Recommendations towards an integrated, life-course approach to women’s health in the post-2015 agenda

Abstract

Noncommunicable diseases and women's health Noncommunicable diseases (NCDs) --primarily cancer, cardiovascular disease, diabetes and chronic respiratory diseases--represent a major health, social, and economic burden that affects women globally, yet their impact on women in low- and middle-income countries (LMICs) has not been fully recognized. (1) NCDs cause premature death and disability among women of all socioeconomic strata worldwide. This burden is expected to increase substantially in the coming decades, especially in LMICs, because of a combination of factors, primarily the ageing of the population, improvements in maternal health in LMICs and a projected increase in smoking, obesity and other risk factors for NCDs among women. (2) Discussions surrounding the post-2015 development agenda provide an important and timely opportunity to realign policies and resources in trying to meet the complex and shifting health problems faced by women globally. The focus of the realignment should be on ensuring that health systems have the capacity to equitably provide health services to women throughout their lifecourse and on maximizing collective efforts to meet women's health needs in all settings, even the poorest. Achieving this will require strengthening the control of NCDs and integrating it into women's health frameworks and platforms, allocating resources optimally and promoting the development of health systems that serve the needs of women throughout all stages of life. (3) NCDs, communicable diseases and maternal conditions are interrelated in complex ways. One can lead to the other. For example, hormonal changes during pregnancy can induce the appearance of diabetes and hypertension. A pregnant woman who has diabetes, hypertension or infection with the human immunodeficiency virus (HIV) as an underlying condition is at greater risk of suffering complications during pregnancy and delivery than a woman who has none of these conditions. (4) Because of these interrelations, the limited availability and accessibility of NCD prevention and control services makes it even harder to make headway in addressing established global health priorities. Opportunities to prevent and treat NCDs and reduce their financial and social burden on women abound, but most of the time they are missed. NCDs develop over years; it takes frequent contact with the health system to detect them at an early stage. In many settings, maternal and reproductive health services are the only potential points of contact for the secondary prevention of NCDs. Health systems are ill-equipped to keep pace with changing patterns of disease and the need for an expanded range of health services for women of all ages. Many women who have some type of NCD also have HIV infection or a pregnancy-related health problem. Integration of NCD prevention and control efforts within existing health services is becoming increasingly necessary to bolster future progress in women's health and socioeconomic well-being and to safeguard the progress made so far in attaining the goals and targets set in the area of women's health and development. As a post-2015 framework that will sustain such progress develops, we must work towards capturing international attention and mobilizing resources to address current disease trends and the wide-ranging health needs of women in LMICs. These efforts should build upon existing health platforms and expand services to meet the health needs of women of all ages (e.g. human papillomavirus (HPV) vaccine programmes for adolescents and NCD screening for women of post-childbearing age). The poverty and gender divide Many of the women being targeted for interventions in the areas of sexual and reproductive health, maternal health and HIV-related problems are the ones who are affected by health inequities that increase their risk of getting and dying from NCDs. Women in all settings, regardless of resources, get NCDs; however, poor women, especially those who live in LMICs, are the least likely to have access to affordable diagnosis, management and treatment services. …