On May 30th, 2017 Dr. Lokesh, Physician and Professor of Pulmonary Medicine at JSS Medical Hospital & College of Mysore, presented a lecture on non-communicable health concerns that are on the rise throughout different regions of India. Among the leading non-communicable health concerns (diseases that are not transmitted from one individual to another) in India were cardiac and respiratory conditions, such as Myocardial Infarction and Chronic Obstructive Pulmonary Disease (COPD. Patients suffering from COPD usually present symptoms of progressive dyspnea, chronic cough, or wheezing, which may be attributed to loss of elasticity of the airways and air sacs, damage of the tissue lining the air sacs, inflammation of the airway walls, or increased mucus production in the airways (Angelis et al., 2014). In his lecture, Dr. Lokesh stated that COPD is becoming more prevalent among individuals in rural villages in Southern India, specifically among women. This observation seemed to contradict the established understanding of the risk factors associated with COPD such as exposure to hazardous fumes, usually from automobiles and factories, as well as accessibility to Tobacco based products; rural villages in Southern India don’t have as many motorized vehicles as densely populated southern cities do and Tabaco consumption among women is less in comparison to men (Jain et al., 2011). A few hours prior to Dr. Lokesh’s lecture, he led field experience at JSS Medical Hospital, which consisted of an introduction to the Respiratory Intensive Care Unit, where 4 out of 6 patients that were admitted were males. Although Mysore is a major city in Southern India, this observation became important in my interest for understanding the gender-related differences that might have an effect of the prevalence of COPD among women in rural Southern Indian villages.
Throughout the world, the interpretations of the words “gender” and “sex” are different. In the United States “sex” is usually the term associated to the biological identity of an individual and “gender” is the term used for the identity that the individual finds suitable. As a guest of Southern India, I have been given basic insight on how “gender” and “sex” influence the manner in which women are perceived as well as their health. A study conducted in Karnataka, India, showed that only 33% of HIV positive pregnant women received antiretroviral prophylaxis in 2007, which is offered at no cost through the government Parent-to-child Prevention Program; the qualitative portion of the study’s findings suggested social stigma and lack of education were the most common reasons as to why women did not receive antiretroviral drugs (Rahangdale et al., 2010). Although the topic of concern is gender-related differences in COPD patients in Southern India, the latter finding is of importance in understanding how social stigmas and education influence various health concerns among women in Southern India. As stated by Rahangale’s study and by Dr. Lokesh in his lecture, women in Southern India are less likely than men to seek medical attention, this may be due to the pressures within a women’s social network, which usually is characterized by family, community, religion, and accessibility of health care/education.
About 60-70% of India’s population is considered to live in the rural regions of the country, and 80% of the homes in the rural regions require bio-fuels as a source of energy (KalagoudaMahishale et al., 2016). In this 2016 study, there was a strong correlation with long term exposure of bio-fuels used for cooking by women in rural villages and COPD incidents; more than 50% of cases of COPD among women are misdiagnosed by clinicians in rural areas due to lack of spirometry and other medical resources (KalagoudaMahishale et al., 2016). In another study, 89% of women in rural villages who were formally diagnosed with COPD were exposed more frequently to hazardous bio-fuels used for cooking, 84% of the men who were diagnosed with COPD reported Tobacco use in their lifetime (Jain et al., 2011). Although this particular study did not support a higher incident of COPD among women than men in rural communities, it did reveal that women diagnosed with COPD had more severe symptoms than men, but had less number of properly diagnosed cases and of hospital admissions than men (Jain et al., 2011).
Not all findings from studies done on COPD gender-related differences have come to the same consensus. This is due to the fact that every population has a different set of variables affecting the way of life, whether it may be social, environmental, or biological. Despite the different risk factors associated with COPD, the majority of the studies done on prevalence of COPD among rural women reveal that there is a correlation between length of exposure to bio-fuels and COPD, associated with severe symptoms of dyspnea and bronchospasms, which may lead to respiratory failure; men are less likely to suffer such severe symptoms, since long-term bio-fuel exposure cause more irreversible damage to the respiratory tract than smoking (Cheng et al., 2015). It has also been supported by various studies that women are less likely to seek medical attention as opposed to men, despite more severe symptoms among women concerning COPD. In the context of global health, this is a major concern for women, not only from rural Southern Indian villages, but also for other women throughout India who are affected by social stigmas for accessing health care and who are uneducated on the dangers of bio-fuel long term.
As a student learning about global health, understanding how health and socioeconomic factors interplay with one another is key in understanding other global health concerns. COPD among women cannot only be attributed to bio-fuel exposure because social stigma and health care accessibility are two major points that must be considered when analyzing women’s health.
Works Cited
Angelis, N., Porpodis, K., Zarogoulidis, P., Spyratos, D., Kioumis, I., Papaiwannou, A., … Zarogoulidis, K. (2014). Airway inflammation in chronic obstructive pulmonary disease. Journal of Thoracic Disease, 6(Suppl 1), S167–S172.
Cheng, L., Liu, Y., Su, Z., Liu, J., Chen, R., & Ran, P. (2015). Clinical characteristics of tobacco smoke-induced versus biomass fuel-induced chronic obstructive pulmonary disease. Journal of Translational Internal Medicine, 3(3), 126–129.
Ford, E. (2013). COPD surveillance--united states, 1999-2011. Chest, 144(1), 284; 284-305; 305.
Jain, N. K., Thakkar, M. S., Jain, N., Rohan, K. A., & Sharma, M. (2011). Chronic obstructive pulmonary disease: Does gender really matter? Lung India : Official Organ of Indian Chest Society, 28(4), 258–262.
KalagoudaMahishale V, Angadi N, Metgudmath V, Lolly M, Eti A, Khan S. (2016). Prevalence of Chronic Obstructive Pulmonary Disease and the Determinants of Underdiagnosis In Women Exposed to Biomass Fuel in India- a Cross Section Study. Chonnam Med J. 2016 May;52(2):117-122.
Lokesh, Dr. (2017, May 30). Mortality and Morbidity: Is There a Gendered Pattern ? Lecture presented in India, Mysore.
Rahangdale, L., Banandur, P., Sreenivas, A., Turan, J. M., Washington, R., & Cohen, C. R. (2010). Stigma as experienced by women accessing prevention of parent-to-child transmission of HIV services in Karnataka, India. AIDS Care, 22(7), 836-842.