When we talk about women’s health, whose health are we actually talking about?
The question matters because the aggregate figures conceal enormous variation. Sixteen percent of all women in the United States report fair or poor health status, according to CDC data. Among Native American women, that figure is substantially higher. Among Black and Hispanic women, it is higher than among white women. The gaps are not random. They are the product of compounding disadvantages that the health system has consistently failed to name, address, or measure adequately.
Health equity is not a niche concern within women’s health. It is the lens through which women’s health policy must be evaluated if it is to mean anything.
What Intersectionality Actually Means for Health
The concept of intersectionality — developed by legal scholar Kimberlé Crenshaw to describe how multiple identities combine to create distinct forms of discrimination — has practical clinical and policy implications that the health sector has been slow to operationalize.
A Black woman in a rural community who lacks insurance, works a physically demanding job, and carries a family caregiving burden does not simply experience the sum of the disadvantages associated with each of those factors. She experiences a compounded vulnerability that the health system was not designed to address — because the health system was largely designed around a different patient: white, male, urban, and insured.
The social determinants of health — income, housing, transportation, food access, environmental exposure, education — affect all health outcomes for women. They do so with compounding intensity for women who face racial discrimination, economic insecurity, and geographic isolation simultaneously.
Where the Disparities Show Up
Maternal mortality is the starkest illustration. Black women die from pregnancy-related causes at two to three times the rate of white women — a disparity that persists across income levels and educational attainment, which should put to rest any explanation that attributes it primarily to socioeconomic factors. Something else is happening in clinical settings, and that something else involves race.
Autoimmune diseases — which affect women at dramatically higher rates than men — show significant racial disparities in both prevalence and outcomes. Lupus is more common, more severe, and more frequently fatal in Black women than in white women. The research infrastructure addressing these disparities remains inadequate relative to the scale of the problem.
Menopause and midlife health have largely been studied in white women. The timing, severity, and clinical management of menopause varies significantly across racial and ethnic groups — a reality that clinical guidelines are only beginning to incorporate.
Mental health care access is distributed unequally by race, income, and geography in ways that affect women with particular force, given that women are diagnosed with depression and anxiety at higher rates than men and are primary caregivers at higher rates than men.
What Policy Needs to Do
The Society for Women’s Health Research launched its Women’s Health Equity Initiative in 2021 to bring systematic attention to these disparities. Its framework is instructive:
Education and awareness are necessary but not sufficient. Research that disaggregates by race, ethnicity, income, and geography is essential. Policies that address social determinants — housing, food security, economic stability — are health policies. Access to care requires addressing the structural barriers that keep women from receiving care they have already been diagnosed as needing.
The policy agenda has a specific obligation here: federal and state funding for community health workers, culturally competent care, rural health infrastructure, and Medicaid expansion is not peripheral to women’s health — it is central to it.
The Disruptive Demand
The disruptive demand is simple and non-negotiable: if your women’s health policy does not improve outcomes for the women with the worst outcomes, it is not a women’s health policy. It is a policy for some women. The measure of progress is not average improvement. It is whether the gaps narrow.
Health equity requires that question to be asked of every policy, every program, and every allocation of research funding. Not as an equity overlay. As the primary evaluation criterion.
