How the diseases we don’t talk about are hurting women
By Donna H. Ryan, MD, President-Elect, World Obesity Federation
Many crises never hit the headlines. They unfold under the noses of journalists, beyond the purview of funders and outside the public eye.
A time not just to celebrate female achievement, International Women’s Day is also an opportunity to highlight those under-the-radar challenges that hit women hardest.
All too often, women’s health focuses on our ability to fulfil our childbearing function. It’s undeniable that, with 830 women dying every day because of pregnancy-related complications, far too many women lose their own lives in the course of bringing new ones into the world. But female fatalities do not simply stem from our reproductive systems; maternal health is not a byword for women’s health.
Discussions of women’s health often miss out a category of diseases that account for 70% of all deaths globally yet receive only 2% of the total aid money spent on health: non-communicable diseases (NCDs). Encompassing diseases like diabetes, heart disease and cancer, NCDs are becoming the defining diseases of our time, as we live longer, eat more and move around less.
While global maternal mortality almost halved between 1990 and 2015, the number of people with diabetes globally nearly quadrupled between 1980 and 2014. By 2030, breast cancer diagnoses could almost double. As the gender commonly tasked with care-giving roles, it typically falls to women to tend to the consequences of these long-term illnesses.
Unfortunately, NCDs are much more of a nemesis than an added workload, causing women around the world to suffer and die needlessly. In 2012, cervical cancer killed approximately 270,000 women worldwide. This death toll is unacceptable for two main reasons. Firstly, screenings can identify the disease before it gets out of hand. Secondly, the HPV vaccine — both safe and effective — can prevent cervical cancer from even developing in the first place.
Considering geographical divides alongside gender inequality, we should also be concerned that the globe is still caught in an “oncoplutocracy”, with wins against cancer only really benefiting wealthy countries and patients. For example, a recent study in the Lancet revealed that five year survival rates for breast cancer are at 90% in the US and Australia but only 66% in India — when diagnosed between 2010 and 2014.
Women also bear the brunt of much of the stigma associated with a condition that puts a person on a crash course with NCDs: obesity. Being obese increases your risk of having a stroke, getting cancer and becoming depressed — among much else. Yet rather than compassionately depicted as something that can make you sick, excess fat is mocked and portrayed with disgust in much of the media.
This culture of mocking women for their stretchmarks or “muffin tops” has complicated efforts to tackle obesity. Fat acceptance and body-positivism are both laudable movements that have grown out of reaction to stigma and weight bias. However, problems arise when their messages collide with health advice, as recent pushback against Cancer Research UK’s campaign to highlight obesity as a cause of cancer demonstrates.
Fat is an organ, we shouldn’t shame people for having it but nor should our response to obesity be silence for fear of upsetting people. That’s not to deny that fat-shaming is a very real and damaging phenomenon, which should be combatted as a means of standing up for the dignity and mental wellbeing of others. However, obesity is also very real and we just can’t avoid the fact that facing up to health problems isn’t always the most comfortable experience.
Fortunately, multiple opportunities for progress in combatting NCDs are scheduled in for 2018, with female leaders at the forefront of the fight. In light of Scotland’s introduction of minimum pricing for alcohol, Nicola Sturgeon, the country’s First Minister, was invited to join a new international task force that will bring tax policy to bear on NCDs.
Dr Sania Nishtar, the only female candidate in last year’s election to be Director-General of the World Health Organization, is co-chairing a Commission on the NCDs, which will feed into a high-level meeting at the UN in September. With the obesity epidemic threatening to undermine already fragile health systems across the world, it is critical that the debate around prevention and treatment of obesity links to the momentum toward ensuring that everyone can access quality health services, free of financial hardship.
NCDs account for seven of the top 10 leading causes of death for women globally. It’s time to expand our concept of women’s health and champion female leaders working across the full spectrum of health issues.
