Non-communicable diseases or NCDs are the world’s number one killer, causing 60% of all deaths globally or nearly 35 million deaths every year.
Non-communicable diseases (NCDs), also sometimes commonly referred to as chronic diseases, include cardiovascular disease (heart disease, hypertension and stroke), diabetes, lung diseases, cancer, and mental illnesses.
Previously thought of as diseases of the rich and elderly; 80% of NCD-related deaths now occur in low- and middle-income countries, and half of those who die of non-communicable diseases are young and in the prime of their productive, working years.
Collectively, NCDs are the leading cause of death for women worldwide causing 65% of all female deaths. Various WHO (World Health Organization) reports point out that chronic diseases such as heart disease, diabetes, and strokes are affecting women in much greater numbers.
Globally, cardiovascular disease, often thought to be a “male” problem – or the disease of middle-aged, stressed out men – is the number one killer of women. Breast cancer is the leading cancer killer among women aged 20–59 years worldwide.
NCDs are a significant cause of female death during childbearing years as well; and are now increasingly affecting women in developing countries in their most productive years; and women with young families.
Women are excellent care-givers for other members of the family; but rarely take care of themselves. Speak with women themselves (in fact speak today with any woman you know) and you will find that most of them perceive that (except breast cancer) these non-communicable diseases are the domain of men. Even in the case of breast cancer, talk to five women around you and assess how many of them have recently undergone any screening for it.
Women seem to have a mis-perception of what diseases affect them and do not seem to take the appropriate health actions. Although, go to any hospital or doctor’s clinic and you will find that the person accompanying the sick person is a woman.
What is the burden of NCDs among women and what is it about women that make them neglect their own health?
In order to find out more about this problem, The Essayist recently interviewed Dr. Nalini Saligram: The founder of a non-profit called Arogya-World (http://arogyaworld.org/) which works in the area of advocacy and prevention of non-communicable disease globally.
Nalini Saligram recently presented her m-Diabetes program to the Clinton Global Initiative meeting (http://www.arogyaworld.org/our-work-in-india/mdiabetes/). The m-Diabetes program has reached a million people with diabetes prevention, treatment and lifestyle change messages in partnership with companies such as Nokia and Emory University in addition to others. She has a doctorate in biochemistry, extensive experience in public relations and marketing for pharmaceutical companies and is now working exclusively in the area of public health. Nalini has been actively involved in advocacy efforts with United Nations (UN) for making the world a healthier place for women.
Nalini is currently based in Chicago. The Essayist met her in Bangalore on one of her visits to review and monitor the m-Diabetes program.
NS = Nalini Saligram; TE = The Essayist
TE: Thank you for speaking with The Essayist. Tell us something about your work in the area of health?
NS: Our focus in recent years has been on creating advocacy and prevention of non-communicable diseases, especially for protecting women. As a team, we initiated the Women for a Healthy Future movement to mobilize women around the world to demand action for better health. This initiative is aligned in spirit with Ban Ki-moon’s “Every Woman, Every Child initiative,” which has the objective of improving the health of hundreds of millions of women and children around the world.
(Team members: Arogya World, Global Health Council, NCD Child, Women Deliver, NCD Action, Public Health Institute, The Max Foundation, Disruptive Women in Health Care, Hriday, NCD Alliance, World YWCA, Beyond Sport)
It is sad that we still have to fight for a very basic human right of good health for women and children. Despite so many commitments and calls to action to improve the health of the world’s women such as the Beijing Platform for Action, Convention on the Elimination of All Forms of Discrimination against Women (CEDAW), and many other regional and national commitments, the truth is that the health of women globally is still under threat. It is not just deaths due to the risks associated with pregnancy or childbirth but due to non-communicable diseases.
Unfortunately this has happened on our watch. Therefore, we must do something about it. This is our responsibility.
In the month of September 2011, many world leaders gathered at the United Nations (UN) for a historic summit on NCDs. (See: http://www.hrc.govt.nz/news-and-media/news/un-summit-discusses-death-toll-non-communicable-disease and http://www.unmultimedia.org/radio/english/2011/09/non-communicable-diseases-a-slow-motion-disaster-who/)
The decisions they make impact the lives of millions and determine whether women and children have healthy todays and healthy futures. We signed and submitted a petition to them to show these leaders how much we care.
We asked governments to invest in educating women about the importance of having normal birth weight babies because low birth weight could predispose the baby to cardiovascular disease and diabetes later in life. We asked businesses, as important stakeholders in the NCD dialogue, to dramatically reduce the marketing of tobacco products, junk foods and alcohol to children and young people.
But just asking policy-makers and leaders to address NCDs in women is not enough. We can all do something about NCDs. We all know at least one woman in our lives. We can take responsibility for that one woman in our lives – mother, daughter, sister, neighbour, colleague, friend, aunt, cousin. We can inform her and educate her about the risk of NCD to her life. We can help her make the necessary changes in behaviour and lifestyle.
We can make this woman feel that her health is important and also educate her family.
UN Secretary General Ban Ki-moon has said, “Success will come when we focus our attention and resources on people, not their illnesses; on health, not disease.” We believe that if we focus our attention on women and children–as people, as valuable contributors to society, as future leaders of the world–success will come indeed.
TE: Why the focus on non-communicable diseases?
NS: Non-communicable diseases or NCDs are also sometimes referred as chronic diseases include cardiovascular disease, diabetes, lung disease, cancer, and one cannot forget – mental illnesses. We differentiate non-communicable diseases from what was very common before – the communicable diseases. Most people used to die of infections. However, as the developed nations improved their water quality, sanitation and hygiene, communicable diseases or infections were better controlled. Furthermore, better antibiotics were developed that helped to further control mortality from infections. And slowly non-communicable diseases or NCDs came into the spotlight as major causes of diseases. NCDs are a major cause of disease, disability, death and household medical expenses globally. These chronic diseases drive many families into debt.
Most factors that cause NCDs or the risk factors of NCDs are preventable in most cases.
TE: Why non-communicable disease and women?
NS: Though all people the world over are susceptible to the threat of these diseases, it is important to know that they impact girls and women differently. Non-communicable diseases (NCDs) have both a direct and indirect effect on women’s health and lives.
The direct impact of NCDs on women’s health
Many of us have seen the statistics that every two (2) minutes a woman dies from complications of pregnancy and childbirth. In fact maternal and child health is often the focus of most women’s health programs.
However, not many of us know that NCDs are the Number 1 killer of women worldwide.
Every single day, 50,000 women lose their lives to NCDs (including cancer, diabetes, cardiovascular disease and chronic respiratory illness). More than 1,000 women die from cardiovascular disease, one of the four main NCDs, every hour.
Women comprise 60% of the world’s poor, and poverty worsens chances of survival from NCDs.
Women are uniquely affected by NCDs. When it comes to coronary heart disease, smoking is 25% more dangerous for women. Research published in The Lancet (Aug 2011) shows that for women, especially pregnant women, the harmful effects of smoking are even higher than for men.
The unnecessary suffering that women undergo is unacceptable in the 21st century. Women’s everyday lives are putting them at risk of these NCDs.
TE: You said women’s everyday lives put them at risk. Can you please explain that further?
NS: Take the example of cooking. Did you know that cooking kills a lot of women? Most women around the world (especially the poor) cook almost every day. This very basic everyday act can be extremely hazardous to women’s (and their child’s) health.
Three billion people — nearly half the world’s people — eat meals every day that are cooked over unclean stoves. And 1.9 million — mostly women and children in developing countries — die each year because of that. Globally, pneumonia is the single most significant cause of under-five childhood mortality. Exposure to cooking smoke doubles a child’s risk for pneumonia, leading to more than 900,000 deaths in young children under five.
In high-income countries, tobacco smoke is the biggest risk factor for Chronic Obstructive Pulmonary Disease (COPD), a chronic lung disease. But in lower- and middle-income countries it is indoor air pollution from the use of solid fuels for cooking and heating. As many as 3 million people die from COPD every year, and a huge portion, 1.8 million, are from India and the surrounding South East Asia region. In India, in some regions, COPD is the number one cause of death, higher even than heart disease.
In many parts of the world, women spend three to seven hours a day preparing food, often in front of an open fire and they do this indoor in closed, dingy, small, cramped spaces. Harsh economic realities force them to rely on cheaper fuels like firewood, coal and even dried cow dung. Their babies are sometimes strapped to their backs or are sitting or sleeping nearby. Young children in such cases spend many hours breathing the indoor smoke from cooking during the first year of life.
Dr. Sundeep Salvi, from Chest Research Foundation in Pune, India, showed that in a study comparing the health outcomes for women using solid fuels for cooking in villages in India and Thailand, 11.9 percent of the women in India got COPD as compared to 1.5 percent of the women in Thailand. During his talk, Dr. Salvi, commenting on the lower COPD rates in Thailand, remarked that though the data were unpublished, they had observed that women in Thailand cooked in homes on average with one more window than did the women in India.
The Global Alliance for Clean Cook Stoves (http://www.cleancookstoves.org/) a public-private partnership led by the UN Foundation is tackling this problem head-on and is committed to provide clean cook-stoves to 100 million homes by 2020.
How about a “One More Window Campaign? Can we create a public health campaign such that women in rural areas can cook in homes with one more window in the kitchen area? Can we make serious efforts to provide them with that one more window in their home? Of course it is an imperfect solution, and does replace indoor air pollution with outdoor air pollution, but may just help to reduce the burden of NCDs faster.
TE: Using terms and acronyms such as NCD’s – does that not make it difficult for people to understand the problem?
NS: What about AIDS? That was just an acronym a couple of decades ago. However, now most people know what the term “AIDS” stands for and many are taking steps to prevent it. Countries have instituted national programs solely to control and prevent AIDS. The same has to be done with NCDs. We have to make it a commonly used term. NCDs responsible collectively for 2/3 of all deaths worldwide are one of the greatest health and development challenges of this century. Countries have to create special divisions and agencies to control and prevent NCDs.
TE: You mentioned the indirect impact of NCD on women?
NS: Yes, women are indirectly connected to NCD too. Women are also the caregivers in most households across the world. The increasing burden of NCD in the world also implies that women’s work as caregivers is impacted.
NCDs impact women as caregivers
Women and girls play a critical role in caregiving. Around the world, we have seen that when someone at home falls sick and needs extensive care (as is usually the case with chronic NCDs); it is the women who stay home to provide care. These women fall behind in school, miss work, or are forced to accept lower paying jobs because they need the flexibility to provide home care for a sick family member. Even if a woman doesn’t suffer personally from an NCD, she is often drastically affected if anyone in the family has a NCD.
Women are so focused on caring for others they often fail to take care of themselves.
TE: Most women’s health programs focus on maternal health, pregnancies? What about NCDs and maternal health?
NS: NCDs are an integral part of maternal and child health. There is increasing evidence that a child who has low weight at birth (also called low birth weight) often ends up with diabetes and heart disease later on in life. So governments and donor agencies can make an important investment in educating women about having healthy pregnancies and avoiding low birth weight babies. This will not only save women’s lives during childbirth but also help set their children up for a healthy future, with less risk for chronic disease.
Since low birth weight predisposes a baby to get diabetes and cardiovascular disease later in life, it is imperative that we educate pregnant women about good nutrition during pregnancy. In fact, some researchers believe the key to the entire NCD crisis lies in ensuring good health for adolescent girls, before they become pregnant, so that they can have safe and healthy pregnancies and give birth to healthy babies of normal birth weight.
TE: Won’t educating women about NCDs help address the problem and reduce the burden of NCDs around the world?
NS: The world has too much to lose when we allow women to die from almost entirely preventable causes. However, often education campaigns focus on creating awareness, giving out messages and expect the individual to follow up with the appropriate change in behaviours.
It is also important for all of us to be aware that messages may not be enough; women are disadvantaged with respect to practising prevention.
While 80% of cardiovascular disease and diabetes and 40% of cancer are preventable through stopping tobacco use, increasing physical activity and improving diet, often these prevention efforts are not accessible to women. When women make up 2/3 of illiterate adults, they are at a great disadvantage to even learn about prevention.
Moreover, social and cultural taboos sometimes restrict a woman’s engagement in physical activity, because sport is considered ‘unfeminine.’ We believe that access to sports and physical exercise is not only a right in itself, but also a catalyst for development, leading to the empowerment of women and girls. In fact, there is some lack of awareness of women’s health risks even among researchers and policy-makers. Most people (including the above figure) attribute lung disease only to tobacco; they do not connect the risk of indoor air pollution from cooking as a risk factor for respiratory disease in women.
Therefore, addressing social norms and cultural beliefs as well as creating women-friendly policies are a must. We have to educate women and also everyone around them.
However, I also see women as a crucial part of the solution to this crisis.
TE: So what do you see as the best handle or lever for addressing NCDs?
NS: The solution to curbing NCDs and maternal mortality ultimately rests in improving women’s access to strong and capable health systems. We know that in too many countries, women get the least access to healthcare. Governments and policy makers must address women’s health needs through integrated approaches that include reducing maternal mortality, improving access to family planning, tackling infectious diseases, and addressing NCDs.
Health systems must be equipped to prevent, diagnose and treat through an integrated approach, particularly given that NCDs increasingly threaten the same women that have been the targets of reproductive health and maternal health efforts over the past decades. We need health systems to keep pace with all women’s health needs, from childhood through old age.
Countries must also get serious about NCDs and maternal mortality. Governments can only truly understand the magnitude of the problem when they have sufficient and reliable data on how women in their country prepare for pregnancy and childbirth and deal with traditional women’s health issues and also with emerging women’s health issues like NCDs. Women count, and their lives must be counted.
TE: What do you think will MOVE governments and families to take action?
NS: The fact that NCDs impact the next generation.
While women are rightly concerned about the health of other women, they are fiercely concerned about the health and futures of their children. Children have a right to health. They deserve a dynamic future full of hope and happiness, a future where they can live their dreams and become productive world citizens. Aggressive marketing of tobacco products, junk foods and sugary drinks, and alcohol to children and young people is threatening that future. When the future of our children is at stake, women must take action.
This is another reason why it is smart to educate women about their health and reducing NCDs: They will ensure that the next generation is cared for. Empowered women will ask world leaders to reduce the marketing of calorie-dense junk foods, tobacco and alcohol to children and adolescents. They will demand that tobacco products are taxed and sugary soft drinks banned in schools. They will make healthier nutrition choices during their pregnancies and afterward. The status quo is not OK. The future of our children — and that of the children of the future — is at stake.
The origin of chronic disease lies in the habits of daily life – the food we eat, and how active we are – our levels of physical activity. Women (especially mothers) are actually the best solution for the problem of chronic disease because they can easily impact the food families eat and also get children into physical activity. However, there are some problems: women are often not the decision-makers and the husband’s tastes decide what gets cooked in the house. Nowadays with massive advertising spends of large companies directed at children and the peer pressure that children face in schools, the family buying-decisions are often run at the whims of children.
As gatekeepers of the food families eat and the physical activities they engage in, women deserve an important seat at the table.
In the spirit of UN Secretary-General Ban Ki-moon’s “Every Woman, Every Child” initiative, which aims to save the lives of 16 million women and children by 2015, we have already asked for a focus on women as countries build NCD action plans. We must seize this unprecedented global movement to improve policy and services on the ground for the most vulnerable women and children.
… Because when you take care of women, women take care of the whole world.
© The Essayist. October, 2013.
Data – NCDs
- World Economic Forum and Harvard School of Public Health Document (2011). http://www3.weforum.org/docs/WEF_Harvard_HE_GlobalEconomicBurdenNonCommunicableDiseases_2011.pdf
- World Health Organization (2005). Preventing Chronic Disease: A Vital Investment: WHO Global Report Geneva
- World Health Organization (2008). Global Burden of Disease 2004 Update Geneva
- WHO Website (Sep 2013). http://www.who.int/mediacentre/factsheets/fs334/en/
- UN Summit discusses NCDs:
Op-eds by Nalini Saligram
- Image 1: NCD definition. From: http://www.indushealthplus.com/ncds-non-communicable-diseases/
- Image 2: Global status report (NCD) http://www.who.int/cancer/en/
- Image 3: Nalini pic: http://unitednationsyak.com/?p=1288
- Image 4: NCD Logo (UN): http://www.unmultimedia.org/radio/english/2011/09/non-communicable-diseases-a-slow-motion-disaster-who/
- Image 5: NCDs and risk factors: http://emanthi-news.blogspot.in/2011/02/health-minister-to-appoint-special.html
- Image 6: Nalini speaks at a meeting - http://www.flickr.com/photos/79240988@N06/7259137562/
- Image 7: 4 Diseases – 4 Risk Factors at http://www.who.int/ncdnet/about/4diseases/en/