Setting health priorities should be a science. A lot rests on it. If you start with the wrong priorities, you not only miss your goals – which means a lot of lives are lost – but you also waste scarce resources in the process. Resources that could have been spent preventing even more deaths. Data should speak loudest when determining health priorities – louder than dollars, louder than politics, and louder than legacy investments. So what does the data tell us when it comes to setting priorities for women’s health?
The Global Burden of Disease (GBD), a data base that just keeps getting better and better, tells us that 25 million women and girls are dying each year. About 3 million are girls under 15, 3 million are women under 50, and 19 million are women over 50. What is killing these girls and women? Among girls under 15, it is still the big communicable diseases – pneumonia, malaria, and diarrhea – and several newborn causes, mainly preterm birth, birth trauma, and sepsis. In fact almost half of all deaths among girls are now concentrated in the first month of life. But the good news is that these deaths are declining. Deaths among girls have halved since 1990.
Infections also remain major drivers of death among women under 50, principally HIV-AIDs, TB, and diarrhea, but it is non-communicable diseases (NCDs) that claim the most lives, especially cancers (breast, cervical, and lung), cardiovascular diseases (heart disease, stroke), and chronic kidney disease. Deaths in pregnancy and childbirth are still killing too many young women and self-harm is the third leading cause of death. Unlike deaths among girls, deaths among women under 50 are not declining. Basically, the same number of women who died in 1990 are stilling dying now.
Among women aged between 50 and 69, five non-communicable diseases cause a massive burden of death, including heart disease, stroke, chronic obstructive pulmonary disease (COPD), diabetes, and breast cancer. For women over 70, Alzheimer’s and pneumonia replace breast cancer and diabetes as leading killers. In fact, Alzheimer’s is the third leading cause of death among women over 70 and is killing 1.4 million women every year. Deaths are rising sharply for older women, driven by aging populations and slow progress in arresting the impact of non-communicable diseases – much of it diet-related.
So where to prioritize? It really matters. There is no doubt that the halving of child deaths since 1990 is largely a result of the sustained focus on child survival over the period and the roll out of effective technologies especially vaccines, as well as improvements in levels of education, incomes, water, sanitation, and hygiene. In contrast, the major global efforts to control HIV-AIDS among women and end maternal mortality have a long way to go, and there has been very little attention paid to cardiovascular diseases, cancers, chronic respiratory and kidney diseases, diabetes, and mental health among women.
If we could start over, what would a global priority list for women’s health look like? Following the GBD, #1 on the list would be a massive new effort to reduce NCD deaths among women under 70 by one-third, prioritizing heart disease, stroke, COPD, diabetes, and chronic kidney disease. #2 would be doubling down on existing efforts to end deaths among women and children from the “big 5” infectious diseases – HIV-AIDS, TB, pneumonia, diarrhea, and malaria. #3 would focus on ending preventable maternal and newborn deaths, and #4 would be reducing cancer deaths among women under 70 by one-third, especially breast, cervical, and lung. #5 would target mental health, prioritizing a one-third reduction in suicide among women, and undertaking special to discover new prevention, diagnosis, and treatment technologies for Alzheimer’s disease (Table 1).