Focus on Women's Health Around the World

Article

By: Donna E. Shalala

Date: 2000

Source:

About the Author: Donna E. Shalala was born in Cleveland, Ohio, in 1941. She attended the Western College for Women and obtained her Ph.D from Syracuse University. She was one of the first U.S. Peace Corps volunteers, serving in Iran from 1962 to 1964. In 1993, President Bill Clinton appointed her as the U.S. Secretary of Health and Human Services, where she served for eight years.

INTRODUCTION

After the United Nations declared 1975 the International Women's Year, it sponsored a series of international conferences to address women's issues around the world. The first, which met that year in Mexico City, proclaimed 1976–1985 the United Nations Decade for Women: Equality, Development, and Peace. The next was held in 1980 in Copenhagen to assess progress made toward the goals identified in Mexico City. This gathering established the Programme of Action for the Second Half of the United Nations Decade for Women: Equality, Development and Peace, and featured a platform that identified additional obstacles toward women's equality and created an international agreement on the actions necessary to address those inequalities.

The Third World Conference for Women met July 1985 in Nairobi and produced "Nairobi Forward-Looking Strategies for the Advancement of Women," an agreement that addressed objectives for women's advancement from 1986–2000, and created concrete objectives—based on the UN charter, as well as other declarations and covenants—to address international cooperation toward the elimination of gender-based inequalities.

In 1995, the Fourth World Conference for Women convened in Beijing. Representatives from the 189 member nations discussed the inequalities that women faced throughout the world and published a declaration that focused on advancing the "goals of equality, development and peace for all women" and identified the United Nation's uneven progress toward universal women's rights. The declaration asserted that poverty affects women and children disproportionately and that "[t]he empowerment and advancement of women, including the right to freedom of thought, conscience, religion and belief, thus contributing to the moral, ethical, spiritual and intellectual needs of women and men, individually or in community with others and thereby guaranteeing them the possibility of realizing their full potential in society and shaping their lives in accordance with their own aspirations." The platform promoted women's issues by advancing their economic independence, ending violence against them, and ensuring equal medical access and treatment-including education and resources.

Five years later, the Women 2000: Gender Equality, Development, and Peace for the Twenty-First Century, dubbed the "Beijing +5 Conference," was held at Hunter College New York City, to review the progress made toward the goals established in Beijing.

PRIMARY SOURCE

Today, we're going to have what—in my younger days—would have been called a "teach-in."

We're here to talk as equals, to share what we know, and to learn from each other. I emphasize the word "equal." When it comes to women and women's health—no country, no leader, no researcher has a monopoly on the truth. So, although we're sitting together in a great lecture hall—I am not here to lecture. You, after all, have been on the frontlines of this battle for years.

You've been the voice for women's health and women's rights in the noisy halls of government, where—let's face it—women often have to fight their way in—just like we had to fight our way in to hear Mrs. Clinton speak in Beijing.

You've been the keepers of women's history—and the protector of women's health in your communities.

You've walked every mile you needed to walk to battle the major killers of women—from TB and malaria, to breast cancer, to HIV/AIDS to violence.

And now you've come here from every corner of the globe to make sure that five years from now—when we celebrate Beijing Plus Ten—we will look back at this moment and say: At Beijing we planted our cause—and at Hunter College our victory took root.

Before we go forward, I want to look back at how far our movement has come in the United States—in partnership with health ministries, non-governmental organizations, and individual women around the world.

Five years after Beijing, we're targeting young girls with powerful messages about staying in school, staying away from tobacco, alcohol, and drugs, and staying strong.

I'll go to almost any lengths to help girls make smart choices. I bring them into my office and say: Talk to me. Tell me what's on your mind. Tell what do you need to feel strong. I enlist their favorite sports stars as my allies. I even visit the writers and producers of their most-loved soap operas and talk shows—to make sure these programs are giving good public health messages. Those messages are getting through. Today, teen pregnancy rates in the United States are down for the seventh straight year—and overall drug use has leveled off or declined.

Five years after Beijing, our State Children's Health Insurance Program is up and running.

This is the largest expansion of health care in 30 years—and will help insure many young girls from low income working families.

Five years after Beijing, we've dramatically increased our funding for women's health research.

Today, we're learning invaluable information through the Women's Health Initiative—the largest clinical trial in history. It's a trial about the major causes of death and disability in older women, including heart disease, cancer, and osteoporosis. At the same time, we've drawn a line in the sand: No more federally funded research on diseases that affect women—unless that research includes women, and examines the differences and similarities between men and women.

Breast cancer is still the second leading cause of cancer death among women in the United States, and as we increase life expectancy in women around the world—breast cancer rates in other countries will likely go up too. That's why we're working overtime to beat this disease—with powerful new treatments, and by offering free mammograms to low-income women. We also support new legislation that will provide free breast cancer treatment for these same women. Better screening, early detection, and new treatments have brought down the breast cancer death rate in the United States. And the 5-year breast cancer survival rate is now over 90 percent when the disease is caught early.

But we are not about to declare victory against any cancer—or other disease which strikes women. All we are going to do is fight harder. Invest more. And raise the bar higher.

Five years after Beijing, we are building a seamless system that responds to the multiple needs of women who are victims of domestic violence….

When a woman makes that first phone call following abuse—she must know that all of her legal and health needs are going to be met, quickly, completely, and with sensitivity.

Five years after Beijing we have an office of women's health inside every major health agency.

We have women's health centers in many large universities….

These centers do not create new women's health programs. They create models for existing programs—models that demonstrate how to integrate services, build a seamless system of care, and address the health care needs of women holistically. In the twenty-first century, women's health must be defined as making sure that women always reach the highest attainable standards of physical and mental health.

That's what we said in Beijing. And that's what we're saying again this week.

The time has come to throw out the narrow view of women's health as simply reproduction, or preventing disease, or aging. Women's health must be woman-centered. Let me repeat that: Women's health must be woman-centered. That's where we should be headed five years after Beijing.

I want to be clear: Health—including reproductive health—must be integrated into our broader Beijing agenda. When we lift women out of poverty. When women have the power to make their own choices about family planning. When women have a full opportunity for an education. Then—and only then—will they have the tools they need to keep themselves and their families healthy.

That's why we must have a comprehensive woman-centered blueprint for health. But we won't get there unless we face up to several critical challenges—for women around the world.

First, we must expand access to health care across the globe.

In the United States alone, over 44 million people are still uninsured. We learned the hard way that this problem cannot be solved all at once. So we've taken a step-by-step approach: Making sure that changing jobs doesn't mean losing coverage. Expanding access for children. And proposing that older workers be allowed to buy into Medicare.

What sometimes gets lost in the numbers and proposals—is how the problem of access to health care directly affects women. Lack of access to health care keeps many women in India from seeking primary and preventive care. Lack of access to health care discourages women in the rural United States from going to work. Lack of access to health care in Africa increases maternal mortality. And lack of access to health care in nations around the world leads to chronic diseases associated with old age.

Which bring me to my second challenge: We must revolutionize long term care.

Some nations in Europe are at or near zero population growth—increasing the percentage of elderly. In Africa and Asia, where AIDS has been so devastating, working age adults are dying, leaving children and the elderly behind. Japan has one of the oldest societies on earth and is trying to encourage parenthood. In the United States, the number of Americans over 65 is expected to double in the next 30 years. A large majority of these older Americans will be women.

So there is no corner of the globe that does not face a crisis in long-term care—with the greatest burden falling on women—women who are elderly or caregivers. This is not a think-tank, academic issue. This is about life. This is about each one of us. My mother is healthy and active in her eighties. But I want my mother to have the care she will one day need. I am hardly alone in feeling this way. Being able to care for our parents—and other loved ones—is a very deep human need that we must never ignore.

Our third challenge is the long struggle against malaria, TB, AIDS, and other infectious diseases.

I mentioned the devastating impact AIDS is having in parts of Africa and Asia. India already has five million AIDS cases—and Africa is heading toward a generation of AIDS orphans. According to a recent World Bank study of 30 sub-Saharan countries, AIDS is likely to subtract up to 1.4 percent per year from GDP growth in these nations.

Ten years ago, many people in the United States thought of AIDS as a man's disease. Now we know better. In most of the world HIV/AIDS is a woman's disease. In this country, women are the fastest growing group of people living with HIV/AIDS. For African American women, the story is even worse. If you're an African American woman, you're almost 20 times more likely to have AIDS than a Caucasian woman.

My point is: HIV/AIDS is not a one-size fits all problem. Different countries have different needs and, frankly, different capabilities. So our approach is to make the solution fit the problem. In the United States, that means dramatically increasing our budget for both AIDS prevention—and health services for people living with AIDS. It means setting a national goal of finding an AIDS vaccine by 2007. It means becoming partners with our diverse communities to address the changing face of AIDS. And it means mobilizing all of our health agencies to close the gaps in health outcomes, including HIV/AIDS, which is having such a disproportionate impact on women of color.

The United States also understands its role as an International partner in the fight against HIV/AIDS. That's why our budget to fight HIV/AIDS abroad is now over 300 million dollars. That's why we're testing nearly 60 microbicides in pre-clinical and clinical trials—compared to just a dozen in 1994. These microbicides will help put the health destiny of women back in women's hands—where it belongs!

Our role as your international partners is also why we're supporting the testing of drugs like nevirapine, which has been shown to be highly effective in preventing mother-to-child transmission, at a fraction of the cost of AZT. It's why we're investing 100 million dollars—along with funds from the United Nations and other donor countries—for the International Partnership for AIDS in Africa. It's why we're encouraging pharmaceutical companies to find new treatments—while reducing the cost of anti-viral drugs in the developing world. And it's why President Clinton is proposing a one billion dollar tax credit for companies that develop vaccines for TB, malaria, AIDS and other infectious diseases. The credit will have the effect of lowering the cost of vaccines for non-profits.

Our fourth challenge can be summed up in one word: Prevention.

I mentioned that breast cancer is the second leading cancer killer of women. The first is lung cancer. And the number one killer of women overall is heart disease. We can dramatically cut the rate of both lung cancer and heart disease—as well of stroke, osteoporosis and other public health risks to women—by changing our behavior.

First, stop smoking. Or, better yet, don't start! There are over 200 million women smokers—most in the developed world. The international marketing of tobacco, directed to women and children and without warning labels, is an outrage and it must stop! That's why the Kobe Declaration formulated at the World Health Organization Conference on Tobacco and Health is a strong message to the international negotiators now drafting the first "Tobacco Convention." That message is simple: Keep the health needs of women, at the top of your agenda. Second, stay physically active—which I've been doing since I was a kid. And third, eat a variety of healthy foods.

Sisterhood is still powerful. International sisterhood is even more powerful. But international sisterhood that takes our health into our own hands is unstoppable. That's what prevention is all about. That's what the UN conference is all about. And that's why we're here today.

Which brings me to my fifth and last challenge: Working together.

Our fight for women's health did not begin in Beijing. It did not begin in 1975—which the United Nations declared the International Woman's Year. It did not even begin in the nineteenth century, when the cry heard throughout the land was: "Cast off your corsets!" Not only did our great-grandmothers fight this battle—their great grandmothers did too. How? By standing together. Learning together. And marching together.

We've come a long way since we hammered out our platform in Beijing. But as long as there is still one woman fighting breast cancer.

  One woman being physically abused.
  One woman being discriminated against.
  One woman at risk for HIV/AIDS.
  One woman dying from an unsafe abortion.

Or one woman unable to make her own choices, that is one woman too many and our work is not finished.

My nation is with you. And I am with you. But most important, we must be with each other. Holding on to our partnership. Staying unified. Staying strong. Sharing what we know. That is how we will advance the great cause of women's health and women's rights everywhere.

I know I'll see you many times between now and then—but I'll certainly see all of you when we take our next victory lap—at Hunter College Plus 5.

Thank you.

SIGNIFICANCE

The document that emerged from Women 2000: Gender Equality, Development and Peace for the Twenty-First Century, "Further Actions and Initiatives to Implement the Beijing Declaration and Platform for Action," reviewed the effectiveness of programs stemming from the Beijing Conference, including achievements and obstacles to reaching those goals. In the area of women's health, the declaration identified an increased life expectancy for women and girls and an improved concentration on sexual and reproductive health issues, as well as reproductive rights. The declaration also cited achievements in additional programs regarding contraception, education and family planning, HIV/AIDS, and increased awareness toward nutrition and breastfeeding.

In developing nations, however, women were still hampered by a lack of clean water, sanitation, and adequate nutrition. A lack of gender-specific health research in certain countries further impedes women's health. The document calls for additional investment into obstetric care to reduce high infant and maternal mortality rates.

In 2001, the UN Millennium Summit was held in New York City. Over 150 member nations signed the Millennium Declaration and agreed to work toward the Millennium Development Goals, which include promoting gender equality and empowering women, reducing child mortality, and improving maternal health.

FURTHER RESOURCES

Web sites

Earth Summit 2002. Toolkit for Women. "Third World Conference on Women, Nairobi." 〈http://www.earthsummit2002.org/toolkits/Women/un-doku/unconf/narirobi.htm〉 (accessed March 13, 2006).

United Nations. Division for the Advancement of Women. "Beijing +5: Women 2000—Gender Equality, Development for Peace in the Twenty-First Century" 〈http://www.un.org/womenwatch/daw/followup/beijing%2B5.htm〉 (accessed March 13, 2006).

United Nations. General Assembly. "Further Actions and Initiatives to Implement the Beijing Declaration and Platform for Action" 〈http://www.un.org/womenwatch/daw/followup/ress233e.pdf〉 (accessed March 13, 2006).

University of Minnesota. Human Rights Library. "Beijing Declaration and Platform for Action, Fourth World Conference on Women." 〈http://www1.umn.edu/humanrts/instree/e5dplw.htm〉 (accessed March 13, 2006).