Part Two. The urgent need for action
Chapter Two. Chronic diseases and poverty
Gender inequality. Spotlight: Blindness in women
Social inequality, poverty and inequitable access to resources, including health care, result in a high burden of chronic diseases among women worldwide, particularly very poor women.
In general, women tend to live longer with chronic disease than men, though they are often in poor health. The costs associated with health care, including user fees, are a barrier to women's use of services. Women's income is lower than that of men, and they have less control over household resources. They may not be able to pay for treatment unless there is agreement from senior members (whether male or female) of the household. Women's workload in the home and their caregiving roles when other family members are ill are also significant factors in delaying decisions to seek treatment. In areas where women have limited mobility, they may be unable to travel to health centres.
Spotlight: Blindness in women
In low and middle income countries, the leading causes of blindness – cataract and trachomatous trichiasis – occur more frequently in women. Population-based surveys of blindness in Africa, Asia and many high income countries suggest that women account for 65% of all blind people worldwide. At the same time, women do not have equal access to surgery for eye diseases. Cataract blindness could be reduced by about 13% if women received cataract surgery at the same rate as men. Women are more likely to wait until they are blind to undergo surgery. The decision to delay treatment is often influenced by the cost of the surgery, inability to travel to a surgical facility, differences in the perceived value of surgery (cataract is often viewed as an inevitable consequence of ageing and women are less likely to experience support within the family to seek care), and lack of access to health information.
Spotlight: Affordability of medicines in the Russian Federation
In 1994, the main obstacle to obtaining medicines in the Russian Federation was unavailability, for both rural and urban populations. Almost 75% of people who could not obtain medicines reported unavailability as the main reason, and only 20–25% could not afford them. However, since then the situation has changed dramatically: availability of medicines has significantly improved but they have become far less affordable. By 2000, 65–70% of people who could not obtain medicines reported unaffordability as the main reason, while unavailability accounted for only 20% of the access gap.