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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A Killer in the Developing World

HIV/AIDS and malaria are major health concerns worldwide, however the World Health Organization (WHO) reports across much of Asia and Africa secretory diarrhea - which accounts for 1.6 million deaths annually - is an even greater threat. Each day in India, diarrhea-related diseases kill 1,250 people, only slightly fewer than the H1N1 virus has killed globally to date (1,500), according to the WHO. Caused by E.coli, cholera, and other bacteria, viruses, or parasites, diarrhea affects individuals more often in areas that lack safe water and appropriate sanitation. In individuals with secretory diarrhea, infectious agents cause too much water to enter the bowel and be evacuated from the body, leading to excessive dehydration and eventually death if appropriate treatment is not received.

In nations of the developing world, including Bangladesh, India, Mali, and Pakistan, aid organizations and government agencies have begun distributing zinc supplements to villagers as a treatment for diarrhea. Data from recent studies documented in the August 2009 issue of the Journal of Leukocyte Biology suggest that zinc may help to activate the T-cells needed to destroy viruses and bacteria, including those that cause diarrhea. Time Magazine reports that in tablet or liquid form, zinc can be used in combination with oral-rehydration therapy (ORT). While it is not entirely clear how zinc helps halt diarrhea, Oliver Fontaine, a diarrhea specialist for the WHO, explains that a single course of zinc treatment can stave off diarrhea for three months.

Unlike zinc, which often produces an immediate improvement in an individual’s health, the glucose present in ORT (a solution of sugars and salts) slows the evacuation of fluids allowing for the absorption of electrolytes in the intestines, and halting the progression of dehydration to a chronic state. Because of the delay in the improvement of symptoms with ORT, “Mothers don’t see ORT as real treatment,” according to Eric Swedberg, senior director of health and nutrition at Save the Children U.S. Though ORT is an effective treatment for diarrhea, only about 35 percent of families in diarrhea-stricken countries utilize the method.

By offering zinc in combination with ORT, government-run programs in Ethiopia and Tanzania hope to increase the number of people surviving diarrheal outbreaks. Additionally, efforts are being made in Mali to add zinc to the country’s list of essential drugs, a step towards improving the distribution of the tablets. To halt the recent outbreaks of diarrhea in Nepal that have led to 235 deaths to date, the Office of the Prime Minister has begun coordinating efforts to construct a toilet in each household, provide sources of potable water, and improve waste disposal systems. In addition, the Nepali government has mobilized 298 personnel to aid in providing treatment in the area through 89 health camps.

To support these and other similar efforts, funding for the provision of the potentially life-saving drugs, and awareness of their effectiveness must be increased. In 2007, only four percent of all U.S. funding for research of epidemics in the developing world was devoted to finding solutions to decreasing the number of diarrhea-related deaths. Support from organizations like the Bill and Melinda Gates Foundation have provided some support, but additional funding is still needed not only to ensure that zinc tablets are more widely distributed, but also to assist in efforts to improve the quality of available water and waste treatment measures.

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WHO on Water Treatment and Safe Storage - On Diarrhea and Tuberculosis in India - Time Magazine on Zinc to Treat Diarrhea - Diarrheal Deaths in Nepal - On Zinc Fighting Infection

Using Telemedicine to Treat Chronic Disease

Chronic diseases pose a threat worldwide, particularly in the developing world. Heart disease, cancer, diabetes, and other chronic diseases account for over half of all deaths each year - double the number of deaths caused by infectious diseases, maternal and perinatal conditions, and nutritional deficiencies combined. Developing nations are facing an epidemic of non-communicable chronic diseases as risk factors such as obesity, lack of physical activity, and tobacco use continue to increase. Contrary to the popularly held belief that infectious diseases are the leading cause of death in the developing world, 80 percent of chronic disease deaths occur in low and middle income countries.

International attention and funding has primarily focused on communicable disease, and as a result the healthcare systems of developing nations are not well equipped to manage chronic conditions. For example, the World Health Organization spends only 50 cents per person on chronic disease (excluding mental health) per year, compared with $7.50 for the major infectious diseases. Regular doctor visits are necessary for proper treatment and management of chronic diseases, but most low- and middle-income countries have not developed the necessary infrastructure or network of specialty physicians to provide this type of care.

Telemedicine and teleconsultation programs offer a cost-effective solution to this problem. Through initiatives like iConsult, healthcare providers in remote or medically underserved areas can consult with specialty physicians over the Internet to gain access to their clinical expertise. By utilizing iConsult, an Endrocrinologist in New York City or Cardiologist in Portland would be able to offer assistance to a provider in a clinic in Chad, and ensure that a patient with diabetes or high blood pressure receives the highest quality of care.

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Reports indicate a nutritious diet, physical activity, avoiding alcohol and tobacco use, and regular medical exams help decrease the risk of developing a chronic disease.

CDC Report on Chronic Disease - WHO Report on Chronic Disease - Report from SciDev Net

See also:
Nugent, R. (2008). Chronic diseases: a growing problem in developing countries. DiabetesVoice, 53, 17-20.