International Women’s Day on March 8 caused me to reflect on the impact of non-communicable diseases (NCDs) on the lives of women in the United States.
Four principal NCDs – cardiovascular disease, cancer, diabetes, and chronic lung disease are largely caused by four shared and modifiable risk factors: tobacco use, harmful use of alcohol, poor diet, and physical inactivity. These modifiable risk factors pose serious and sometimes unique challenges for women and girls.
NCDs as a cause of death among females in the United States
According to the Centers for Disease Control and Prevention’s (CDC) latest statistics (2011), cardiovascular disease (heart disease and stroke) is the leading cause of death of females in the United States, resulting in 29% of all deaths. Nearly 22% of females die from cancer, 6 % from chronic lower respiratory diseases, and 2.8% from diabetes.
Smoking
In the United States today, 15.3% of adult women (nearly 20 million) and more than one in seven high school girls (1.3 million) smoke cigarettes. Each year, over 200,000 US women die from diseases caused by smoking.
Although the risks for female smokers were previously thought to be lower than for male smokers, one of the 10 major conclusions of the US Surgeon General’s 2014 report was that “[t]he disease risks from smoking by women have risen sharply over the last 50 years and are now equal to those for men for lung cancer, chronic obstructive pulmonary disease, and cardiovascular diseases.” According to the Campaign for Tobacco Free Kids, increased risks for women smokers are largely due to a convergence in smoking patterns among men and women.
Alcohol
Among women aged 18-44 years, about half consume alcohol, and 15% binge drink. Binge drinking, according to the National Institute on Alcohol Abuse and Alcoholism, is consumption that leads to a blood alcohol concentration of 0.08% or more (about 4 or more drinks within 2 hours for women).
According to the CDC, women are more vulnerable than men to long-term health effects of alcohol consumption. This is due to gender differences in chemistry and body structure, which cause women to absorb more alcohol and take longer to remove it from their bodies. This means that health effects occur faster and last longer.
Negative health effects of alcohol consumption include increased risk of cancer of the liver, colon, mouth, throat, and breast. According to the CDC, studies show that women who consume excessive amounts of alcohol are at increased risk for damage to the heart muscle and increased risk of alcohol-related liver diseases than men who consume comparable amounts.
Diet, physical inactivity, and obesity
The recently released Scientific Report of the 2015 Dietary Guidelines Advisory Committee states that 117 million US adults – approximately half of the US adult population – have one or more preventable chronic diseases associated with poor dietary patterns and a lack of physical activity. Poor diet and physical inactivity lead to weight gain and obesity, and are also associated with cardiovascular disease, type 2 diabetes, and some types of cancer, including post-menopausal breast, endometrial, colon, kidney, and mouth cancer. Obesity, while a serious health concern in its own right, also markedly increases the risk of heart disease, cancer, and diabetes. 
According to the 2015 report, the majority of the US population has low intakes of key food groups including fruit and vegetables, whole grains, and dairy, and high intakes of sodium, added sugars, solid fats, and refined grains.
In addition to these poor dietary patterns, we are not living physically active lifestyles. In 2011, only 20.6% of US adults (23.4% of men and 17.9% of women) met the aerobic and muscle-strengthening recommendations set out in the Physical Activity Guidelines for Americans.
Poor diet, physical inactivity, over weight, and obesity are serious health concerns for all Americans – men, women, and children. In 2011-2012, 34.9% of US adults were obese. Overall prevalence of obesity is similar among men and women, however, the CDC reports that among non-Hispanic black adults, 37.1% of men were obese, compared with 56.6 % of women.
Females and NCD across the life-course
Traditionally, we have thought of cardiovascular disease, cancer, diabetes, and chronic lung disease as diseases that afflict older people. But we know that NCD-related behaviors – smoking, harmful use of alcohol, poor diet, and physical inactivity – are common among young people. Health effects of NCDs and NCD-related behaviors affect females across our lifetimes – as girls, as young adults, as students, throughout our reproductive years while pregnant and as mothers, as workers, as caregivers for others with NCDs, and in our later years.
An important component of women’s health is reproductive health. Among women in their reproductive years (15-44), nearly half are physically inactive, about half use alcohol, over 30% are obese, over 20% smoke, nearly 12% have high cholesterol, and over 8% have prediabetes. Among pregnant women, 12.3% report smoking, over 7% use alcohol, and more than half of pregnant women are overweight or obese.
NCDs and NCD risk factors can affect fertility, maternal and fetal health, neonatal health, and the mother and child’s longer-term health outcomes. For example:
- Obesity during pregnancy increases the risk of gestational diabetes, preeclampsia, and hypertension. Children of obese mothers face an increased risk for chronic disease.
- Smoking reduces women’s fertility.
- Smoking during pregnancy increases the risk of premature delivery, low birth-weight, and Sudden Infant Death Syndrome. Children of mothers who smoked during pregnancy (or were exposed to secondhand smoke) face an increased risk for health problems such as childhood respiratory disorder and cleft palates and lips.
- Binge drinking and heavy drinking (> 8 drinks per week for women) can disrupt menstrual cycling and increases the risk of infertility.
- Alcohol use during pregnancy increases the risk of Fetal Alcohol Spectrum Disorders and Sudden Infant Death Syndrome.
Women’s reproductive years largely coincide with our prime working years (25-54), so in addition to human suffering and direct medical costs, it is also important to note the indirect economic costs resulting from reduced working capacity and productivity among younger women with NCDs.
How can law help reduce the burden of NCDs on women?
Although smoking, harmful consumption of alcohol, poor diet, and physical inactivity affect all Americans, these NCD risk factors pose serious, and sometimes unique challenges for women and girls.
Public health policy-makers and lawyers are implementing innovative policies and laws to address NCDs, including taxes on sugar-sweetened beverages, public education campaigns on the health effects of second-hand smoke, and planning and zoning laws to provide parks and recreation facilities. These policies and interventions should take into account gender differences in the prevalence of NCDs and their risk factors and address the different and unique health effects of NCD-related behaviors on females throughout their lifetimes. Behavioral change messages must be relevant and accessible to women and girls, and interventions must be accessible and inclusive.
We have many powerful policy and legal tools to reduce the impacts of NCDs on all Americans. International Women’s Day reminds us to make sure that we effectively address the serious and unique challenges that NCDs pose for women.
