U.N. Election Raises Questions about Women's Health

(WOMENSENEWS)–Today or tomorrow, ballots will be cast at the World Health Organization and agency director-general Dr. Gro Harlem Brundtland will officially step away from a long and illustrious political life. During her tenure as the first woman director-general of WHO, the United Nations agency responsible for improving the world’s health, Brundtland re-established the organization’s credibility and direction by coordinating health initiatives between developing and industrial countries.Alleviating poverty through improvements in people’s health has been the organization’s focus.

How and whether that focus–one that acknowledged that the disproportionate burden of poverty is shouldered by women–will change under new leadership is the subject of concern of women’s health advocates.

“I do not believe that gender and women’s health issues can be addressed in isolation from the current challenges of global health and poverty,” Brundtland said in an e-mail interview. “It is a stark reality that 70 percent of the world’s 1.2 billion poorest people are women. We cannot advance women’s standing in society without improving their health. In other words, tackling global poverty means tackling women’s issues–starting with women’s health.”

Think of Noura, an Egyptian girl who at 12 years old quit school to work in a rice field, says Dr. Shelley Ross, president of the Medical Women’s International Association. Noura, who was interviewed by the association, married at 16, and soon became pregnant. Her husband’s family couldn’t afford a midwife, and because chronic schistosomiasis infection left her anemic and small, she had a premature delivery and postpartum hemorrhaging. Her family couldn’t afford a blood transfusion, and she returned home weak yet needing to work.

The Norwegian-born Brundtland is a medical doctor and has addressed difficulties like Noura’s through the Making Pregnancy Safer initiative, the goal of which is to reduce by three quarters the maternal mortality ratio by 2015. Brundtland’s political activism began in Norway’s ministry of health. She was named minister of environment in 1974 and is renowned for her seminal work on sustainable economic development. Brundtland went on to become the youngest and first female prime minister of Norway, an office she held for three terms.

Brundtland has spent nearly 40 years in public service and steps down from her position after a successful five-year term to tend to the personal rather than the political. Brundtland put women’s health on the global agenda, maintaining that it must be a priority not only for “medical, nursing, and midwifery schools, but for research and funding bodies, industry, government and political leaders.”

Brundtland’s combination of public health vision and political savvy would serve an incoming director-general well. The candidate must work closely with developing countries and wealthy donors to implement effective health programs, especially in poor countries where need is great but resources are often slim, and shuttled elsewhere.

Brundtland Views Women’s Health Within a Broader Context

“Brundtland brought a whole new kind of energy and vitality to WHO, and that has implications for women’s health,” says Carol Bellamy, executive director of UNICEF, adding that international health workers must redouble their efforts to address grave and persistent maternal mortality. “The other key area is expanding prevention of mother-to-child HIV transmission to extending the life of the mother. Vulnerability, exploitation and violence against women are giving AIDS a female face,” she says.

Workplace exploitation in factories or environmental risks such as the use of smoky, asthma-inducing cooking materials are two social determinants that may greatly impact women’s health, says Michelle Hindin, a sociologist at Johns Hopkins University in Baltimore. Important areas for both policy and research include “women’s mental health, which is not well studied in the developing world and domestic violence, which has been the focus of increasing research. Service provision for women in both these areas is really lacking,” she says.

WHO’s budget includes staffing but only limited program funds, and therefore must rely on local partnerships and non-governmental organizations to reach those in need. The new director-general must ensure that practitioners have the latest research and technology to do the work local health care providers can do best when given the tools–ministering to their communities.

“Brundtland has been extremely brave on tobacco control,” says a U.S. professional who held a senior position in the UN for many years. She addressed the high-risk group of adolescent girls, this official added, an issue that a “number of industrialized countries, including the U.S., have avoided because it’s not in their economic export interests.”

However, this official believes that Brundtland could have done more for women. “I hoped Brundtland would have cut political caution and made more programmatic and clear women’s health strategies,” says this former UN official. “We need leadership that will talk courageously about women’s right to health and provide programmatic guidelines rather than saying the right thing politically.”

Pushing Women’s Health Initiatives Beyond Reproductive Health

The election provides an opportunity for advocates to call for fresh priority setting on gender and health.

Disaggregating data by gender will point the way to sex differences in health that need addressing, says Elaine Wolfson, president of the Global Alliance for Women’s Health. “I’d like to see women’s morbidity looked at as much as women’s mortality, because women suffer a disparity in heart disease, osteoarthritis, and autoimmune diseases, among others,” she says.

Dr. Shelley Ross, the president of Medical Women’s International Association, agrees that “women’s health can include diseases that are more prevalent or serious in women and that often women’s health suffers from narrowness of focus, meaning that it is equated with reproduction.” Health care for women should include social, emotional and cultural well-being along with biology, she says.

“Rates of HIV infection among women have surpassed rates of infection among men in sub-Saharan Africa,” says sociologist Hinden, “leaving women unable to support or care for themselves and creating an orphan problem that’s going to increase exponentially.”

Access to inexpensive drugs is key to controlling the impact of AIDS, but also to addressing other diseases neglected by the developed world, such as malaria and sleeping sickness.

Inside the organization, Brundtland’s goal was a workforce comprised equally of men and women, but such staff policies came towards the end of her tenure, and women are not equally represented among new recruits or in current leadership. WHO’s new leader must address these disparities, as well as shaky employee morale.

Short-listed candidates include Dr. Julio Frenk, Mexico’s secretary of health, Dr. Jong Wook Lee of the Republic of Korea and director of WHO’s Stop TB program, and Ismail Sallam, former minister of health and population from Egypt. Also in the running are Dr. Pascoal Manuel Mocumbi, Mozambique’s prime minister, a gynecologist who puts women’s health high on his agenda, and Dr. Peter Piot of Belgium, who acts as Under Secretary-General of the U.N. and leads WHO’s UNAIDS program.

Ross adds that a male director-general “must make a special effort to promote women’s health and to appoint women to key positions in the organization,” maintaining, “too much work has been done in promoting gender equality to allow the world’s most important health body not to have female influence.”

Kathleen Nelson is a freelance journalist based in New York City.