Noncommunicable diseases among women: a ‘slow motion disaster’

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.