Editors' Comments

Women's Health: Permanente Medicine
Lee Jacobs, MD, Associate Editor, Health Systems

I was reminded again at a recent Infectious Disease meeting of the global importance of women's health.

The continued increasing AIDS incidence for women in the United States is striking. Especially alarming is the worldwide statistic that out of 16,000 new HIV infections each day in 1997, 40% were women. How about the fact that the cumulative number of children orphaned by AIDS worldwide is 11.2 million? How discouraging is it to see the continued high incidence of perinatal transmission of HIV from mother to infants in other countries when we know that with treatment it is preventable? We have documented evidence that breast-feeding increases the transmission of HIV to infants, but third-world mothers are placed in a Catch-22 since the death rate from diarrhea is so very high if they don't breast-feed.

Certainly women's health in the United States and around the world, especially related medical, social and ethical issues, deserve special attention. For that reason we are dedicating the next two issues of The Permanente Journal to this very important topic.

It is not just a popular topic-of-the-month. No, it is right at the core of Permenante Medicine as we are always seeking to better understand the evidence-based approach to the care of a population of people. Too often the women's health focus in the community is based solely on economics. Such is not the case for Permanente.

In the Health Systems section of this edition, we present several articles on women's health that are representative of the type of work that is taking place throughout Kaiser Permanente. Dr Jill Steinbruegge shares personal observations on women's health and then presents the challenge to Permanente Medical Groups to address the gender gap in leadership. Dr Rhoda Nussbaum's introductory commentary and her article summarizing the work of the Women's Health Task Force in Northern California sets the agenda for the articles that follow. Dr Philip Tuso's article on an estrogen replacement anchors this issue with articles on breast cancer and mobile mammography to follow in the second part of the series on women's health issues which will appear in Fall 2000 edition of The Permanente Journal.

I hope you enjoy your reading of the work that your Permanente colleagues are doing. As always, we invite your articles and comments for future publication.

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