Congratulations to WHI scientist Chloe E. Bird, PhD, who was appointed Editor-in-Chief of Women’s Health Issues effective January 1, 2014! Dr. Bird, a Senior Sociologist at RAND and Professor of Sociology and Policy Analysis at Pardee RAND Graduate school, has authored several WHI publications, focused primarily on the impact of neighborhood factors on health. Her latest, a commentary on continuing the WHI, was published this month in Women’s Health Issues and is summarized below.
The longitudinal follow-up of the WHI cohort has already yielded hundreds of breakthrough findings on women’s health and health care, including the effects of estrogen and progestin on a large range of outcomes, from cardiovascular disease to dementia. An increasingly large and diverse group of researchers are using WHI data to assess an expanding array of women’s health behavior and conditions. In this time of limited resources for research, obtaining support to continue the Women’s Health Initiative may be difficult, and questions have arisen as to the potential and relative value of extending the cohort follow-up beyond 2014, now that the majority of women are in or beyond their late 60s and on Medicare. However, continuing the follow-up of the WHI cohort can inform health care and policy decisions and research in countless ways:
The geographic diversity of the cohort offers a unique opportunity to assess how variations in women’s lives and circumstances contribute to their health and longevity as they age. For example, what household and community factors are associated with physical activity and exercise, and can these factors be supported through local policies and programs? WHI data, collected nationwide, can inform healthy aging policy and community programs in a way that smaller studies, particularly those confined to a particular geographic area, cannot.
Social and economic costs are growing rapidly as our population ages, with the corresponding decline in health and physical functioning. These factors are particularly relevant to research on women, who outnumber men in the oldest cohorts. Key policy questions, such as what individual and community factors and policies facilitate older women’s ability to “age in place”, may be answered by following WHI women into older age. The WHI is unique in providing the longitudinal health data needed to assess how health trajectories play into decisions about living arrangements and whether particular health behaviors or factors can potentially prevent decline and enable women to continue to live on their own.
Continued follow-up of the WHI cohort can help answer questions regarding which types of programs and medical care are most effective for maintaining health and health-related quality of life throughout the aging process. These national data provide a unique opportunity to inform a wide range of state and federal policy decisions with potentially substantial economic benefits to both women and tax payers; conversely, the costs of failing to fund the continued follow-up of this unique cohort may represent an irrecoverable loss.
WHI is potentially at risk, not just because of the lack of funding resulting from sequestration, but because of the lack of Institute devoted to either Women’s Health or to Sex/Gender and Health at the NIH. While some will argue that research and an institute specific to women’s health is not necessary, differences in men’s and women’s biology and the social and biological pathways that lead to their health trajectories substantiate the need for a more systematic evaluation of whether research findings apply similarly to women’s and men’s health.