Siriorn Sindhu

Women and Health: the key for sustainable development

Executive summary Girls’ and women’s health is in transition and, although some aspects of it have improved substantially in the past few decades, there are still important unmet needs. Population ageing and transformations in the social determinants of health have increased the coexistence of disease burdens related to reproductive health, nutrition, and infections, and the emerging epidemic of chronic and non-communicable diseases (NCDs). Simultaneously, worldwide priorities in women’s health have themselves been changing from a narrow focus on maternal and child health to the broader framework of sexual and reproductive health and to the encompassing concept of women’s health, which is founded on a life-course approach. This expanded vision incorporates health challenges that aff ect women beyond their reproductive years and those that they share with men, but with manifestations and results that aff ect women disproportionally owing to biological, gender, and other social determinants. The complexity of the challenges faced by women throughout the life course needs an increased focus on health systems, which heavily rely on the many contributions of women to care as members of the health workforce, in which their numbers are rapidly increasing, and in their traditional roles as primary caregivers at home and in communities. Women and Health—the focus of this Commission—is a novel concept that refers to the multifaceted pathways through which women and health interact, moving beyond the traditional and exclusive focus on women’s health to address the roles of women as both users and providers of health care, and highlighting the potential for synergy between them. We envision a virtuous cycle that builds on the premise that women who are healthy throughout their lives experience gender equality and are enabled, empowered, and valued in their societies, including in their roles as caregivers, are well prepared to achieve their potential and make substantial contributions to their own health and wellbeing, to that of their families and communities, and, ultimately, to sustainable development. Such thinking needs an interdisciplinary, cross-sectoral perspective to identify women-centred solutions to the unique obstacles that girls and women face as both consumers and providers of health care. In this Commission, we analyse existing and original evidence about the complex relations between women and health. We examine the major economic, environ mental, social, political, demographic, and epide miological transitions happening worldwide, their implications on the health system, and their eff ects on women and health. The health status of girls and women is analysed using a life-course approach to show the breadth of women’s health beyond the reproductive role. We estimate the fi nancial value of the paid and unpaid health-care-related duties that women undertake in health systems and in their homes and communities, which are a hidden subsidy to health systems and societies. We conclude that gender-transformative policies are needed to enable women to integrate their social, biological, and occupational roles and function to their full capacity, and that healthy, valued, enabled, and empowered women will make substantial contributions to sustainable development (key messages). In view of these issues, we propose crucial actions for development partners, governments, civil society, advocates, academics, and professional associations that are needed to advance the women and health agenda (panel 1).

Women and Health: the key for sustainable development. The Lancet Commissions.

Executive summary Girls’ and women’s health is in transition and, although some aspects of it have improved substantially in the past few decades, there are still important unmet needs. Population ageing and transformations in the social determinants of health have increased the coexistence of disease burdens related to reproductive health, nutrition, and infections, and the emerging epidemic of chronic and non-communicable diseases (NCDs). Simultaneously, worldwide priorities in women’s health have themselves been changing from a narrow focus on maternal and child health to the broader framework of sexual and reproductive health and to the encompassing concept of women’s health, which is founded on a life-course approach. This expanded vision incorporates health challenges that aff ect women beyond their reproductive years and those that they share with men, but with manifestations and results that aff ect women disproportionally owing to biological, gender, and other social determinants. The complexity of the challenges faced by women throughout the life course needs an increased focus on health systems, which heavily rely on the many contributions of women to care as members of the health workforce, in which their numbers are rapidly increasing, and in their traditional roles as primary caregivers at home and in communities. Women and Health—the focus of this Commission—is a novel concept that refers to the multifaceted pathways through which women and health interact, moving beyond the traditional and exclusive focus on women’s health to address the roles of women as both users and providers of health care, and highlighting the potential for synergy between them. We envision a virtuous cycle that builds on the premise that women who are healthy throughout their lives experience gender equality and are enabled, empowered, and valued in their societies, including in their roles as caregivers, are well prepared to achieve their potential and make substantial contributions to their own health and wellbeing, to that of their families and communities, and, ultimately, to sustainable development. Such thinking needs an interdisciplinary, cross-sectoral perspective to identify women-centred solutions to the unique obstacles that girls and women face as both consumers and providers of health care. In this Commission, we analyse existing and original evidence about the complex relations between women and health. We examine the major economic, environ mental, social, political, demographic, and epide miological transitions happening worldwide, their implications on the health system, and their eff ects on women and health. The health status of girls and women is analysed using a life-course approach to show the breadth of women’s health beyond the reproductive role. We estimate the fi nancial value of the paid and unpaid health-care-related duties that women undertake in health systems and in their homes and communities, which are a hidden subsidy to health systems and societies. We conclude that gender-transformative policies are needed to enable women to integrate their social, biological, and occupational roles and function to their full capacity, and that healthy, valued, enabled, and empowered women will make substantial contributions to sustainable development (key messages). In view of these issues, we propose crucial actions for development partners, governments, civil society, advocates, academics, and professional associations that are needed to advance the women and health agenda (panel 1).

Trapped in Circle of Threats: Violence Against Sex Workers in Thailand

Most researchers studying sex work have focused on the risks of sexually transmitted diseases, predominantly HIV, for sex workers, their clients, and subsequent partners. Violence against these women often goes undocumented and unnoticed. Consequently, few researchers have addressed violence against sex workers, and these few have generated limited evidence about the nature of violence from the sex-worker perspective—especially the street sex worker perspective. In this study, we used qualitative methods to explore characteristics of violence against street sex workers and how violence influences personal and societal health risks. The participants were 28 female street sex workers. The data were collected through in-depth interviews with 23 women, one focus group with 5 women, and observations of these women in their working and social environment. The results revealed that violence against sex workers can be clustered into three categories, threat to their life and health, threat to control of work and financial security, and finally, threat to humanity. Because they are disadvantaged, and engage in illegal employment, theses women were trapped in a circle of threats. To reduce violence, sex work should be decriminalized along with strategies to decrease poverty and social inequality. A special agency needs to be established to protect the rights and safety of sex workers.

The Health of Women and Girls Determines the Health and Well-Being of Our Modern World: A White Paper From the International Council on Women's Health Issues

The International Council on Womens Health Issues (ICOWHI) is an international nonprofit association dedicated to the goal of promoting health, health care, and well-being of women and girls throughout the world through participation, empowerment, advocacy, education, and research. We are a multidisciplinary network of womens health providers, planners, and advocates from all over the globe. We constitute an international professional and lay network of those committed to improving women and girls health and quality of life. This document provides a description of our organization mission, vision, and commitment to improving the health and well-being of women and girls globally.

PREDICTORS OF INTENTION TO USE HIV TESTING SERVICE AMONG SEXUALLY EXPERIENCED YOUTH IN THAILAND

This study examined the predictors of intention to use HIV counseling and testing (HCT) services among those who had never used HCT services in a sample of 2,536 Thai youth in Bangkok (ages 15-24). Web-based questionnaires included assessments of HIV knowledge, HIV testing attitude, AIDS stigma, and youth-friendly HCT (YFHCT) service expectation. More than 80% of the sexually experienced youth had never used HCT services but among this group 74.06% reported having intentions to do so. The significant predictors consisted of favorable expectations of YFHCT services (p < .001), positive attitude toward HIV testing (p < .005), perceived high risk for HIV infection (p < .01), having multiple sex partners while also using condoms consistently (p < .01), willingness to pay (p < .001), and being informed about HCT and knowing service locations (p < .001). Policy makers, as well as health promotion program developers and researchers can use these findings to increase intention and use of HCT services among at-risk youth.

The Early Outcomes of Nurse Case Management in Patients with Acute Ischemic Stroke Treated with Intravenous Recombinant Tissue Plasminogen Activator: A Prospective Randomized Controlled Trial

Background Intravenous recombinant tissue plasminogen activator (i.v. rt-PA) is the milestone treatment for patients with acute ischemic stroke. Stroke Fast Track (SFT) facilitates time reduction, guarantees safety, and promotes good clinical outcomes in i.v. rt-PA treatment. Nursing case management is a healthcare service providing clinical benefits in many specific diseases. The knowledge about the efficacy of a nurse case management for Stroke Fast Track is limited. We aim to study the effect of nurse case management on clinical outcomes in patients with acute ischemic stroke involving intravenous recombinant tissue plasminogen activator (i.v. rt-PA) treatment. Methods Seventy-six patients with acute ischemic stroke who received i.v. rt-PA treatment under Stroke Fast Track protocol of Thammasat University Hospital were randomized into two groups. One group was assigned to get standard care (control) while another group was assigned to get standard care under a nurse case management. The National Institute of Health Stroke Scale (NIHSS) at 24 hours after treatment between the control and the experimental groups was evaluated. Results Time from triage to treatment in the experimental group was significantly faster than in the control group (mean = 39.02 and 59.37 minutes, respectively; p=.001). The NIHSS at 24 hours after treatment in the nurse case management group was significantly improved as compared to the control group (p=.001). No symptomatic intracranial hemorrhage (sICH) was detected at 24 hours after onset in both groups. Conclusion The nurse case management should provide some benefits in the acute stroke system. Although the early benefit is demonstrated in our study, further studies are needed to ensure the long-term benefit and confirm its profit in patients with acute ischemic stroke.