Knowing the answer to this question could save your life
by Professor Robyn Norton, Principal Director, The George Institute for Global Health
What is the single biggest killer of women globally?
The correct answer, cardiovascular disease (notably ischaemic heart disease and stroke), might surprise you, as it has historically been associated with older men, despite causing 1 in 3 women’s deaths a year. Cardiovascular disease claims the lives of 8.6 million women a year from all backgrounds and in all contexts, but those most at risk are women living in low-resource and remote settings, who experience disproportionately poor outcomes.
The title of this blog aims to pique your interest, we admit, but we believe attention is worth grabbing when greater awareness and evidence-informed policy and practice could improve – and save – lives.
Historically, women’s health has been narrowly defined in terms of women’s sexual and reproductive health, which enjoys a major share of the global annual spend on women’s health. Evidence suggests that many women and health providers are not aware of the significance of chronic conditions such as heart disease, or of differences in the way women and men are vulnerable to, and treated for it.
For instance, we know that while more men are diagnosed with cardiovascular diseases, similar numbers of women die from these diseases each year. We also know that female smokers have a 25% greater risk of ischaemic heart disease than men, while women with diabetes have a 27% higher risk of stroke.
At The George Institute for Global Health, we have dedicated research looking specifically at sex- and gender differences in risk factors, treatment patterns and outcomes for ‘non-communicable diseases’ such as heart disease and stroke.
Our findings show that even in the US, a high-resource setting, women who have experienced heart attacks are less likely than men to receive the high-intensity statins recommended to prevent further heart attacks and strokes. While more research is needed to uncover the reasons, lead researcher Dr Sanne Peters notes that they may include concerns that these treatments carry a greater risk of side effects in women, or a perception among healthcare providers that women are less likely to experience another heart attack.
Of specific concern is evidence that women who have diabetes, hypertension and anaemia during pregnancy have a heightened risk of future cardiovascular disease. This highlights both a critical need - to identify women at risk, and manage their healthcare in order to reduce premature deaths - and an opportunity: to integrate prevention and treatment of conditions such as heart disease and stroke into reproductive, maternal, child and adolescent health services.
The George Institute is developing an innovative solution to address this issue - SMARTHealth Pregnancy - which aims to improve women’s heart health in low- and middle-income countries, by integrating screening for risk factors into care during pregnancy. Using smartphone-based technology, we are developing a ‘mobile clinical support system’ which will help community healthcare workers in rural India identify and manage the care of women at high risk of heart disease, both during and after pregnancy.
Integrating the prevention and treatment of chronic diseases into reproductive, maternal, child and adolescent health services in this way is likely to be both effective and cost-effective, particularly for conditions that affect girls and women across the course of their lives, and must be part of the drive to expand the women’s health agenda going forward.
In light of the sex and gender differences our studies have uncovered, we are calling for data collected from both men and women to be analysed separately in future. Such analyses are essential if we are to understand and take into account any identified differences in planning future prevention and treatment strategies.
Together with our fellow members of the Taskforce on Women and Non-Communicable Diseases, we will be taking these messages to a High-Level Meeting called by the UN on 27 September to discuss what urgent measures governments around the world must put in place to tackle these chronic conditions, which between them account for a staggering 7 out of 10 deaths worldwide.
We’ll be calling for campaigns to drive a better understanding among women and health service providers of the risk factors for heart disease and other chronic conditions in women. We want to see recognition that non-communicable diseases impose a particular burden on women’s health, and that priority should be given to closing unacceptable health disparities between women and men.
Two days later, on 29th September, World Heart Day will provide a timely reminder of the enormous burden of heart disease and stroke on women worldwide, and how much work there is to be done to combat these conditions. Understanding what represents the single biggest threat to women’s health globally is just the beginning. Join us on Twitter @RobynNorton8 @georgeinstitute and @GeorgeInstUK with #TGIimpact.