At the crossroads: transforming health systems to address women’s health across the life course

Bull World Health Organ 2013;91:622 | doi: http://dx.doi.org/10.2471/BLT.13.128439 Editorials 622 In 2010, the World Health Organization (WHO) published a report titled Women and health: today’s evidence, tomorrow’s agenda. The report summarized the evi- dence surrounding the health-related is- sues affecting girls and women through- out their life course1 and signalled the need for innovative strategies and new health service delivery models. Since then, other global initiatives, including the Women Deliver 2013 conference, the United Nations Commission on Information and Accountability for Women’s and Children’s Health, Family Planning 2020 and the call of the Global Fund to Fight AIDS, Tuberculosis and Malaria in support of child and maternal health, have kept the world focused on women’s health issues, particularly ma- ternal mortality and universal access to reproductive health. Yet these initiatives do not address all the health problems that women are facing in the 21st cen- tury as a result of the epidemiological and demographic transitions. According to the Global Burden of Disease Study 2010, the years of life lost (YLLs) on ac- count of conditions addressed under the Millenium Development Goals (MDGs) declined by 2.0% per year between 1990 and 2010, but those attributable to con- ditions not targeted under the MDGs increased by 0.8% per year. If these trends continue, by 2015 more than two thirds of all YLLs will be caused by conditions not included in the MDG framework.2 Noncommunicable diseases (NCDs) already represent 54% of the world’s burden of disability-adjusted life years; injuries represent an additional 11%.3 This is one reason that WHO, together with key global partners, conceived this theme issue on women’s health beyond reproduction. Our intention is to under- score the changing nature of the health problems confronting women and to highlight policies and strategies that low- and middle-income countries can implement.4 A life course approach to women’s health makes sense because many of the health problems faced by adult women have their roots in early life. Interventions that promote good nutri- tion during pregnancy, optimize early child development and facilitate access to health information, especially during adolescence, can lay the foundations for a healthy life in later years. Changing exposures across the life course, particu- larly in terms of harmful tobacco and alcohol use, unhealthy dietary habits and poor physical activity, pay impor- tant health dividends in the long term. This continuum can best be pro- moted by building on existing repro- ductive and maternal health services “diagonally” – i.e. by expanding the role of health workers, strengthening their skills and reorienting services towards the prevention and early detection and management of NCDs and their risk factors.5 For example, women with ges- tational diabetes have a significantly el- evated risk of developing type 2 diabetes in later life, and antenatal care provides an opportunity to intervene early to try to prevent the subsequent onset of diabetes in this group. The life-course approach to wom- en’s health involves several health system challenges. We need to better understand the epidemiological char- acteristics of diseases affecting adult women and the overlapping effects of gender inequalities and advancing age on women’s health. Data are still not regularly disaggregated by sex when collected or reported and age disaggre- gation is seldom done beyond 50 years of age. Particular attention should be paid to the consequences of harmful gender norms and roles and to the effects of stigma and social isolation among older people on patterns of disease, illness and mortality. The development of an evidence- based policy framework on the health of women across the life course is a formidable task for which WHO and its partners are seeking to bring together policy-makers and public health experts from around the world. The life-course approach to women’s health has three innovative aspects. First, it marks the convergence of three complementary domains: maternal and reproductive health, ageing and noncommunicable diseases. Second, it involves the develop- ment, piloting and testing of new health- care delivery systems featuring diagonal approaches and private–public part- nerships. Third, it is driven by policy- makers engaged in applying knowledge translation methods that encourage the use of research and evidence in policy development and planning. This theme issue of the Bulletin and other initia- tives, such as the Lancet Commission on Women’s Health, are intended to stimu- late interest in women’s health beyond reproduction and to encourage joint, decisive action on the part of multiple stakeholders in promoting a life-course approach to women’s health. ■ References 1. Women and health: today’s evidence, tomorrow’s agenda. Geneva: World Health Organization; 2009. 2. Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012;380:2095–128. 3. Murray CJL, Vos T, Lozano R, Naghavi M, Flaxman AD, Michaud C et al. Disability- adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012;380:2197–223. 4. Bustreo F, Knaul FM, Bhadelia A, Beard J, Araujo de Carvalho I. Women’s health beyond reproduction: meeting the challenges. Bull World Health Organ 2012;90:478–478A. 5. Sepúlveda J, Bustreo F, Tapia R, Rivera J, Lozano R, Oláiz G et al. Improvement of child survival in Mexico: the diagonal approach. Lancet 2006;368:2017–27. At the crossroads: transforming health systems to address women’s health across the life course Flavia Bustreo,a Oleg Chestnov,a Felicia Marie Knaul,b Islene Araujo de Carvalho,a Mario Merialdi,a Marleen Temmermana & John R Bearda a World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland. b Harvard Global Equity Initiative, Harvard Medical School, Boston, United States of America. Correspondence to Islene Araujo de Carvalho (e-mail: araujodecarvalho@who.int). E itorials