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The Global NCD Epidemic: Shifting the Definition of Women’s Health and Development

Written by Ann Keeling - CEO of International Diabetes Federation (IDF).

theGlobalNCDEpidemicIn 2011 an epidemic of non-communicable disease spread fast among women, surrounded by myths and misconceptions that hinder both prevention and treatment. Today non-communicable diseases (NCDs) namely diabetes, cancer, cardiovascular disease, and chronic respiratory disease are the leading cause of death in women globally, killing a staggering 18 million women each year.1

No longer diseases of the rich and elderly, NCDs are increasingly affecting women in developing countries during their reproductive and productive years.

Diabetes alone is affecting 181 million women worldwide today.2 As the age of onset of diabetes has shifted down a generation in many developing countries, more women of reproductive age have diabetes and more pregnancies are complicated by diabetes. Today 92 million women of reproductive age have type 2 diabetes, and gestational diabetes (GDM), a type of diabetes that starts or is first recognised during pregnancy, affects up to 15% of pregnant women worldwide.3

For women, the risk and impact of these diseases such as diabetes is profound and goes beyond their own health. Not only does the low socio-economic, legal and political status of girls and women in many low- and middle-income countries increase their exposure and vulnerability to the risk factors of NCDs–namely unhealthy diets, physical inactivity, tobacco use, and harmful use of alcohol. But a compelling body of evidence now indicates that the health of women before and during pregnancy can determine the risk of their infant developing an NCD such as diabetes and cardiovascular disease later in life.4

The global NCD epidemic is financially debilitating for individuals and families and is tearing the very fabric of society. Husbands are losing wives and children are losing mothers. Families across the world incur debt and destitution when mothers become disabled by NCDs and struggle to pay for treatment.5 Every case is a personal tragedy and collectively the high cost of NCDs in terms of healthcare and lost productivity threatens to undermine gains made in other areas of development and health.

Indeed, diabetes and NCDs are one of the major health and development paradoxes of our time. These diseases, which are the biggest killer worldwide and risk the stability of societies by imposing a huge economic, social and political burden on women, their families, communities, and countries remain marginalised on the global health and development agenda and vastly under-resourced. The Millennium Development Goals set in 2000 failed to include these diseases and it is this agenda that has since driven the policy and funding priorities of multilateral and bilateral agencies. Not only has this led to distorted health financing–with less than 3% of the $22 billion Official Development Assistance for health being spent on these four diseases that cause 60% of the global burden of disease6 but this blinkered approach has also undermined the achievement of these noble and ambitious goals and stalled progress on women's health.

Neglect of diabetes is directly impacting progress in improving maternal health. Uncontrolled or undiagnosed diabetes in pregnancy is associated with the delivery of macrosomic or large-for-gestational-age (LGA) infants, which can result in life threatening and costly complications for the mother, such as obstructed labour, as well as the newborn child. Similarly, GDM is a key cause of maternal morbidity and mortality. It makes no sense to invest in unconnected vertical health initiatives that will save a woman from dying from infection during labor, only to have her die from diabetes-related obstructed labor. Preventing and treating diabetes and GDM is essential for women's rights and health equity. The same can be said about progress on infectious diseases, as diabetes exacerbates TB,people with diabetes are 2.5 times more likely to develop TB, and the links between certain cancers and HIV/AIDS are well established.7

The direct omission of diabetes and NCDs from the global development agenda is hindering progress on women's health. But equally, the specific focus of women's health in the MDGs is questionable. The MDG's focus on reproductive and maternal health was for good reason. With 350,000 women dying each year from preventable complications related to pregnancy and childbirth, there was a clear need for accelerated action to improve maternal health.8 But demographic trends and a changing global disease burden highlight the need for a more comprehensive approach to women's health, going beyond the reproductive and maternal realm. While a narrow definition of women's health and a focus on reproductive health may still be appropriate today in the world's least developed countries, with low life expectancies, high infant mortality, and high rates of infectious diseases, this does not serve the needs of women in less developed countries. Increasing life expectancy coupled with decreasing fertility, as well as urbanisation and sedentary lifestyles in these countries is changing mortality patterns for women requiring an urgent shift in the definition of women's health to include diabetes and NCDs, and the factors and events that cause these diseases across the life course.

The global health landscape has changed, and the priorities and processes driving health and development urgently need to be realigned to reflect this. With just four years until the end date of the MDGs and a potential rewrite of the global agenda, world leaders and policy makers are finally grasping this. The most marked example is the UN High-Level Summit on NCDs, held on 19-20 September 2011. For the first time since the historic UN General Assembly Session on HIV/AIDS in 2001, the UN dedicated two days exclusively to a health issue and unanimously adopted the Political Declaration on the Prevention and Control of NCDs.9 This Declaration includes a set of commitments that firmly position diabetes and NCDs as a global development issue and advocates for integrated programmes across infectious, maternal and newborn child health and NCDs and health system strengthening at the primary care level. It is a major milestone in the journey to elevate diabetes and NCDs onto the global agenda, and a major step forward in creating a paradigm shift in global health that moves from fragmentation to integration; and from disease to health.

As a pioneer in women and diabetes, a leader in the women and NCDs movement, and one of the earliest voices calling for a UN Summit on NCDs, the International Diabetes Federation is working to ensure the next global health and development agenda post-2015 is realigned with the reality on the ground and has integration at its core. Only then will we begin to see real change for global health and the millions of women, girls, men and boys we serve.

References

1 World Health Organization (2005) Preventing Chronic Disease: A Vital Investment, WHO Global Report Geneva.

2 International Diabetes Federation (2011) Diabetes Atlas. 5th Edition. Brussels.

3 International Diabetes Federation (2011), Policy Briefing – Diabetes in Pregnancy: Protecting Maternal Health, Brussels.

4 International Diabetes Federation (2011), Policy Briefing – Early Origins of Diabetes, Brussels.

5 NCD Alliance (2011), Non-Communicable Diseases: A Priority for Women’s Health and Development, Brussels.

6 Nugent R A, Feigl A B (2010), Where have all the Donors Gone? Scarce Donor Funding for Non-Communicable Diseases, CGD Working Paper 228, Centre for Global Development, Washington D.C.

7 International Diabetes Federation (2011) Diabetes Atlas. 5th Edition. Brussels.

8 United Nations Inter-Agency Group on Child Morality Estimation (2010), Levels and Trends in Child Mortality: Report 2010, New York.

9 A/66/L.1, United Nations (2011), Political Declaration of the High-Level Meeting of the General Assembly on the Prevention and Control of NCDs.

GHD Winter 2014 Digital Edition

GHD Contributors - Winter 2013

David B. Agus, MD, Shamsia Anwari, F.E. Baralle, MD, PhD, Dr. Seth Berkley, Vittorio Cammarota, The Honourable Gunilla Carlsson, Francis Collins, MD, PhD, Dr. Suraya Dalil, Ambassador Mark Dybul, Dr. Thomas Evans, The Right Honourable Stephen Harper, Karl Hofmann, His Excellency Jakaya Kikwete, Gregory T. Lucier, Partha P. Majumder, PhD, Dr. Carole Presern, Scott C, Ratzan MD,MPA, Dr. David Reddy, Janet Hatcher Roberts, Professor Jeffrey D. Sachs, Dr. Sima Samar, His Excellency Dr. Jorge Sampaio, Dr. Ataulhaq Sanaie, Dr. Khaled Seddiq, Dr. Richard Sezibera, Dr. Ahmed Shadoul, Jill Sheffield, Michel Sidibé, Prabhjot Singh, Her Excellency Ellen Johnson Sirleaf, Kari Stoever, H.E Jakaya Kikwete, Hervé Verhoosel, Princess Sarah Zeid