Intro
In health, more than in other social sectors, sex (biological) and gender (behavioral and social) variables are acknowledged useful parameters for research and action because biological differences between the sexes determine male-specific and female-specific diseases and because behavioral differences between the genders assign a critical role to women in relation to family health. Until recently, however, the importance of sex and gender informed work on female-specific diseases but did not carry over to diseases shared by men and women. As a result, the literature contained comparatively little about which diseases affect men and women differently, why that difference might be the case, and how to structure prevention and treatment in response to these differences. This situation has changed, however, and interest in measuring, understanding, and responding to sex and gender differentials in disease has surged, nurtured by breakthroughs in science and advances in advocacy.1
In line with this interest and using global burden-of-disease data for 2001, this chapter reviews worldwide gender differentials in mortality and morbidity that result in excess disease burdens for women and examines cost-effective interventions drawn from chapters 17 (on sexually transmitted infections), 26 (on maternal and perinatal conditions), 29 (on health service interventions for cancer control in developing countries), 31 (on mental disorders), 32 (on neurological disorders), 51 (on musculoskeletal disability and rehabilitation), and 57 (on contraception) to address them.
The focus on women's excess disease burden is justified to fill gaps in knowledge regarding women's health that are in part a product of male bias and male norms in clinical studies. In the past, medical research often wrongly assumed that women were biologically weaker (male bias) and extrapolated findings from trials with male subjects only (male norm) to both sexes, whereas female biology can affect the onset and progression of disease, and women's lower position in society can affect their health-seeking behaviors (Pinn 2003; Sen, George, and Ostlin 2002).
As A. K. Sen (1990) and others have indicated, gender bias results in the neglect of female children and in selective abortion and excess female mortality in China, India, and other South Asian countries, explaining the "missing" women in population counts. In addition, such bias can have intergenerational health effects, starting with maternal undernutrition and leading to fetal growth retardation, low birthweight, child undernutrition, and ailments in adult children of disadvantaged mothers (Osmania and Sen 2003).
This chapter only partially addresses women's health needs. It omits important disease conditions for women, such as lung cancer and HIV/AIDS, where men and women currently have similar disease burdens. (In the case of HIV/AIDS this balance is changing, and women's disease burden is rising over men's, especially for the 18-25 age group and for specific world regions.) It also does not cover important sources of the disease burden for women that are not measured in disability-adjusted life years (DALYs), such as burden from female genital mutilation (FGM). Last, the emphasis on disease underplays women's reproductive and other health needs.
