Hoosier women’s health status and state policies ranked among the worst in a nationwide report card released Wednesday, but new efforts may bolster Indiana’s standing in years to come.

   That’s the hope of Indiana’s health commissioner, Judith Monroe, who was distressed but not surprised by Indiana’s poor showing.

   Indiana ranked 40th among the 50 states and Washington and was one of 12 states, mostly in the South, that got an “F” on the report card, “Making the Grade for Women’s Health,” developed by the advocacy group National Women’s Law Center and Oregon Health and Science University.

   “We have room for improvement everywhere,” said Monroe, who is particularly concerned with women’s high smoking and diabetes rates.

   “But we’re beginning to see a lot of momentum,” she said.

   “Once schools, colleges, work sites, faith communities and local governments are engaged and serious about policy and program changes, we will significantly see the needle move.”

   Steps already taken — including raising the cigarette tax and the Healthy Indiana Plan that provides health insurance for the uninsured — should improve Hoosiers’ health, Monroe said. She also cited INShape Indiana, a Web-based program focusing on healthy lifestyles, a new emphasis on workplace wellness and her office’s Influence Women’s Health grassroots educational program.

   Yet the state-by-state report paints a grim picture of the state of women’s health.

   Little progress has been made in Indiana or the nation since the first of four report cards was released in 2000, said Judy Waxman, vice president for health at the Washington-based law center.

   “As each year passes, the nation and the states are falling further behind in the quest to meet the national goals,” Waxman said.

   No state received an overall “satisfactory” grade. The top three — Vermont, Minnesota and Massachusetts — received “satisfactory minus” grades. Most states earned “unsatisfactory” marks.

   Indiana improved its ranking of 41st in the 2004 report. But its grade slipped from unsatisfactory to failing because the state was more than 50 percent away from reaching the goals.

   While Waxman said that only a handful of states meet at least half of the policy goals, the top three states have in place or are putting in place good health insurance coverage and Medicaid eligibility standards. Minnesota, for example, has the lowest percentage of women without health insurance  and its Medicaid system covers smoking cessation and numerous health screenings.

   “It’s rather depressing, I think, to be 40th,” said Dr. Robert Deaton, co-director of the St. Vincent Center for Women’s Health, which provides healthy lifestyle risk assessments to women, screenings and nutritional and medical consulting.

   The keys, he said, are working harder at preventive care and wellness, improving health access in rural areas and helping women lose weight, exercise and stop smoking.

   Indiana women got an “F” for rates of obesity, smoking, physical activity, high blood pressure and diabetes, among others.

   “I think people don’t realize that most of these issues would be better if they took personal responsibility,” Deaton said.

   Still, barriers and policies exist that make it harder for women to get health care.

   “We are set up as a (health) system to not have women succeed,” said Dr. Sharree Grannis, program director for the Indiana University Family Medicine Residency.

   She said poverty and a lack of child care, transportation and workplace wellness initiatives make it harder for women to seek care.

   Of particular concern, Grannis said, are higher rates of minority women who are without health insurance and prenatal care, have diabetes and high blood pressure, and die from coronary heart disease and strokes.

   “If we control blood pressure and cholesterol and create systems by which exercise is easier, we know we can improve those things,” she said.

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