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Region V

Region V consists of:

• Illinois
• Indiana
• Michigan
• Minnesota
• Ohio
• Wisconsin

Region V overview

Region V is the largest of the 10 HHS regions and represents almost 18 percent of the total U.S. population with over 50 million inhabitants. The region is home to many major metropolitan areas including Chicago, Indianapolis, Detroit, Milwaukee, Minneapolis, Columbus, Cleveland and Cincinnati in addition to large suburban and rural areas. Region V is racially and ethnically diverse and home to representatives of many minorities.

Although 82.3 percent of women in Region V are white, Illinois, Michigan and Ohio have large urban areas where racially and ethnically diverse populations, especially African Americans and Latinos, live. Because this diversity is largely found in urban areas, states with fewer and smaller urban centers such as Indiana, Minnesota and Wisconsin, are much more homogeneous with largely white populations.

There is also a substantial American Indian population in Region V. The Bemidji Area Indian Health Service Office, located in Bemidji, Minnesota, provides quality healthcare to the 88,239 American Indians living in Indiana, Michigan, Minnesota, and Wisconsin. Most numerous of the 32 tribes served by the Bemidji Area are the Chippewa.

Health issues of concern to women in Region V are similar to those of women all across the country and include, but are not limited to, access to care, poverty, domestic and all forms of violence, cardiovascular disease, smoking, physical inactivity, substance abuse, poor nutrition, mental health, disparities among various racial and ethnic groups, sexually transmitted diseases including HIV and AIDS and a shortage of health care providers adequately trained to provide care that is both appropriate and sensitive to the needs of women.

Health status in Region V is comparable to the average for women across the nation. Age-adjusted death rates for women in the region are slightly higher than found nationally (for all causes and leading causes except for pneumonia/influenza) and cancer and diabetes morbidity are higher in the region. Mental health is comparable to the national average, reproductive and maternal health varies from better than to similar to national values and violence against women is lower in the region. Additionally, while murders, robbery, and assaults were less frequent in the region, the rate of rapes was slightly higher. With regard to prevention, women in the region appeared to fare better than their counterparts across the nation. Women in Region V have better access to health resources than do women nationally; however, there are still substantial pockets of underserved women in the region, as with the rest of the nation.

Fortunately, the region is rich with academic medical centers that conduct women's health research and train health care providers in the appropriate care of women. In fact, 5 of the 20 designated National Centers of Excellence in Women's Health (CoE) are located in the region.

Region V programs

Pathways Into Health

Pathways Into Health is a grassroots collaboration of more than 200 individuals and organizations dedicated to improving the health, health care and health care education of American Indians and Alaska Natives (AI/AN). We are combining the expertise, resources, and strength of Tribes and AI/AN organizations, tribal colleges, prominent universities, the Indian Health Service and American Indian and Alaska Native communities as we work together to solve a major problem that exists today - the shortage of AI/AN healthcare professionals.

The 2009 Pathways Into Health Conference was entitled "Achieving Excellence, Harmony and Balance: Innovation Powered by Partnerships to Transform Health Professions Education in American Indian and Alaska Native Communities.” The conference took place October 7th-9th (with pre-conference meetings) at the beautiful and serene Big Sky Resort in Big Sky, Montana (near Bozeman).

The purpose of this conference is to bring together a diverse group of individuals to contribute to the development of appropriate and effective educational methodologies for primarily distance-based AI/AN health professions education. The overall theme and focus will be on cultivating collaboration and partnerships. Three core concepts that will be illuminated to advance this process include:

1. Cultural Attunement
2. Interprofessional Education
3. Distance Learning and Telehealth Technologies

Midwest Network on Female Genital Cutting

The Midwest Network on Female Genital Cutting (MNFGC), formed April 2005, is a group made up of health professionals, representatives from community organizations, refugee resettlement agencies, and immigration law experts across Region V concerned for the needs of African immigrant girls and women affected by or at risk for female genital cutting. Network members collaborate to present at various conferences, within the U.S. and internationally, and offers presentations to academic institutions and health care facilities. Additionally, members perform research in this field and are working to address culturally-competent care through policy regarding the training of clinicians and service providers.

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State of Illinois

The state of Illinois ranks fifth in population, with an estimated total of 12,713,634 in 2004, of which 50.9 percent were women. The racial/ethnic distribution according to the 2000 census is as follows: White alone (79.5 percent); Black or African American alone (15.1 percent); Asian alone (4.0 percent); Native Hawaiian and Other Pacific Islander alone (0.1 percent), American Indian/Alaska Native alone (0.1 percent); and Hispanic or Latino of any race (14.0 percent). The life expectancy for Illinois women (78.3 years) is slightly below the national average (78.8). The life expectancy for non-white women is 73.8 years. About 67 percent of the state's population lives in the 8 county Chicago-Naperville-Joliet metropolitan area. Sixty-six of Illinois' 102 counties are rural. More than 17.0 percent of the Illinois population was living in households with incomes at or less than 150 percent of the federal poverty level (in 1999) and 14 percent of the population was uninsured (2001-2003 CPS). Illinois has a substantial population living in federally designated health professional shortage areas.

The leading cause of death among Illinois females in 2002 was diseases of heart. Malignant neoplasms (cancer) were the second leading cause of death. Breast cancer ranked behind cancer of lung and bronchus as the 2 leading causes of death among cancer sites for females in Illinois. Colorectal cancer ranks third. The 2002 Illinois infant mortality rate was 7.2 deaths per 1,000 live births, the lowest rate ever recorded. The number of births (and rate) to teens also has been declining. In 2003, 3.4 percent of all births were to mothers under the age of 18 years, down from 4.9 percent in 1990. In 2004, the annual cost of hospitalizations due to osteoporosis in Illinois reached approximately $737.5 million, nearly double the amount from 2000. Illinois hospitalizations for hip fractures show a decreasing trend since 2001, dropping to 11,953 in 2004.

Illinois has a state-funded Office of Women's Health and there is a designated Center of Excellence on Women's Health at the University of Illinois at Chicago. There is also a solid foundation of poorly funded, yet very effective non-profit organizations that provide direct services, such as the Chicago Women's Health Center, which has an established women-centered practice and other grassroots efforts such as the Women's Health Education Project, and the Illinois Women's Health Coalition which works to impact health policy related to women.

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State of Indiana

Indiana has a total population of 6,080,485, of which 51 percent are women. The racial/ethnic distribution is as follows: White (87.5 percent), Black or African American (8.4 percent), Asian/Pacific Islander (1.0 percent), American Indian/Alaska Native (0.3 percent), and Hispanic (3.5 percent). Other races comprise 1.6 percent, and 1.2 percent of the population considers itself of 2 or more races.

Women in Indiana experience mortality from heart disease at a rate well above the median for all states (106.6 per 100,000 in Indiana compared to 90.9 per 100,000 in the U.S.); the state ranks 40th overall in average annual mortality rate among women from heart disease (based on 1995 data). Obesity is one of Indiana's major health problems due to its contribution to heart disease and diabetes. Based on BMI, 28 percent of women in Indiana are overweight and 19 percent are obese. Furthermore, 31 percent report little or no leisure-time physical activity.

Indiana has a designated National Centers of Excellence in Women's Health (CoE) at Indiana University School of Medicine, Indianapolis and a state-funded Office on Women's Health.

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State of Michigan

According to U.S. Census estimates, Michigan's population reached over 10,200,000 in 2005, reflecting growth by 2.7 percent from 2000. Based on estimates, 51 percent are women. The racial/ethnic distribution estimates are: White (82 percent); Black (14 percent); Hispanic (3 percent); Asian/Pacific Islander (2 percent); and American Indian/Alaska Native (1 percent). [Percentages do not add up to 100 percent due to round off error.]

In 2003, there were 86,306 deaths in Michigan and the top five leading causes were: heart disease (29.9 percent), cancer (22.7 percent), stroke (6.3%), chronic lower respiratory disease (5.1 percent) and unintentional injuries (3.8 percent). The top leading causes of death for women were the same except Alzheimer's disease, fifth, and type 2 diabetes, sixth. (same thing for the next set) For Michigan women, in 2003, the rates of potential life lost below age 75 due to the top 10 causes of death are as follows: cancer (1,516.1), heart disease (872.9), Unintentional Injuries (516.6), Stroke (192.0), Chronic Lower Respiratory Diseases (176.5), type 2 diabetes (140.0), Homicide (115.4), Suicide (134.4), Chronic Liver Diseases and Cirrhosis (102.3) and Pneumonia/Influenza (80.0).

The Michigan Department of Community Health (MDCH) has a wide variety of women's health programs promoting women's health issues which focus on access to care and prevention. Following is a list of women's health programs within MDCH:

• Family Planning
• Family Planning/Substance Abuse Demonstration Projects
• Fetal Alcohol Syndrome Maternal and Child HIV/AIDS Program
• Maternal and Infant Health Advocacy Services Program
• Maternal Support Services
• Prenatal Care Outreach and Advocacy Program
• Prenatal Care Clinic Program
• Prenatal Smoking Cessation
• Women, Infants, and Children Program
• Breastfeeding peer counselors Initiative
• Farmer's Market
• Priorities of the Michigan Cancer Consortium
• Violence Against Women Prevention Program
• Women's Cancer Screening Program in Michigan
• Michigan Steps Up Healthy Lifestyle Campaign
• Women's Designated Services Program

The University of Michigan Health System, Ann Arbor is a designated National Centers of Excellence in Women's Health (CoE).

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State of Minnesota

Minnesota is the 20th largest state in terms of population. Minnesota has a total population of 4,657,758 of which 50.7 percent are women. Minnesota is located in the north central portion of the country. Slightly more males are born in Minnesota each year than are females. However, the mortality rate for males is higher at every age throughout the lifespan. The cumulative effect is considerable. After age 44 years there are more females than males, and of those Minnesotans 80 years and older, 68 percent are female. Minnesota has a relatively small proportion of its population made up of people of color. The racial/ethnic distribution is as follows: White (93.9 percent); Black (2.7 percent); Asian/Pacific (2.2 percent); American Indian/Alaska Native (1.2 percent); and Hispanic (1.6 percent). Projected demographic changes show populations of color growing faster than the white population.

Women's health priorities for the state of Minnesota are breast and cervical cancer, sexual assault and violence, domestic violence, HIV/AIDS, sexually transmitted diseases, substance abuse, family planning, tobacco use, alcohol and other drug use, mental health, nutrition, physical fitness, cardiovascular health, WIC, reproductive health and adolescent health. In addition, key health issues for Minnesota women include assuring access to well-women screening assessments, early and regular prenatal care, tobacco use reduction and alcohol free pregnancies.

Minnesota has a designated Center of Excellence in Women's Health at the University of Minnesota, Minneapolis and a Community Center of Excellence in Women's Health at Hennepin Primary Care Department, Minneapolis.

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State of Ohio

In Ohio, the 2000 population was listed as 11,353,140 (according to the Office of Strategic Research, Ohio Department of Development) of which 51.6 percent are female. The racial/ethnic distribution is as follows: White (84.9 percent); Black (11.3 percent); Asian/Pacific (1.2 percent); American Indian/Alaska Native (0.2 percent); and Hispanic (1.9 percent). Ohio women are shifting into older age groups. Currently, more women are between the ages of 40 and 49 than any other age group. In 2015, it is estimated that there will be a more even distribution among age groups with slightly more females falling between 50 and 59. The number of Ohio women in their childbearing years (ages 15 to 44) exceeds 2.3 million.

The leading causes of death among Ohio women are heart disease, cancer and stroke. Mortality rates are much higher among minority populations. Ohio ranks as the ninth highest state in cancer mortality rates, with cancer being the second-most-frequent cause of death among Ohio women. Lung cancer causes the most cancer deaths in women followed by breast, colon-rectum, ovarian and uterine. The most frequent site of cancer in Ohio women is breast cancer. With greater emphasis on early detection, however, cancers are being identified at less lethal stages, and more women are surviving breast cancer. Diabetes is the fifth-leading cause of death among Ohio women and is higher than the mortality rates nationally. With the aging of the Ohio population, there are greater numbers of people at risk of developing osteoporosis.

Behavioral and lifestyle factors are the primary factors associated with the leading causes of morbidity and mortality for Ohio women. Smoking, obesity, and pregnancy issues are of chief concern for the women of Ohio. Tobacco smoking is a significant public health problem for Ohio women. More Ohio women die annually from lung cancer than breast cancer. Twenty-five percent of Ohio women report smoking cigarettes, while over 23 percent of female high school students report smoking 1 or more cigarettes a day. Rates of smoking among young pregnant women average 33 percent.

Slightly more than 49 percent of Ohio women are overweight. Minority women are more likely to be overweight and sedentary, placing them at increased risk for heart disease, stroke, high cholesterol, high blood pressure, and diabetes. About 25.8 percent of Ohio women have high blood pressure according to the Ohio 2001 Behavioral Risk Factor Surveillance System. In 2002, 71.5 percent of Ohio women were determined to be at increased health risk due to a sedentary lifestyle, compared to 72.8 percent of U.S. women.

Bullying, sexual harassment and violence against women continue to be a concern in Ohio. According to the Ohio Youth Risk Behavior Survey, 31 percent of Ohio teens reported some type of harassment or bullying on school grounds in 2003 and 5.2 percent of female students did not go to school because of safety issues. According to the state report in Ohio, the number of rapes per year is 1 in 7 and of the approximately 4.4 million adult women living in Ohio, about 634,000 have been raped at least once during their lives.

NorthEast Ohio Neighborhood Health Services, Inc. in Cleveland is a designated Community Center of Excellence (CCoE) in Women's Health.

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State of Wisconsin

The state of Wisconsin has a total population of 5,363,675, with the ratio of women to men as 1.05. The racial / ethnic distribution of women is as follows 91.3 percent Caucasian, 5.1 percent African American, 1.1 percent Asian /Pacific Islander, .8 percent American Indian/Alaska Native, and 1.8 percent Hispanic.

Sixteen of Wisconsin's 72 counties are considered rural, and 68.5 percent of the female population lives in urban areas.

Heart disease, cancer, and stroke are the 3 leading causes of death for Wisconsin women. Tobacco use, which is a behavioral risk factor for the leading causes of death, is a concern for Wisconsin women. 37 percent of reproductive-aged Wisconsin women smoke; this is the highest percentage of any state in the nation. Additionally 18 percent of new mothers report having smoked cigarettes during their pregnancy. The death rate (per 100,000) for lung cancer is 23.5 which is higher than breast cancer at 18.4. Both the lung and breast cancer death rates are lower than the national average. Wisconsin's women's death rate from stroke (24.6) is comparable to the national average (24.5).

Wisconsin women tend to lead sedentary lifestyles with approximately half of adult women reporting no leisure-time physical activity. Additionally, the percent of overweight women in Wisconsin has increased from 21 percent in 1990 to 31 percent in 1998. Wisconsin women are less likely to participate in binge drinking than men in every age group. However both Wisconsin women and men have the highest rates of binge drinking compared to all other states.

The women's health officer works closely with the non-profit Wisconsin Women's Health Foundation, a designated Rural Frontier Coordinating Center, on a variety of health education projects, including a smoking cessation program for pregnant women. Wisconsin is also home to one of the National Centers of Excellence in Women's Health at the University of Wisconsin, Madison.

Content last updated July 8, 2008.

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