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(12/22/02 11:07 pm)
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Women's health in the new millennium - Is FMD here?
Women's health in the new millennium
By Elisabeth Anne Aron, M.D.
As we enter the new millennium, it is only natural to reflect on the changes that have occurred in our world. One part of that world is the state of women's health. The changes are a reflection of who we are as a society and where our society is headed.
What have we accomplished over the past 100 years?
Speaking from personal experience, there have been many recent changes in women's health care that have greatly affected my daily routine and how I practice medicine. These include the availability of hormone replacement therapy; less invasive surgery like laparoscopy, hysteroscopy, and uterine embolization; better birth control; changes in breast cancer diagnosis and treatment; and advances in infertility treatment. Most of these therapies have been driven by the fact that women are living longer and have demanded a better quality of life. The fact that women have taken a more active role in their health care is a reflection of their place in our society.
Women have a totally different attitude and approach toward health care than they had 100 years ago. Women of today are more health conscious, informed, and questioning. They use newspapers, magazines, and the Internet to obtain information about their health. They know to demand certain tests, get second opinions, and ask a lot of questions. They are active participants in their health care and have worked to create a new type of relationship with their health care providers. No longer are physicians all-knowing, but instead have become part of a patient-doctor team.
If we step back and look at the bigger picture over the past 100 years, developed nations have seen a decrease in child mortality, an increase in life expectancy, a decrease in infectious disease related rates, and an increase in non-infectious disease related rates. This has been due to improved sanitation, antibiotics, immunizations, and increased health care spending with better medical services. Today, the most common health concerns in women of developed countries are cardiovascular disease, lung disease, lung cancer, colorectal cancer, breast cancer, diabetes, HIV/AIDS, and depression.
Unfortunately, many of the positive changes have yet to occur in the developing world. According to Claudia Morrissey, MD, MPH, Advisor for International Women's Health, the most common health concerns in developing nations include pneumonia, diarrhea, tuberculosis, malaria, measles, HIV/AIDS, and cervical cancer. More than 99% of maternal deaths occur in the developing world and are due to sepsis, hemorrhage, obstructed labor, eclampsia, and abortion complications. It is a sad fact that most of these health problems could be eliminated, as they have been in the United States. This is a reflection of the gender and economic inequalities that exist in these nations.
The major health challenges facing women in the new millennium
The good news of increased life expectancy comes with new problems of living longer. Cardiovascular disease, osteoporosis, colorectal cancer, and Alzheimer's disease are more commonly seen now that women can expect to live longer. I think that one of the major health challenges for women in the new millennium will be to deal with these new problems. This can be accomplished by taking hormone replacement therapy, getting early screening for cancers (e.g., breast, colorectal), exercising, maintaining good nutrition, and recognizing and treating Depression. We must also reevaluate how we view and treat the elderly. Long-term care is becoming a necessity for a greater number of the population and we must come up with a kinder system.
Given the disparity between developing and developed nations, we must work to improve the status and health of women in developing nations. Preventative/public health has gone a long way in this country to reduce disease and increase our life spans. Immunizations, safe sex, birth control, and prenatal care need to be available to people of these nations. In order for this to happen, issues of gender inequality must also be addressed. The World Health Organization is recommending programs to help women of developing nations. These programs include delaying marriage and first births, improving access to maternal health services, and addressing unwanted pregnancy and abortion.
Tobacco use is one of the major causes of lung disease and cancer. Margaretha Haglund, President of the International Network of Women Against Tobacco and Chairman of the Tobacco Control Programme of the National Institute of Public Health in Stockholm, says that tobacco use is one of the greatest threats facing women around the globe today. Many of these women will die prematurely secondary to tobacco-related causes. Tobacco companies have been aggressively targeting young girls and women in developing nations. Thus, it is predicted that Lung cancer will become the number one cause of death in women. We need to inform and educate women and girls around the world of this danger.
What remains to be done?
We should continue to support science education and encourage basic research so that new discoveries and treatments can become available. Current research involving gene therapy may provide a future cure for cardiovascular disease and cancer. New vaccinations to protect people against HIV may become available.
We should continue to work toward gender equality. Education and self-help programs are necessary to help communities to provide better economic social equality for women.
Health care costs must be controlled so that medical services and preventive health care will continue to be available to all people regardless of their income.
Finally, one of our major challenges will be to develop the skills to deal with all the new bio-ethical questions that have arisen and will arise from the available technology. Science has advanced faster than our ability to answer all the new questions that it creates. Questions about euthanasia and abortion, how old is too old to have a baby, and ownership of a fetus need to be addressed. We must continue to think about these issues so that the available technology can be used wisely and in the service of humanity.
Happy New Year!
For more information about health around the world, check out these interesting sites:
The Center for Communications, Health and the Environment (CECHE) at www.ceche.org/
The World Health Organization (WHO) at www.who.org/
© 1999, Elisabeth Anne Aron, M.D.
All rights reserved
Editor's note: Dr. Elisabeth Anne Aron, an editorial board member of The Medical Reporter, is a board certified obstetrician/gynecologist and medical writer residing in Fort Collins, Colo. She earned her M.D. at Albert Einstein College of Medicine, Bronx, N.Y., and completed her residency training at St. Luke's/Roosevelt Hospital Center, New York, N.Y. She is open to writing assignments and may be contacted by phone at (970) 377-3106 or by e-mail at: Elisaaron@aol.com
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