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Chapter One: An Exciting Time for Women's Health
It is an exciting time for women's health. Women are living longer lives today than ever before, and research on the treatment and prevention of disease in women is finally catching up with that of men. Even more notable, women are increasingly making health a top priority in their own lives. Traditionally women, as the primary caregivers in the family, have looked after the health of others before their own, but now they are realizing how important their own health is to leading productive, fulfilling, and happy lives.
The average life span of American women has increased from around fifty years in 1900 to close to eighty years today. Yet there is more to good health than a long life. Quality of life throughout the years is also important. Chronic conditions (such as heart disease and osteoporosis) that can make doing the things you enjoy more difficult are much more common as people age. And, with the aging of the U.S. population as a whole — by 2030, one out of every four women will be over the age of sixty-five — taking steps to avoid such disorders is even more important.
While most chronic diseases occur fairly late in a woman's life, they often stem, in part, from much earlier behavior. Coronary heart disease, the leading killer of women, begins to develop as early as adolescence, and the risk of diabetes and breast cancer also seems to have roots in youth and young adulthood. Establishing healthy habits early on and maintaining them throughout life is essential to enhancing overall health — at every stage of life.
Until fairly recently, much of the research on ways to lower the risk of chronic diseases was conducted mainly on men. One reason for this was convenience. Because men tend to develop chronic diseases earlier in their lives than women do, data on the risk factors for such diseases could be collected over a shorter period of time. This was not the only reason, however. Unwitting bias also served to exclude women from research studies, and for years, women had to follow health recommendations based primarily on data in men. Today, however, the situation has improved. Equal participation in research studies is now a national priority, and there is an increasing body of data solely on women's health issues. Not surprisingly, men and women are very similar when it comes to the steps they need to take to optimize their health and lower their risk of chronic diseases, but we now know that there are also some important differences.
Over the past twenty-five years, the Nurses' Health Study has made many important contributions to the field of women's health, leading the way in numerous areas. Most important, the study has helped identify many of the behaviors that contribute to good health in women. Based on these data, we have found that a huge proportion of the leading diseases in the United States could be avoided by healthy lifestyle choices. Fully 80 percent of the cases of heart disease and diabetes and 70 percent of the cases of stroke and colon cancer could be significantly delayed or prevented by women's leading healthier lives. Of course, 90 percent of lung cancers could be prevented by not smoking. And for smokers, there are huge benefits to stopping, even as an older adult. Quitting at age sixty can cut the lifetime risk of lung cancer in about half.
Of course, not everything that determines health is under a person's control. Genes also play a role in many disorders. But contrary to what many people think, your genes are not your destiny. Even women with a mutation in the BRCA 1 gene — the "breast cancer gene" mutation — are not destined to get breast cancer. Up to half of women with a BRCA 1 mutation do not go on to develop the disease. Clearly, there is more to good health than the hereditary hand you were dealt by your mother and father. For most illnesses, a combination of heredity, lifestyle, and other factors (both known and unknown) cause disease to develop. For some diseases, such as coronary heart disease, diabetes, colon cancer, and melanoma, lifestyle factors play quite a large role in making up risk. For others, the contribution of lifestyle to risk is smaller.
Personal Health Choices
With an almost overwhelming amount of health information available to women today, what is the best way for you to approach making personal health choices and getting answers to such important questions as: "What diseases should I be most concerned about, and what are the most important changes I should make to try to lower my risk of illness?" Although each woman has a unique set of goals and concerns when it comes to her own health, all women can use some universal strategies to make the best health choices possible.
First — as we discuss in detail throughout the book — certain key lifestyle choices have such large health benefits that it pays for everyone to make them. An overall healthy lifestyle — avoiding smoking, eating a healthy diet, being physically active, and maintaining a healthy weight — can not only lower the risk of many serious diseases but also enhance the overall quality of life. Regular physical activity alone lowers the risk of coronary heart disease, stroke, diabetes, high blood pressure (hypertension), osteoporosis, and colon cancer as well as improves energy levels, helps combat stress, and enhances mood.
Not everything, though, has such wide-ranging benefits and so few risks as the key lifestyle choices. Many factors lower the risk of some disorders while increasing the risk of others. Deciding whether or not to concern yourself with these is a bit more complicated. A good example is regular aspirin use. Studies show that using aspirin regularly can lower the risk of colon cancer as well as of heart attack and ischemic stroke in people with cardiovascular disease. But aspirin can also have some serious side effects, increasing the risk of bleeding in the stomach, intestines, and brain. Weighing such potential risks and benefits is essential to the health decision-making process. If you have cardiovascular disease or are at high risk of colon cancer, it likely makes sense for you to use aspirin regularly. However, if you are not at high risk of cardiovascular disease or colon cancer, it may not make sense, given aspirin's potentially serious side effects.
In addition to the risks and benefits of a specific health choice, the number and type of diseases affected by that choice also go into the decision-making process. The biggest potential payoff comes from health choices that lower the risk of a number of serious diseases. Focusing your efforts on a single risk factor that is linked to only one or two uncommon diseases is probably not the best use of your energy. That energy is best spent on health choices that may protect you from a number of diseases and improve your overall health.
Of course, there are always exceptions. If you happen to be at high risk for a certain disease (because of a family history, for example), you may want to take all the steps possible to lower your risk of that disease, even if it means making choices that may protect you against only that disease and no other. For most people, though, making healthy choices is like making most other choices in life: it is usually best to choose the options with the most advantages and the fewest disadvantages.
Health Choices in the Real World
In a perfect world, we would all have the time and energy to weigh these factors and to make (and put into practice!) an in-depth plan for improving our health. But as we know, reality is quite different. The time we have to devote to our health can be limited. It competes with all the other important parts of our lives — family, friends, jobs, the home, and good old-fashioned free time. So what is the best way to approach making healthy choices?
To begin, it is important not to become overwhelmed. As you go through this book, you will read about a large number of risk factors for a wide variety of diseases. But relax. This book is not meant to be a lengthy checklist of every single healthy choice you should make, nor is it intended to make you feel guilty for past choices. Rather, it is a resource that can help you explore the details of women's health and decide where your efforts are best placed.
Throughout, you will be pointed toward the key lifestyle choices. Beyond these, the healthy choices you decide to make depend very much on your level of concern about a certain disease and the benefits and risks of certain choices. Essential to making any good decision, though, is being well informed. Often this means gathering information on your own, such as reading this book. Sometimes, when the issues are more serious or complicated (as with aspirin or postmenopausal hormone use), it means meeting with a health care provider.
Everyone is unique, and when it comes to strategies for successfully making healthy choices in your life, what works for somebody else may not necessarily work for you. Overall, however, people tend to have the greatest success when they begin with only one or two changes and slowly add on others. You can pick the one thing you think will be the easiest to change — such as taking a multivitamin every day — or the one thing you think will have the biggest benefit for your health — such as stopping smoking — and then build from there. Changing too many things at once can be overwhelming and set you up for failure. Beginning slowly allows time for new behaviors to become ingrained in your daily routine. This way, when you tackle the next behaviors, the first ones are already part of your lifestyle. And it is never too late to make these changes; there are still many benefits to be gained by making healthy choices later in life.
Of course, despite any amount of planning, some factors that influence our health decisions may be hard to control. Although running may be your favorite form of exercise, it can be difficult to run as often as you would like during the early evenings of winter. Similarly, it may be a challenge for you to get more fruits and vegetables if the office cafeteria favors pizza and hamburgers. Like most things in life, health decisions often require compromise, but with a little creativity and forethought, you can usually find your way around these types of obstacles.
Whether you are able to make one healthy change in your life or ten, the important thing is that you play an active role in your own health. There is a lot you can do — as we detail throughout this book — to try to lower your risk of disease and improve your overall health. Any positive steps you take, no matter how small, are positive ones in the right direction.
Women's health has come a long way from the time its primary focus was on issues of childbearing and family health. Now, thankfully, a woman's health is much more broadly defined, including her well-being across her entire lifetime. By sharing our experiences and the knowledge we have gained over the last twenty-five years of the Nurses' Health Study, we hope that Healthy Women, Healthy Lives will become one of your indispensable resources for learning about women's health and making healthy choices throughout your life.
Copyright © 2001 by the President and Fellows of Harvard College
