“We need to effectively communicate the problems and conditions, but also the solutions to public health professionals, community-based organizations, community members and policymakers.”
— Dr. Dawn Upchurch
AFTER SPENDING THE EARLY PART OF HER CAREER studying factors associated with poor health at midlife, Dr. Dawn Upchurch made a conscious shift to examining the factors associated with good health. She has been especially interested in assessing strategies for stress reduction and positive coping — an interest that led her to years of study on the potential for complementary and alternative medicine as a health-promoting tool. Upchurch, professor and vice chair of the Department of Community Health Sciences at the Fielding School, spoke with FSPH’s Public Health Magazine on the importance of expanding the paradigm for how women’s health is studied and promoted.
Q: You have advocated for the need to broaden the way we view women’s health. How so?
A: Historically the model was to look at health problems and risk factors for disease. Now there is more focus on health promotion, but we need to go even further — looking at how we can promote a robust quality of life for women, even in the face of social and environmental constraints. If we’re talking about health promotion and disease prevention rather than just treating illness that’s certainly getting us on the right track, but we have to go beyond that to consider issues around positive coping, resilience, and other things that can lead to healthy aging trajectories that will help women thrive in their senior years.
Q: So it’s expanding the thinking beyond biological factors?
A: That’s right. For a long time, it seemed like all we knew about women at midlife was menopause. That’s important, but there are a lot of other things going on for women around that time as well — economically and socially, with changes in the family, for example. At midlife many women find themselves taking care of their parents, but still having their kids at home. What many of us in public health have contemplated over the last several years is how we can develop a more holistic model of women’s health at midlife, so that we are looking at multiple aspects of women’s lives as well as approaches within these contexts that can contribute to better health.
Q: What are examples of traditionally overlooked factors involved in promoting healthy aging for women?
A: In public health the focus is typically on behaviors like maintaining a healthy weight, consuming a healthy diet, exercising, not smoking, and limiting alcohol consumption. But increasingly we are also interested in strategies around stress management, given that stress is an important contributor to chronic conditions. We also want to be thinking about psychosocial factors, including social support, since we know that women who have higher levels of social support during midlife do better as they age. Social support goes beyond family and friends. It can include meaningful work, meaningful volunteering, and community activities that promote a sense of purpose. We also know that personality characteristics affect healthy aging — including having an optimistic outlook, as opposed to one characterized by cynicism or negativity.
Q: What is the role of public health in this realm?
A: What’s important from our perspective in public health is that all of these factors can be potentially modified through training or teaching. Many people cope with stress in negative ways: They don’t sleep, they eat poorly, they stop exercising. But we can learn positive coping skills in the face of life stressors. We need to ask whether there are programs we can develop as public health researchers and practitioners that would help groups of women to better manage their stress so they don’t take a mental or physiological hit from it, or at least it’s not as severe as it would otherwise be. There’s a lot of research now around mindfulness meditation and its physiological effects, both specific and non-specific. It’s not for everyone, but if we have a number of options, women can make choices based on what is going to work best for them.
Q: How are issues of women’s rights, equality and empowerment important to public health goals?
A: Frankly, these issues are fundamental to women’s health. We have to consider the multiple ways that women are marginalized. In the U.S. we know that men and women have very different salary structures, and that when you look at that over a woman’s life course, it’s going to affect the level of benefits she has available to her when she retires — and if she’s in a heterosexual marriage, she’s likely to live longer than her male spouse. That structural difference in the economics of what it means to be a man and a woman can have a profound impact on women’s wellness as they go through midlife and into their senior years. Then when you start to think about other factors — a woman’s racial/ethnic background, what kind of education and other economic opportunities she has available, what kind of community she lives in…all of these factors contribute to her ability to maintain and promote her health. Workplace equality is a public health issue as well as a social justice issue, as are educational opportunities and policies such as parental leave.
Fortunately, the last year has seen the growth of a powerful social movement with the potential for important change that will be positive for both men and women in U.S. society. As structural constraints are removed, women will have opportunities available to them in ways they haven’t historically. We’re in the midst of an exciting, historic moment with implications for improving health and well-being.