The WHO Report on Global Women's Health

The World Health Organization (WHO) recently released a comprehensive report entitled “Women and health: today’s evidence tomorrow’s agenda.” The report documents the difficulties that women worldwide face when seeking healthcare at all stages of life. Findings in the report indicate that though women live six to eight years longer than men, on average, they often lack essential healthcare throughout their lives.

According to Reuters, women seek medical services more often than their male counterparts, especially before, during, and after pregnancy. In addition, women in the United States pay approximately 48 percent more than men for healthcare services. The report discusses the fact that in many nations “sexual and reproductive health services tend to focus exclusively on married women,” therefore assistance during childbirth can be particularly difficult to access for “unmarried and marginalized women, teenagers and sex workers.” Further, the WHO report notes that 99 percent of the estimated 500,000 women who die during childbirth each year are in the developing world where there is an extreme shortage of medical supplies and trained healthcare providers.

The Boston Globe reports that 15 percent of deaths in adult women worldwide occur in maternity, and one in five deaths among women in this age group is linked to unsafe sex. The WHO report indicates unsafe sex, stemming from the dearth of information regarding safer sex strategies and contraception, has also contributed to the spread of HIV and other sexually transmitted infections. In sub-Saharan Africa, one in four women who wish to delay or stop bearing children do not use any family planning methods, according to the WHO. A National Public Radio (NPR) report indicates that HIV is the number one killer of women ages 15 to 49 worldwide. Further, in 2007, 15.5 of the 30.8 million global cases of HIV-positive adults were women. Reports indicate that the largest portion of these individuals live in Africa, where six percent of women of childbearing age have the disease. NPR reports that, per the CIA World Factbook, half of the women ages 25 to 29 in Swaziland are infected with HIV – a small nation with a total population of one million people, 26.1 percent of whom are HIV-positive.

Women in resource-limited regions are at a particular disadvantage, as these areas often lack access to screening and treatment resources for diseases like cervical cancer, the second most common type of cancer in among women. A study of the introduction of the HPV vaccine published in the New England Journal of Medicine in 2007 stated “Of 274,000 deaths due to cervical cancer each year, more than 80% occur in developing countries, and this proportion is expected to increase to 90% by 2020.” Complications related to pregnancy, including unsafe abortion procedures, are among the leading causes of death among girls aged 15 to 19 in developing nations. Though these issues are substantial concerns in middle- and high-income nations, the WHO report indicates that road traffic injuries are the leading cause of death in girls between the ages of 10 and 19 in these regions. Among women over the age of 60, chronic diseases account for almost half of the deaths worldwide, and cardiovascular disease – generally considered a “male disease” - is the primary cause of death for this age group.

Discussing the importance of the comparative women’s health report, Dr. Margaret Chan, director-general of the WHO, said “The obstacles that stand in the way of better health for women are not primarily technical or medical in nature. They are social and political…It’s time to make sure that women and girls get the care and support they need to enjoy a fundamental human right at every moment of their lives, that is, their right to health.” The overview statement for the report echoes this sentiment, explaining that “we will not see significant progress as long as women are regarded as second-class citizens in so many parts of the world…women are excluded from educational and employment opportunities…and have no freedom to spend money on health care, even if it means saving their own lives.”

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Mobile Medical Apps

New technologies, both mobile and Internet-based, hold potential medical applications that may advance care. Through cellular telephones, netbooks, and laptops, physicians and healthcare providers are now able to utilize these technological improvements at the point of care. Non-profit organizations, research teams at universities, and other groups are working to develop applications for use on cell phones, often with integrated web-based features, to ensure that medical knowledge is fully accessible worldwide.

Web-based iConsult, the flagship program of the iCons in Medicine initiative, allows for collaboration between healthcare providers worldwide through a teleconsultation software and social networking website. The iConsult application, which functions like email, is easy-to-use, reliable, and designed for use in areas with limited or intermittent connectivity. The system facilitates knowledge transfer worldwide by pairing Volunteers, medical specialists who lend their expertise, with Requestors, medical professionals who work for non-profits in remote or medically underserved areas. Through the software and website, Volunteers and Requestors may collaborate on difficult medical cases from a distance, providing specialty advice that otherwise might not be available. Volunteers in the iCon Network who elect to take part in iConsult agree to provide at least three teleconsults per year. The iConsult software allows Requestors to upload a case consultation form, including digital images, and discuss potential diagnoses and treatments on a one-to-one basis with Volunteers in a secure environment. Other organizations, like InSTEDD (Innovative Support to Emergencies Diseases and Disasters), develop free and open source technologies to enable seamless and reliable collaboration between individuals working in the developing world and areas affected by conflict situations or natural disasters. GeoChat is a mobile communications service designed to allow for group communications via cellular telephones and online. The technology can be used in humanitarian crises to ensure that individuals who may be trapped, injured, sick, or in need of assistance can be reached quickly and their needs addressed. Unlike platforms that are only web-based, InSTEDD’s GeoChat allows healthcare providers and others to form a team and use SMS messaging, email, and/or a web browser to share information based on their location, providing an accurate documentation of conditions in a given region.

In addition to web-based initiatives, many organizations have begun developing and distributing applications for smartphones, creating a new base of information for both physicians and the general public. An analysis published by Manhattan Research in February 2009 indicates that more than 10 million adults in the United States use mobile devices to access health information. This figure may include individuals who chose to purchase the Merck Manual Home Health Handbook (3rd Edition) in its iPhone application format. Users can reference a range of health topics on-the-go with this and other similar applications. The Merck Manual is available in both a home and professional edition, and features a search engine and the ability to bookmark and email subjects. Other organizations, such as health insurance company Medica, are making efforts to increase the public’s awareness about healthcare and its costs through iPhone applications like Main Street Medica. The application, which is available to all consumers, not only Medica members, offers users the chance to compare the cost of common procedures at hundreds of clinics and facilities.

Though some look for health information on their own, a recent Opinion Research Corporation survey found that 64 percent of consumers turn to their physicians for health advice and feel that they are their most trusted source of health information. In an effort to ensure that healthcare providers have up-to-date information, organizations like Emerging Solutions in Pain (ESP) have also begun releasing mobile applications intended for use by medical professionals. ESP has launched an application for healthcare professionals involved in pain management or addiction medicine called ESP Mobile, which provides multimedia information in a mobile format and also includes up-to-date information and educational programs in pain management, news articles, and clinical support resources for providers. Physicians at Houston-based Memorial Herman Healthcare System use this and a number of other iPhone applications, including Airstrip OB, which displays medical notes and real time vital statistics of women as they approach delivery. The thousands of doctors and nurses within the 11 hospitals that comprise the System also utilize apps in the emergency room to quickly identify medications – particularly useful “if an unconscious patient comes in with a pocketful of pills."

Other applications may be of use to both physicians and patients including language translation applications and a number of websites and mobile applications developed to provide up to the minute disease outbreak tracking and evaluation. Primarily focused on the medical community, applications like the Arabic Language Buddy, which provides real time, two-way English-Arabic translation; and Jibbigo, which converts English to Spanish and vice versa, offer potential tools for doctors working in regions where they are not fluent in the native language. Websites developed by the United States government and a joint effort from Microsoft Corp. and Emory University are more focused on providing patients with information, and may help individuals determine if their symptoms indicate possible H1N1 virus infection and warrant a doctor visit. Outbreaks Near Me, a mobile application for the iPhone developed by researchers at the Children’s Hospital of Boston, provides real time tracking of the spread of H1N1 infection. IntuApps application Swine Flu Tracker provides similar information as well as maps and “threat level” indicators.

Both mobile applications and web-based tools provide a chance to share information and knowledge across borders and ensure that quality medical care is delivered worldwide. New innovations continue to flood the marketplace, and it remains to be seen what the next improvement in healthcare technology will bring.

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