Childbirth and infectious diseases were once the leading causes of death among women around the globe. That’s changed over the last three decades. Today, noncommunicable diseases (NCDs), once considered diseases of affluence, are, along with injuries, the leading causes of death and disability among women in developing and developed countries alike. Noncommunicable diseases affect women and children across the life-course: They are a critical issue for child and adolescent health, a threat to maternal and reproductive health, and a major driver of ill health for older women.
Described as a “slow motion disaster” by former World Health Organization Director-General Margaret Chan, noncommunicable diseases include cardiovascular disease, cancer, diabetes, chronic respiratory diseases, and mental and neurological conditions, among others. The WHO estimates that these diseases kill 41 million people each year, accounting for almost three-quarters of all deaths.
One of the United Nations’ Sustainable Development Goals for 2030 is to cut by one-third the number of people dying prematurely from noncommunicable diseases. That will be doable only if we have an urgent and serious conversation around gender and NCDs — a conversation that can draw parallels with those connecting gender with HIV and other infectious diseases. These conversations will help us better understand differences in risk in order to ensure that interventions are more appropriately targeted.
Around the world, women and girls face persistent inequalities that increase their vulnerability and affect every aspect of their lives, including their health. In low- and middle-income countries with limited health infrastructure and poorly resourced or specialized health workforces, women face economic as well as gender barriers, and are less likely to access timely, adequate, or affordable diagnosis and care. As a result, chronic diseases are often detected at a late stage, increasing the likelihood of disability and premature death, both of which are largely preventable.
Take, for example, cardiovascular disease, a catchall term that includes heart attack, stroke, heart rhythm problems, heart failure, and more. Women in low- and middle-income countries who develop cardiovascular disease — the biggest killer of women globally, with heart disease and stroke causing one-third of all deaths in women worldwide — are more likely to die from it than women in high-income countries. Cervical cancer, which is preventable through vaccination and screening, kills 266,000 women each year, with 88 percent of these deaths in low-resource settings.
Many women do not have access to information and education about the importance of screening for diseases such as breast and other cancers, especially when they aren’t experiencing any signs and symptoms of disease. In low- and middle-income countries, illiteracy, low socioeconomic and political status, and other factors limit the ability of girls and women to inform and protect themselves against noncommunicable diseases. In addition, the education of girls is often threatened or disrupted as they are forced into being caregivers for family members with chronic diseases. As women age, they may face the challenge of caring for family members while living with their own NCDs.
We also need to seriously consider the impact of mother-to-child transmission, looking at a mother’s health status before, during, and after pregnancy, and how it can influence her own — and her children’s — risk of developing one or more noncommunicable diseases later in life. Common risk factors for these diseases, such as high blood pressure and high blood sugar, can lead to serious complications during pregnancy and also increase the likelihood of developing cardiovascular disease or diabetes later in life. At the same time, under- or over-nutrition during pregnancy can significantly affect the health of a woman’s offspring, perpetuating an intergenerational cycle of noncommunicable disease.
Women in low- and middle-income countries often face a triple burden of reproductive and maternal health conditions, communicable diseases, and noncommunicable diseases, which combine and interact to erode health. Women living with HIV/AIDS are at increased risk of developing noncommunicable diseases due to the effects of the virus and/or the effects of the medications used to treat it.
We must act fast to put the brakes on this slow-motion disaster. Governments must adopt a gender-transformative, evidence-based approach to tackling noncommunicable diseases across the life course as a key part of progress towards ensuring universal health coverage for all. We need to break down traditional silos and foster new collaborations and partnerships with the maternal and child health community and others. Prevention, screening, and treatment of noncommunicable diseases must be urgently integrated into existing maternal, child, and adolescent health programs, as well as those tackling HIV/AIDS.
We also urgently need a better understanding of women’s health throughout the life course, going well beyond the reproductive years. Research to understand the impact of sex and gender on health, and the factors that influence health trends for women and men, must be prioritized. A simple step towards achieving this would be to ensure that data are routinely collected and analyzed separately for women and men.
Let us be clear: We are racing the clock on this global health emergency. As Dr. Mahmoud F. Fathalla has often said: “Women are not dying of diseases we can’t treat. They are dying because societies have yet to make the decision that their lives are worth saving.” Our societies need to make that decision, and make it now.
Robyn Norton is the principal director of The George Institute for Global Health. Katie Dain is the chief executive officer of the NCD Alliance.
If we had a functioning system, something like this would be a wake up call. Not here in America, where alternate facts and advertising are used to determine public policy. The US is in a health crisis, years of lies, misinformation and propaganda, have led to this. Our public health system is still relying on industry interests and misinformation to determine health policy. In Fact, sites like this perpetuate the ignorance and denial. The monetized the deceptive advertising and corporate propaganda. There will be an unequal amount of counter narratives, cleverly written by corporate spin departments.
On May 18th, 2018 I started having issues with my blood pressure. The condition never got any better and on my second visit to my doctor, my meds were increased. This is when it dawned on me that my condition was deteriorating and I had to do something. With the high blood pressure, I would either suffer from a heart attack or stroke and this is something I wanted to avoid at all cost. Just when I was about to give up I came across a story online (google ” How I Helped My Sister Cure the Hypertension ” ) The story was about how one Mary was able to manage her blood pressure. I read the story and implemented her program and I was surprised by how fast I got results. The next time I visited my doctor for a follow up my medications were reduced, I even manage to shed off some extra weight. I am still sticking to Mary’s ways of managing blood pressure and I’m confident that next time my meds will be reduced even further. I have an upper hand on this since if I can opt out of meds and adopt natural methods!
This is an excellent, thought provoking piece, raising new issues and adding a new lens to examine NCDs, the gender burden for women, and maternal-fetal transmission.
Another aspect of NCDs are the autoimmune diseases that seem to favor women. Also, the rise of food allergies and sensitivities that are associated with leaky gut. And the rise of metabolic syndromes.
An additional fruitful line of research and of diagnostic testing and treatment strategies could focus on identifying external and internal environmental triggers that together, tip the balance from healthy function to dysfunction. On a bus trip to a Clean Water Action event in DC several years ago, I met a contingent of young women from Maine who, before getting pregnant, got screened for heavy metals and chemicals, and worked to lower them. More can be done than avoiding alcohol and eating healthy.
In addition to screening for NCD health conditions and earlier treatment, perhaps we can also on screening for contributing factors, early intervention, and going upstream for prevention.
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