Rehema is a caregiver to nine grandchildren in Uganda. She is also living with both diabetes and hypertension.
Up to 75% of adults with diabetes also have hypertension. Rehema's dual diagnosis increases the complexity of day-to-day management of her diseases. While she has the support of a home-based caregiver provided through an outreach program she still has difficulty managing her conditions.
Rehema’s main challenge involves getting access to her medications. Even though she lives near the city of Entebbe, Rehema finds that the pharmacy of the government hospital — where the costs of her diabetes medications are covered — is sometimes sold out of her medications. When that happens, she has no choice but to travel to the military hospital and purchase the drugs herself. Both the transportation and medicine costs are a challenge on her modest budget.
Not having diabetes medication and treatment can lead to serious consequences. A few years ago, her sugar levels drastically destabilized and she began losing her eyesight. Only through emergency eye surgery does she still have her sight today.
When she doesn’t have care and treatment for her diabetes and hypertension, her grandchildren suffer as well. They attend school through Rehema’s support. Without her health, she would not be able to continue earning income for their school fees.
Rehema and her grandchildren are not alone.
This is why addressing gender barriers across the life course is so important. A woman’s health and well-being later in life reflect the sum of all her experiences and opportunities — including the ones she has been denied.
Leveling the playing field earlier in a woman’s life has exponential impacts across her lifetime. An education helps her earn a better income; reproductive health care enables her to plan for a family; and access to appropriate health services ensures she can be there for her family and participate in what matters to her. Preventing and treating NCDs across the life course will not only help her live longer, it will also improve her odds of having enough resources to manage multiple challenges later on.
Noncommunicable diseases such as cardiovascular diseases, cancer, chronic respiratory diseases, diabetes, and mental and neurological conditions, such as depression and dementia can lead to devastating, long-term economic consequences for older women and their families, particularly in resource-poor settings. More than 60% of patients with NCDs encounter catastrophic health expenses. Though women are at the heart of their families and communities, they are often not “seen” by health services once past reproductive age.
Women on average live longer than men and represent the majority of people over the age of 60. In 2015, women accounted for 54% of the global population aged 60 years or more and 61% of the global population aged 80 years or more. But there’s a hidden statistic here too — those extra years are quite often in poor health.
Older women face unique barriers to accessing primary health care, especially in low-income countries. Inequality on so many levels — unpaid care responsibilities, denial of education, discrimination, and poorer nutrition, accrues over a woman's life and is a significant determinant of health in older age. The cumulative impact of this inequality is the primary reason why access to health services is that much more difficult for women when they are older.
Older women such as Rehema are at risk of “multiple jeopardy” where social disadvantages — such as lower education levels, lack of secure income, lack of mobility, and widowhood — combine to exacerbate age-related disabilities and chronic conditions.
Currently, global health and development discussions remain largely focused on girls and women of reproductive age, even though older women will represent an increasingly larger proportion of the world population. If universal health coverage is to be meaningful in name and spirit, we need to focus on all ages and pair that with the need to transform health systems to a chronic care model, which is essential for aging populations with large NCD burdens.
As life expectancy increases, global populations are aging. This is the case not only in G-20 countries but in low- and middle-income countries as well. The population of people 60 and over in sub-Saharan Africa, for example, is projected to more than triple between 2015-2050 — 46 million in 2015 to 161 million in 2050.
And this global demographic shift is contributing to an epidemiological transition from infectious diseases such as tuberculosis and HIV/AIDS, to NCDs.
So where to now? How do we map out the response to the global NCD tsunami for older women?
We need to embrace, as the World Health Organization now officially does, all those life course interventions that can shape someone’s life-long health and well-being, creating healthier environments with multisectoral action plans covering better food choices, tobacco-free policies, physical activity, safer communities and workplaces, and inclusive health services. This reorienting of health systems to prevent and manage the rising burden of noncommunicable diseases would also include — the availability of essential NCD medicines at affordable costs.
Primary health care providers must be trained on how to detect early signs of aging-related declines in physical mobility and sensory functions such as seeing and hearing. Similarly, health care workers need guidance and training on how to recognize cognitive declines related and risk factors for Alzheimer’s or other forms of dementia. Most health care professionals lack guidance on how to detect and manage aging-related impairments.
Health insurance, a critical part of health care access, must offer coverage of care and services that maintain functional capacity. Further, insurance schemes must be designed to provide affordable, comprehensive coverage to all older people, including those outside of, or retired from, the formal sector.
Debate around UHC gives us the space to begin serious consideration of all these challenges. Challenges that must be met head-on if we are to be able to guarantee that a generation of women including Rehema and those to come after her have their health — and their dignity.