Embracing the broad definition of Women’s Health

Although women’s health has a lot of focus worldwide, but the real definition of women’s health is still not clear or precise to many people. This has led to incorrect collection of data, screening, treatment, diagnosis, and information. 

The increased emphasis on women’s research has opened our eyes in seeing that women are affected by many more diseases apart from reproductive health.
According to McKinsey, women’s health should be re-defined based on the disease profile and broken down into four (4) components. [1]

1- General conditions: 
• Non-communicable diseases like Hypertension, Diabetes mellitus, hypercholesteremia, cardiovascular disease, stroke, and COPD
• Alzheimer’s disease, autoimmune disease, aches and pains, migraine. osteoporosis, fatigue, and obesity. 
• Mental health like anxiety, depression, and substance abuse,
• Violence against women and children.
• Infectious disease: HIV, Covid, and malaria.

2- Reproductive health: 
• Contraception, Adolescent issues like teenage pregnancies, menopausal symptoms, and genital mutilation.
• Fertility issues and maternal health (perinatal, prenatal, and post-natal problems) including breast feeding.

3- Gynaecological problems:
• Gynaecological infections: Human papilloma virus: (HPV), bacterial vaginosis, sexually transmitted infections (STI).
• Other Gynaecological conditions: Fibroids and endometriosis, pelvic floor issues, menstruation, and sexual health.
 
4-Oncology: Breast cancer, Ovarian cancer, endometrial and cervical cancer.
Non-communicable disease has become a leading cause of death amongst women especially in the low- and middle-income countries (LMIC) and this evidence is worrisome.[2]

One in five women might die of a stroke when compared to men and stroke has become the 3rd leading cause of death in women [3]. 

United Nations Sustainable Development Goals (SDG 3.1) is to reduce the global Maternal Mortality Ratio (MMR) to less than 70 maternal deaths per 100,000 live births by 2030. We understand from this paper that preventable causes of death related to pregnancy and childbirth has taken about approximately 800 women daily especially in the low- and middle-income countries. How can we make a change to this information?[4] 
Breast and cervical cancers are leading causes of death in women followed by ovarian cancer due to late diagnosis. Approximately 685 000 women died Breast cancer in 2020 globally and 1 in 3 females are diagnosed with breast cancer every year [5]. According to Tania Dahesh, there is an increased chance of developing breast cancer in an obese post-menopausal woman especially in African, Asian, European, and North American women [6]. 

World Health Organisation (WHO) advocates for cervical cancer elimination by 2030 [7]. HPV vaccination has been implemented in many low- and middle-income countries as a national program. 
There is an increase rate of obesity amongst women with the change in eating habits; eating processed and low-cost food have resulted in consequent effects on women’s health [8].

World Health Organization (WHO) advocates that the life of the women and children should be improved by 2030 [9]. Can we achieve this target by 2030?

As WONCA’s working party on women and Family Medicine (WWPWFM) doctors, are we able to define women’s health and the target population?

Can we focus on following people: women health workers, women patients, female adolescence, and children when we consult in our daily practice? 

It is important to emphasise the need to looking after one’s own self:

1) How up to date are you with your screening if you are 40 and above? (Annual blood tests, Blood pressure (BP), Haemoglobin (HB), Thyroid function test (TSH), and Bood sugar checks, mammogram, Pap Smear tests etc)
2) Do you ensure your diet is healthy?
3) Do you take regular supplements?
4) Do you take “me time”, go for exercise, travel, or have hobbies etc? 
5) If diagnosed with a disease, do you consult a doctor regularly and take medications as prescribed?
6) Do we practice what we preach to the patients?

The above information will assist you to highlight the need to look after the female patients and to get the following information.

1) Do we know the target population that needs screening, diagnosis, and treatment? 
2) Do we focus on women’s health during our daily practice?
3) Do we use the consultation time as an opportunity to educate women and give health promotion advice? 
4) Is there any evidence of data collection that we can use to improve the quality of life of women?
5) Is there mechanism to analysis and disseminate this information?
6) How can Wonca assist and support you in this regard?

Women are the wealth of the society, and we need to treat them with love, respect, and care. Care includes screening, early diagnosis, and treatment, educating women on their conditions and how to prevent the disease.
We need to improve our access to health by increasing community health workers within the society to optimise the care to women in a holistic approach. 

WWPWFM’s focus on these issues will improve the physical, emotional, and mental wellbeing of women. We encourage female doctors to dedicate sometime to women’s health for the betterment of the society.

I take this opportunity to thank all the doctors especially women, who have put immense time and work on improving the health of other women. Let’s celebrate being a woman.

References:

1- Closing the data gaps in women’s health, April 2023. https://www.mckinsey.com/industries/life-sciences/our-insights/closing-the-data-gaps-in-womens-health (last accessed 10th Aug 2023).

2- Women's health: a new global agenda Sanne A E Peters, Mark Woodward, Vivekanand Jha , Stephen Kennedy5, Robyn Norton http://dx.doi.org/10.1136/bmjgh-2016-000080.


3- Women and Stroke https://www.stroke.org/en/about-stroke/stroke-risk-factors/women-have-a-higher-risk-of-stroke.

4- Trends in maternal mortality 2000 to 2020: estimates by WHO, UNICEF, UNFPA, World Bank Group and UNDESA/Population Division [EN/AR/RU/ZH] WHO: Trends in maternal mortality 2000 to 2020: estimates by WHO, UNICEF, UNFPA, World Bank Group and UNDESA/Population Division. Feb. 2023

5- https://www.who.int/health-topics/cancer#tab=tab_1Cancer (who.int).

6- Dahesh T et al. BMC Women’s Health (2023) 23:392. https://doi.org/10.1186/s12905-023-02543-5.

7- Cancer of the cervix uteri: 2021 update. https://doi.org/10.1002/ijgo.13865.

8- How does globalisation affect women health? Lancet. Vol 6 January 2018. Http://dx.doi.org/10.1016/ S2214-109X (17)30456-4. 

9- The Global Strategy for Women’s, Children’s and Adolescents’ Health (2016-2030) https://www.who.int/publications/i/item/A71-19). 

Authors: Dr Elizabeth Reji
      Dr Hina Jawaid