Non-Communicable Diseases: Gender Considerations

Transcription

1 Non-Communicable Diseases: Gender Considerations Introduction The rapid rise in non-communicable diseases poses major risks to global economic and social development as well as health challenges to both men and women. The major chronic non- communicable diseases (NCDs) are cardiovascular diseases, diabetes, chronic respiratory diseases and cancers. They are largely preventable and share common modifiable risk factors such as tobaccos use, alcohol abuse, unhealthy diet and physical inactivity. Purpose NCDs prevention, care and management is largely associated with people s lifestyles which influence their exposure to the key risk factors. The magnitude of impact of exposure to these risk factors-tobacco, alcohol, diet and physical activity- varies for men and women depending on their economic, social gender, political, behavioral and environmental differences. Additionally, due to biological differences, social marginalization and gender roles, women are especially vulnerable when it comes to NCDs. At the 2011 High Level Meeting on Prevention and Control of NCDs, NCDs were acknowledge as a gender issue with reference to the wide disparity between men and women in access to diagnosis and treatment. According to the World Health Economic Forum 2010, NCDs represent the biggest threat to women s health worldwide. Because women and men experience these determinants differently strategies to NCDs care and management should incorporate the different needs of men and women. This paper will discuss the additional considerations of each of the 4 NCDS and their risk factors as well as health system needs for NCD control and management for women. Diabetes Diabetes, a chronic condition of raised blood sugar levels has unique implications for women. The Global Alliance for Women s Health: Key Facts on Women and Diabetes states that although the ratio of men-to-women with diabetes is equal,

2 women are uniquely and often more severely affected by the complication and comorbidity of diabetes. For instance, they say the risk of death from coronary heart disease is 50% higher for women with diabetes compared to men with diabetes. This statistic increases if a woman smokes. Additionally the risk of diabetic ketoacidosis and coma is 50% higher among women than men. Diabetes during pregnancy also has additional complications and can lead to higher risk of vascular complications, macrosomia, and poor pregnancy outcome. Gestational diabetes, which develops during pregnancy but goes away, often results in type 2 diabetes 2-5 years later. Additional, considerations of the American Diabetes Association include the predisposing affect of diabetes on women to develop recurrent yeast infections and that women with diabetes are at risk of developing premature menopause and increased risk of cardiovascular disease. Cardiovascular Disease Heart disease is the leading cause of death in women in every major developed country and most emerging counties. The American Heart Association recommendation challenged the conventional wisdom that women should be treated the same as men. There are possible gender differences in the magnitude of potential benefits and risks for preventative interventions, they say. Women have more comorbidities and are older than men when experiencing CHD. Pregnancy and hormone therapy are unique risk factors for stroke and have greater prevalence of HTN in older ages. The NCD Alliance in Non communicable Diseases: A priority for Women s Health and Development states that a gender gap exists in diagnosis and treatment of cardiovascular diseases in women and that women are more often than men to be under diagnosed. The World Heart Federation articulates the differences in heart attack symptoms in men and women. Women experience diffuse or no pain that can be inconsistent, where as men experience intense chest pain and pain in left arm or jaw. According to them, women also tend to have more severe first heart attacks, which more frequently results in death. Additionally, while more women are being included in studies today, many studies already done on women use small sample sizes which does not take into consideration women with different cultural 2

3 and racial backgrounds as stated in Effectiveness-Based Guidelines for the prevention of cardiovascular Disease in Women 2011 Update: A guideline from the American Heart Association. Cancers As indicated in Control Cancer in Developing countries: Prevention and treatment strategies merit further study, the top cancers among women in developing nations are breast, cervical, stomach, lung and colorectal. Cervical cancer accounts for the great number of deaths. According to Why are women dying from a preventable disease by the Union for International Cancer Control, 80% of new cervical cancer cases are of women in developing countries, where effective screening programs are unavailable. HPV vaccines for adolescent girls can reduce cervical cancer drastically. In Women s Health beyond reproduction: meeting the challenges by Bustreo F., Knaul F.M., and others, deaths from cervical and breast cancers now exceed maternal deaths and that chronic and non-communicable disease are new and ignored challenges in women s health. They say that there is a need for a life course perspective for women s health that combines NCD care, reproductive and maternal health. Chronic Lung Diseases: The leading risk factor for lung diseases is tobacco exposure. Women are more vulnerable to this exposure through indoor cooking stoves, as second hand smoke exposure, and the increasing number of women who are smoking. Additionally the NCD Alliance notes that asthma onset during adulthood is more common and more severe in women. Risk Factors Tobacco Use 3

4 Tobacco use is the leading risk factor for chronic respiratory diseases such as COPD, asthma, and other chronic lung diseases. The NCD Alliance in Non-communicable diseases: A priority for Women s Health and Development claims that although usually more men than women smoke tobacco, smoking rates are increasing at an alarming rate among young women. Girls and women are new targets of tobacco companies with advertisements showing smoking as a way of improving women s social and political status, according to the PAN American Health Organization in Noncommunicable Diseases and Gender. Many women are unaware of health risks of tobacco and some fear that quitting may lead to weight gain. Women and children, who spend most of their time indoors also make up a large portion of involuntary smokers, as mentioned in Women and the Rapid Rise of Non-communicable Diseases by WHO s Department of Non-communicable Diseases and Mental Health. The NCD alliance mentions women are at in increased risk of smoke exposure from inefficient cooking stoves for indoor cooking or heating, which use solid fuels for cooking. This disproportionally leads to lung and respiratory condition in women and children, Physical Inactivity A major risk factor for diabetes and cardiovascular diseases is physical inactivity and obesity. Firstly, WHO s Women and Health: Today s evidence, tomorrow s agenda shows that adolescent girls are less physically active than boys of the same age. Reasons for this include the lack of safe and supportive environment, shortage of income and leisure time, negative cultural stereotypes of body image, and social norms about dress and mobility, which restrict girls from routinely being physically active. Additionally, the Political Declaration on the High level meeting on prevention and control of NCDs claims that women who share a disproportionate portion of the burden of caregiving are also less physically active than men. Housekeeping chores are unevenly distributed but not quite the same as deliberate physical exercise. While social norms for women and girls reduce their opportunities for activity, food consumption patterns due to globalization add on to the risk of obesity. As a result, women are more likely than men to be obese and thus more likely to suffer from diabetes and cardiovascular disease. 4

5 Alcohol Abuse In most parts of the world, women are not considered major consumers of alcohol and thus most alcohol treatment programs are geared towards men without acknowledging women. However, since women develop problems associated with alcohol consumption more quickly and at lower doses than men, they are at a higher risk of developing NCDs, according to Non-communicable diseases: A priority for Women s Health and Development. Women also tend to be hidden alcoholics and thus programs need to these women. Poor Diet Urbanization leads to change in diet of increased of food with high saturated fats, sugar and salt, which fuels levels of overweight and obesity. As stated by the NCD Alliance, 43 million children under 5 are overweight, and girls at this age are more likely than boys to be overweight. Under-nutrition co-exists with rapid change in nutrition in young adulthood. They also state that maternal under nutrition during pregnancy leads to risk of infant developing chronic conditions such as diabetes and cardiovascular diseases later in life. Women and the Rapid Rise of Noncommunicable Diseases says changes in consumption pattern as a result of globalization has led to increased consumption of tobacco, alcohol, to displacement of vegetables and fruits with high fat/low fiber foods, and reduced physical activity. There are also strong links between maternal malnourishment, offspring s birth weight and early insulin resistance in child. Moreover, women are twice as likely as men to suffer from malnutrition. Special Considerations for Women: Pregnancy and NCDs Non communicable diseases and its risk factors also impact pregnancy. At the UN High-Level Meeting on NCDs the rising prevalence of high blood pressure and gestational diabetes were acknowledged to lead to increased adverse outcomes of 5

6 pregnancy and maternal health. The resolution adopted at the High-Level Meeting on Prevention and Control of NCDs declares that NCD and risk factors on maternal and child health can lead to malnutrition and low birth weight. This predisposes both mother and child to obesity, high blood pressure, heart disease and diabetes later in life. Children born to a malnourished mothers have increased risk of under nutrition, low birth weight and increased vulnerability to NCDs in adulthood, as claimed in Non-communicable Diseases and Gender. Diabetes during pregnancy presents serious risk to both the mother and the baby such as vascular complications and worsening of diabetic retinopathy. The Global Alliance for Women s Health says gestational diabetes mellitus that is not properly managed can lead to macrosomia, which can cause fistulas, hemorrhaging, infection and death. Access to Prevention, Diagnosis and Treatment Women and men also face differences in access to diagnosis and treatment. Because women are often caregivers and stay in home, poverty and lack of access to and control over resources, limit her ability to pay for healthcare. In many homes, women are unable to make decisions about care for themselves or children without approval from their husbands. Women most often also prioritize spending on family s well-being over their own. Non-communicable diseases and Gender says Majority of studies are done on men, women are less likely to be diagnosed with an NCD at the early stages. According to Controlling Cancer in Developing Countries, early detection by screening women once or twice between reduces risk by 35-40%; 3 lifetime screenings can reduce risk by more than 50%. In terms of cardiovascular diseases, a gender gap exists in diagnosis and treatment. Women are often under diagnosed for CVDs because they have less apparent symptoms and less likely than men to receive measure for prevention and control of CVD. According to the American Hearth Association s Effectiveness-Based Guidelines for the prevention of cardiovascular Disease in Women 2011 Update some barriers to adoption of its guidelines on CVD care include lack of access to primary care services, lack of knowledge and skill of healthcare provider, lack of time to properly 6

7 discuss lifestyle issues such as smoking cessation, and the lack of women s understanding for their own emergency care. Uncontrolled and under diagnosed diabetes as affects on pregnancy outcomes leads to delivery of macrosomic infants, which could result in life threatening complications. Gestational diabetes, which develops during pregnancy, women and offspring are a high risk of developing type diabetes later in life. The Global Alliance for Women s Health: Key Facts on Women s and Diabetes says diabetes screening for pregnant women is often unavailable in poor countries, which eliminates the possibility of access to care and treatment. They also say women with diabetes are offered less-aggressive treatment and intervention than men. Implication of NCD on Women s Lives For women, the rapid rise in non communicable diseases not only affects their health directly, it can also severely impact on their assumed gender role as unpaid carers of the sick and can leave women financially vulnerable. Gender roles assign women the task of providing care to the sick, disabled, and elders. Women are not paid for this caregiving and less likely to have financial independence to make their own choices. Furthermore, Women with chronic non communicable diseases are more likely to be divorced, separated, or abandoned by their husbands, according to the NCD Alliance. The economic Burden of Non-communicable diseases in the Americas-PAHO claims that NCDs have the potential to deepen inequality because it limits opportunity to obtain and maintain paid work in the formal economy. Women with NCDs are also less likely to receive employer provided health insurance or social security credit, have little of their own money to pay for healthcare and are often excluded from publically reimbursed health and social services. Approaching NCDs management for Women Women s Health beyond reproduction: meeting the challenges notes that while the High Level Meeting of General Assembly on NCDs makes important strides in NCDs 7

8 and noting that they are a gender issue, the intersection between NCDs and Women s health is still yet to be explored. U.N. s Global Strategy for Women and Children s Health, released in 2011 focuses mainly on maternal health, family planning, reproductive health and other diseases such as TB, malaria and etc. There is very little mention of NCDs. The Pan American Health Organization along with the International Diabetes Federation published, Non-communicable diseases and Gender in which they highlighted 4 key gender-focused opportunities for NCDs. This includes, pro-poor and gender-sensitive health policies which provide health insurance and social protection for unpaid workers, NCD surveillance systems that recognize differences in men and women, data that is disaggregated by sex, and different prevention and treatment methods. The second is using primary health care for NCD prevention and control that takes advantage of community health clinic and incorporating NCD screening into maternal and child health services. The third is investment in girls, women and their health through education on healthy nutrition, physical education on sports in schools, and education that allows women more control over financial resources. They also mention for long-term care to support training for home health care givers, which invests in current work of women and lower future healthcare costs. Moreover, the resolution of the High- Level Meting on Prevention and Control of NCDs also makes similar recommendations such as promoting gender-based approach for prevention and control of NCDS and promoting NCD prevention and control within sexual and reproductive health and maternal and child health programs especially at the primary health-care level and integrate interventions in these areas into NCD prevention programs. Additionally, the NCD Alliance notes the important roles that women and girls have to be potential instruments in reducing the modifiable NCD risk factors. Healthcare providers should enforce routine screenings and community and healthcare providers to work on educating both men and women about the different considerations for each other. A few things not discussed included strategies for dealing with the tobacco from stove cooking, tobacco industries targeting of women, development of safer 8

9 exercising environments for women, such as women only wellness centers, nutrition geared towards needs of women and girls, such as healthy food and emphasis on iron and other nutrients, the need for more alcohol programs that target women and educating them about adverse effects of alcohol. More research is still needed in areas such as women and cardiovascular disease, and lung disease. 9

10 Sources: 1) Non communicable Diseases: A priority for Women s Health and Development. (2011) NCD Alliance. Availbable : 2) Bustreo F., Knaul F.M., Bhadelia A., et al. Women s health beyond reproduction: meeting the challenges Bulletin of World Health Organization 3) United Nations Secretary General. Global Strategy for Women s and Children s Health. (2010). The partnership for Maternal, Newborn, and Child Health 4) UN High-Level Meetin on NCDs: Summary Report of discussion at round tables. (2011). Availble: ary.pdf 5) Political Declaraction of the High Level Meeting of the General Assembly on the Prevention and Control of Non-Communicable Diseases. United Nations General Assembly. (2011). Available: n_en.pdf 6) Non Communicable Diseases and Gender. Pan American Health Organization and IDF 7) The Economic Burden of Non Communicable Diseases in Americas. PAHO 8) NCDs on Global Agendas. PAHO. ory&id=3707&itemid=4021 9) Halting the rise of non-communicable diseases: An urgent priority for women s health. (2011). Diabetes Research and Clinical practice. International Diabetes Federation 10)Miskurka M., Haddad S., Langlois E.V., et al. Heavy Burden of noncommunicable diseases at early age and gender disparities in an adult population of Burkina Faso: world health survey (2012) 11)Effectiveness-Based Guidelines for the prevention of cardiovascular Disease in Women 2011 Update: A guideline from the American Heart Association. American Hearth Association. (2011). 12) Why are women dying form a preventable Disease? Union for International Cancer Control. 13)World Health Organization (2009). Women and Health: Today s evidence, tomorrow s agenda Geneva 14)World Economic Forum (2010) Global Risks Report Cologny/Geneva 15)Women and the Rapid Rise of Non-communicable Diseases. NMH Reader. (2002). World Health Organization. 10