MedicalResearch.com Interview with:
Professor Robyn Norton
Principal Director of The George Institute for Global Health
Board Member, The George Institute for Global Health
Professor of Public Health at the University of Sydney
Professor of Global Health at the University of Oxford
Medical Research: What is the background for this study? What are the main findings?
Prof. Norton: The impetus to focus on women’s health, stems from the knowledge that, while noncommunicable diseases (NCDs) are the leading cause of death and disability for women worldwide, this is not sufficiently recognized nor sufficiently resourced. Equally, while there is increasing evidence that we can learn so much more about how to address the burden of disease for women, by collecting and analyzing data on women, separately to that for men, this is not happening.
We are calling for a refocus of the women’s health agenda on NCDs – given that globally and in many countries the focus of women’s health almost exclusively is still on women’s sexual and reproductive health. The fact is that in all but the poorest countries, the greatest health burden, for women, is noncommunicable diseases and so that if we are to make significant gains in improving women’s health then we must focus on addressing NCDs. The current global burden of disease for women reflects both the significant gains that have been made as a result of addressing maternal mortality and changes that have affected both women and men equally – namely, that populations are living longer, as a consequence of reductions in both infant mortality and communicable diseases, as well as the fact that populations are becoming wealthier and, as a result, are engaging in behaviors that increase the risk of noncommunicable diseases.
Medical Research: What should clinicians and patients take away from your report?
Prof. Norton: An important takeaway for stakeholders is the need for a gendered approach to healthcare overall, and in medical research specifically. We now know that there are differences for women and men in disease occurrence and outcomes. We are also beginning to understand that health systems respond differently to women and men such that both access to care and the quality of care differs. Yet, far too commonly, there is no examination of sex differences or gender disparities in health data, and women are underrepresented in many scientific and clinical studies. For many years it was assumed that data and studies involving only men would be equally relevant for women. Consequently, in some cases, the clinical definition of disease symptoms are based exclusively on characteristics of those reported in men. This can lead to warning signs in women being ignored, unrecognized or misdiagnosed because they fall outside of the defined parameters for symptoms – parameters that were defined for men. Because of the assumption that men and women would respond consistently, sex-specific findings and outcomes have not been regularly reported. Understanding those differences will help us deliver treatment and prevention options that take those differences into account.
Medical Research: What recommendations do you have for future research as a result of this study?
Prof. Norton: We have called on health administrators and the scientific and academic communities to ensure a gendered approach to the analysis of health data – to identify sex differences and the biological explanation for these differences, as well as gender disparities and the sociocultural factors, including health system responses, which might account for these disparities.
Further, the international community must do more than pay lip service to noncommunicable diseases – they can no longer describe them as an “emerging” problem and an issue of relevance only to high-income countries. We are calling for the UN and other UN agencies such as the WHO to take the lead in ensuring that resources are put into reducing the burden of NCDs in women. Already those agencies recognize the importance of NCDs in women but the resources aren’t following and they do need to follow.
Medical Research: Is there anything else you would like to add?
Prof. Norton: Access to safe, effective and affordable healthcare is still one of the greatest challenges for the majority of the world’s population – both women and men. In high-income countries, healthcare costs have increased dramatically and need to be reduced without compromising the quality of care. In low and middle-income countries, GDP expenditure on healthcare is still low, demand for good healthcare is increasing, both primary and tertiary healthcare systems are not designed to manage individuals with chronic conditions and the healthcare workforce is suboptimal. So improvements in healthcare for women (and men) will require innovative thinking about how we best deliver healthcare. Harnessing new technologies – especially mobile technologies – and training non-physician health care workers to fill the workforce gaps, as well as the identification of other low cost, but effective solutions must be key priorities. However, as we develop such solutions, it will be imperative that we take a gendered approach to innovation, to ensure that solutions recognize sex differences and that they reduce rather than increase gender disparities.
Prof. Robyn Norton (2016). Group Urges Focus on Non-Communicable Diseases in Women