledge that racism is intertwined into the fabric of America and our

We must openly acknowledge that racism is intertwined into... and impedes our efforts to eradicate health disparities. Page 5




Percent of Adult Women Reporting Health and Healthcare Status by Race/ Ethnicity, Kaiser Family Foundation; Women’s Health in Pennsylvania (DHHS Region III), U.S. Department of Health & Human Services, Office of Women’s Health, 2012.

We are at a critical point for so many areas in women’s healthcare- so today is a very pertinent and important juncture for all of us to be talking about women’s health together in this forum, to bring change for the future. Sally Heimann, MSN, CRNP Clinical Administrator Bryn Mawr College Health Center Lifecycle WomanCare Emeritus Board Member

Panelists Kay Kinsey, PhD, RN, FAAN, and Hon. Val Arkoosh, MD, address the vital importance of integrative care and services, particularly for vulnerable families.

Visit Lifecycle WomanCare www.lifecycle

Join us to continue the conversation at #SWH2016: 9.14.16!

Today’s program was a great opportunity for providers and for people in the community to find out what’s happening in women’s health, both the obstacles and potential policy initiatives that could address those issues. I’m leaving more enlightened than when I arrived this morning…[and] the fact that it’s an event that could actually build upon itself is very exciting and I’m looking forward to next year. Bill Ryan, Assistant Vice President Government Relations and Public Affairs Einstein Healthcare Network

Panelists Physician General Rachel Levine, MD, and Lois Evans, PhD, RN, FAAN, advocate for improved healthcare screening and services relating to mental health, trauma, and addiction.

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Coming away from here, I feel excited, invigorated, and ready to go. I work with the Nurse-Family Partnership and it was inspiring to be part of this conversation on the state of women’s health. I feel empowered that I’m in the right field - in public health - and ready to continue that work. Aly Keefer Public Health Project Coordinator Philadelphia Nurse-Family Partnership

#SWH2015 Nonprofit Partner Maternity Care Coalition discusses its Breastfeeding Friendly Philadelphia initiative with attendees.

Integrative Healthcare and the Midwifery Model It was great to participate in #SWH2015, with so many dedicated to advancing women’s healthcare. One concern that emerged repeatedly was the lack of integrative healthcare in the U.S., and its significant impact on women and families. Women, particularly those who are socio-economically or educationally disadvantaged, are still by and large not able to access interdisciplinary care that addresses the underlying causes of health disparities. Our health system is still directed at treating only immediate presenting issues, and often misses larger concerns. Care is often fragmented, with insufficient time to take a holistic, lifelong approach and to help individuals positively change their healthcare behaviors throughout their lives. The Midwifery model of healthcare, with twin roots in public health nursing and the women’s movement, and collaboration with other providers and services, is a key model for change. It is based on input, trust, mutual respect, and continued partnership between patients and providers, empowering and educating women to be more in control of their health and healthcare decisions, at all stages of life. A key part of our model is time. For example, at Lifecycle WomanCare all our appointments are at least 30 minutes long; this is nearly unheard of in healthcare these days, but critical for establishing the partnership necessary to care for the whole person. This partnership enables us to better identify what other services may be most helpful to the patient, and work collaboratively in these referrals. The most effective care is provided when midwives have close access to and strong collaboration with OB/GYN colleagues, specialists, behavioral

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practitioners, pediatricians, physical therapists, nutritionists, and countless others, including agencies offering housing, employment, and other economic support services. Changing the reimbursement structure to give incentives for improving collaborative care is another critical piece of the puzzle. Fostering better collaborative care would help achieve gains in cost-containment, in health outcomes, and in productivity and satisfaction for all.

The Midwifery model of healthcare, with twin roots in public health nursing and the women’s movement, and collaboration with other providers and services, is a key model for change. Julie Cristol, CNM Director of Clinical Services Lifecycle WomanCare

Visit Lifecycle WomanCare www.lifecycle

Click to see the short video of #SWH2015

Regrettably, in the arena of sexual and reproductive health, politics too frequently trump science, best medical standard of practice, and public opinion. For more information visit and Sarah Evans, Lifecycle WomanCare’s Director of Development and Communications, demonstrates to the audience how to participate in live polling via, and see votes in real-time.


A Word From One of our Nonprofit Partners Everywhere you turn you see people navigating the world on their cell phones, with information at their fingertips. While technology undoubtedly has increased access to important health information, significant health disparities persist. In both rural and urban settings, low income individuals with limited education have low health literacy levels and diminished access to healthcare. This too often leads to poor preconception or prenatal health, exposure to HIV and other STDs, and unplanned pregnancies. AccessMatters rectifies health disparities by increasing access to education and sexual and reproductive health care. The Title X Family Planning program and the Ryan White HIV Care program allow women to take charge of their health and plan their future. Family Planning funding gives women the ability to choose if and when to begin a family, and what contraceptive method is best for them. HIV Care programs allow women and families to lead healthy, productive lives. Health technologies including HIV prevention strategies using Pre-Exposure/PostExposure Prophylaxis (PrEP/PEP) medication to reduce risk of HIV infection, and the availability of anti-retroviral medicines to treat HIV, are critical life-saving interventions. Regrettably, in the arena of sexual and reproductive health, politics too frequently trump science, best medical standard of practice, and public opinion. Even as the Affordable Care Act promises expanded access to health services, politicians across the country are placing unacceptable burdens on women seeking to make the best decisions for their health, their family and their future. Join us in supporting proactive initiatives such as the Pennsylvania Campaign for Women’s Health and by combating attempts nationwide to roll back critical care for women.

It was thrilling to see so many great women leaders up there, speaking about women’s issues and educating and encouraging women to be their own advocate – that was one of the highlights of today. Denise McKnight, CPA Partner Friedman LLP (FKA Shechtman Marks Devor PC)

Photo credits: AccessMatters

Melissa Weiler Gerber President and CEO AccessMatters

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What Can I Do to Support Efforts to Advance Women’s Health? Suggestions from our #SWH2015 Panelists

Continue the Conversations Be a Guest Blogger on

Elections Matter: Vote! Be a "Positive Squeaky Wheel" Contact your Government Representatives Expect more from your providers including discussion of Mental Health and Trauma Issues

As you requested, LWC is developing opportunities to chat/continue the conversations; stay tuned! Write Letters to the Editor Check out and follow Legislative developments via

Do you have a suggestion for a discussion or workshop at #SWH2016? Send us your suggestions.

Collaborate for Change Attend #SWH2016 on 9.14.16 and Become a Partner or Sponsor To fulfill audience requests, 2016 will feature 2 sections of the program: first, a breakfast panel with similar format as #SWH2015; following, we will offer optional break out sessions for more thorough analysis and networking.

I thought today was wonderful and I was really honored to be able to participate. It was great to have a large group of women, and men, present to address women’s issues, specifically around health. I’ve been involved in healthcare initiatives for over thirty years, and it was thrilling to be a pioneer audience member for a yearly event that will bring together diverse members of our community to help advance women’s health. Gladys Thomas Consultant Black Women's Health Alliance

CEU Corner

You spoke we heard! The overwhelming feedback we received from CEU attendees at The State of Women’s Health was incredibly positive and helpful, thank you! The bottom line is that people want more: a longer program to allow us to thoroughly examine the issues raised.

The State of Women’s Health program for 2016 will fulfill this request! The 2016 event will be structured into two sections: first, a breakfast panel, following the same format as #SWH2015. Following the panel, the event will offer optional breakout sessions for more thorough analysis. We expect to offer substantive interactive workshops and networking opportunities, with leaders and experts facilitating discussions on topics pertinent to the day's agenda. Attendees can delve into issues that they care passionately about while connecting with other professionals from across the women’s healthcare spectrum.

Don't forget if you still need these CEU credits: Last year's official Program # for State of Women’s Health: Breakfast Panel Symposium from the ACNM was 2015/026. Page 9

Thank you to our #SWH2015 Sponsors and Partners Advancement Sponsor

Innovation Sponsors Center City Film & Video First Financial Group of Mass Mutual

Grimm & Grove Communications Malvern Federal Savings Bank

Advocacy Sponsors AFSCME Council 13

Lenhardt Rodgers Architecture & Interiors

J.M. Patton Associates, Inc.

Kalogredis, Sansweet, Dearden & Burke Ltd

Law Offices of Willig, Williams & Davidson

Milestone Bank Shechtman Marks Devor PC

Contributing Sponsors Chatsworth Consulting Group

401 East Elm Alliance:

Corrigan Manning Inc

Jennifer L. Bragg, Esq.

Curtin & Heefner LLP

Julia E. Gabis, Esq.

Women’s Health Care Group of PA:

Judith A. Mackarey, Esq.

Bryn Mawr Women’s Health

Karen E. Davidson, Esq.

Main Line Women’s Healthcare

Mandy C. Rosenblum, Esq.

Women’s Healthcare Specialists

Managed Care Consultants

Erin Hadley, PhD Licensed Clinical Psychologist


Gardner/Fox Associates, Inc.

Pedro Cunillera – TV/Film/Media Production Services

Hahnemann University Hospital

Productive Tech, Inc

Nonprofit Partners

Small Business Partners


Bloom at King of Prussia Family Wellness Center

Mabel Morris Family Home Visit Program

Family Focus Media

Maternity Care Coalition

Paksima Productions Film & Video

Nurse-Family Partnership

The Wellnest

Planned Parenthood Southeastern Pennsylvania The Family Practice and Counseling Network Therapy Center of Philadelphia Resources for Human Development Many thanks to all contributors to our #SWH2015 symposium and Outcomes Report, and a special thanks to our Report designer, Susan Rains of Rains Design!

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Save the Date! The State of Women’s Health 2016 Wednesday September 14, 2016 at The Union League of Philadelphia • Expert Panel featuring Clinical Specialists and Policy Leaders • Interactive Audience Live Polling via • Optional breakout Roundtable Discussions & Workshops derived from the morning’s program • Extensive Networking Opportunities with Panelists, Sponsors and Attendees

#SWH2016 9.14.16

for more information contact Become an Early Bird Sponsor or Partner and receive Deep Discounts!

® TM

918 County Line Road | Bryn Mawr, PA 19010 T. 610.525.6086 | F. 484.381.3035

Lifecycle WomanCare, previously known as The Birth Center, has been providing exceptional healthcare services to women throughout their lives - from adolescence through post-menopausal years - since 1978. We were the first licensed independent birth center in Pennsylvania and are one of the longest continually-operating birth centers in the United States.

The State of Women's Health  

#SWH2015 Outcomes Report - Lifecycle WomanCare

The State of Women's Health  

#SWH2015 Outcomes Report - Lifecycle WomanCare