When it comes to pre-election debates on health care in America, the consensus is clear: the badly broken system is in need of significant reform. For women, in particular, much is at stake.

Approximately one in seven women in the US lack health insurance, including nursing home workers and home health providers, many of whom earn the minimum wage. Drug prices are out of control, a particular issue for older women, and health care expenditures now account for nearly half of all personal bankruptcies. Women have less access to mental health services and are, therefore, more likely to be prescribed psychotropic drugs. And as presidential candidate Senator Hillary Clinton (D-NY) told Our Bodies Ourselves, in an interview on the politics of women's health, "Every day mothers all over the country worry about the health of 8.7 million children." (Our Bodies Ourselves is a not-for-profit, public interest women's health education, advocacy, and consulting organization.)

And for an immigrant, Black, Latina, or otherwise marginalized woman, the situation is even bleaker. In fact, according to the National Asian Pacific American Women's Forum (NAPAWF), in Washington, D.C., despite their higher rate of poverty and uninsured rates, Medicaid coverage (the Federally-funded central source of health care for low-income people) for most Asian
Pacific American (APA) women remains lower than for all other groups. Cultural differences, immigration restrictions and transportation barriers help account for APA and other women being unable to access Medicaid.

These kinds of well-documented problems and the hope that this year's election will usher in a new political climate have led three key women's organizations - the Avery Institute for Social Change, the National Women's Health Network, and The MergerWatch Project - to launch the Raising Women's Voices for Health Care Campaign.

By engaging women leaders in diverse communities to identify their health care needs and then developing a vision for a system that meets those needs, the campaign hopes to mobilize and support a network of women who can advocate at all levels for expanded, responsive, appropriate health coverage. Building creative partnerships with other organizations, for instance, the National Latina Institute for Reproductive Health, is another goal so that there is a powerful base from which to address barriers and obstacles to comprehensive health care.

Byllye Avery, founder of the Boston-based Avery Institute for Social Change, likens the campaign's model to the highly successful women's health movement that began in the 1970s, with women meeting to share their health care establishment experiences. "There are gaps that require action. So we're at the
conversation stage right now," she says. "Health care reform hasn't caught on because we start with the end point and ask 'how can we pay for it' rather than asking 'what do we need'," she adds.

Cindy Pearson, Executive Director of the National Women's Health Network, agrees, citing recognized successes of the women's health movement, including getting Congress to conduct long-term, in-depth research on women's health issues. "We can do things like that," Pearson says. "It takes time and people think we're 'out there' but we stick with it and bring women's voices into the dialogue. That can make a big difference over the long haul."

One successful model for change at the state level is the Maryland Women's Coalition for Health Care Reform, an alliance of over 40 women's organizations, all 15 county commissions for women, and an individual membership base of 160,000. It is the only state women's organization in the US that has organized
effectively to impact health care reform. Its organizer and chair, medical sociologist Anne Kasper, says that in addition to fostering grassroots dialogue, the Coalition formed member advocacy teams who visit their legislators to advocate for specific bills. This year it is focusing on financing health
care.

Says Kasper, "We are increasingly aware that the current system is not designed to promote and maintain our personal health or the health of others. Instead we are aware of a medical system that delivers sporadic, interventionist, hi-tech, and curative care when what we really need is continuous, primary, low-tech and preventive care. ...We need a health care system that is part of changes in other social spheres - wage work, housing, poverty, inequality and education - since good health care results from more than access to medical services."

MergerWatch, a component of Community Catalyst in New York City, is a non-profit advocacy organization concerned with patients' rights in medical decision-making. It grew out of family planning advocacy in New York State 10 years ago when Catholic hospitals were acquiring private hospitals and limiting reproductive rights for women. Eesha Pandit is Director of Advocacy. "We're in a good place to address policy," she says.

Based on small group discussions with women in New York and Boston to date, Pandit says two themes always emerge: accessibility and cost. Women, she points out, often coordinate and manage family health care. They want preventive and holistic care and more respect for women's understanding of their families and their bodies. They want life transitions and the life cycle
to be taken into account. And, she adds, "They want to see the medical establishment become more nuanced rather than seeing health as an industry."

One thing Pandit has discovered in talking with South Asian women is that the issue of cultural competency and language is crucial. She gives the example of dental reconstruction, usually considered cosmetic. But, she points out, when you've lost your teeth from domestic violence, the issue becomes a psychological one. "It changes the parameters of what health care looks like," she says.

Notes Priscilla Hwang, Policy and Program Director for NAPAWF, "The system is so broken. There are so many immigrant women with poor health outcomes. In addition to vehement, restrictive health polices, women are fearful, often because they are undocumented or because costs are high. So they don't ask for help. There is nothing in the system to help people take care of themselves." She adds, "Health care reform is inevitable. Raising Women's Voices will lead to a proactive agenda."

To that end, the MS Foundation has given a $50,000, two-year grant to the three organizations mounting the Raising Women's Voices for Health Care campaign. Their support will help build a movement based upon the UN Universal Declaration of Human Rights. According to Avery, the effort "is not really an election issue. We just need to get people interested and keep the momentum going."