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Emerging Infectious Diseases Journal


Volume 2: No. 2, April 2005

Making the Grade on Women’s Health: A National and State-by-State Report Card 2004


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Michelle Berlin, Judith Waxman

Suggested citation for this article: Berlin M, Waxman J. Making the Grade on Women’s Health: A National and State-by-State Report Card 2004 [abstract]. Prev Chronic Dis [serial online] 2005 Apr [date cited]. Available from: URL:


Track: Methods and Surveillance

Making the Grade on Women’s Health: A National and State-by-State Report Card is a comprehensive study of the status of women’s health in the United States based on selected health status and policy indicators. Health status indicators reflect conditions with a significant impact on quality of life and well-being, affect large numbers of women generally or disproportionately affect a specific population and/or age group, are amenable to prevention or improvement, and are measurable through consistent, reliable data. The 27 indicators fall within four categories: women’s access to health care services, preventive health care activities, key women’s health conditions, and whether women live in healthy communities.

The states and the nation received grades for each status indicator  based on whether the benchmark was met (Satisfactory) or not met (Satisfactory Minus, Unsatisfactory, or Fail, based on scores’ distance from the benchmark). In the 2004 Report Card, grades take into account that states and the nation have several years to achieve those benchmarks based upon Healthy People 2010. The Report Card also provides 67 policy indicators to evaluate the performance of state and federal governments in promoting women's health; these are based on state statutes, regulations, and policies and programs that address problems identified by health status indicators.

The nation met only two indicators (mammograms in women aged >40 years and annual dental visits) and received an overall grade of Unsatisfactory. All states and the District of Columbia met one benchmark (annual dental visits) and missed eight (including proportion of women with health insurance, rates of high blood pressure and diabetes, infant mortality, poverty, and wage gap). Twenty-five states improved at least five policies, and the majority of states weakened in one to three policies. The policy most consistently improved was preventing tobacco sales to minors. Only one policy goal, Medicaid coverage for breast and cervical cancer treatment, was met by all the states.

For most health status indicators, the nation and the states fall short of meeting national goals. Despite interest in health disparities, key differences (including race/ethnicity and age) persist. A number of state governments improved policies in key areas to meet women’s health needs, but many states have fallen behind. The 2004 Report Card findings identify pressing issues that must be tackled by policy makers, public health administrators, and care providers. To improve and maintain the health of U.S. women, these issues must be addressed swiftly and accurately.

Corresponding Author: Michelle Berlin, MD, MPH, Director, OHSU National Center of Excellence in Women's Health, and Associate Professor, Departments of Obstetrics and Gynecology, Public Health and Preventive Medicine, and Medical Informatics and Clinical Epidemiology, Oregon Health and Sciences University, 3181 SW Sam Jackson Park Rd, UHN 50, Portland, OR 97239-3098. Telephone: 503-494-4480. E-mail:

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The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.


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