key: cord-0731132-fdd2bqms authors: Mobasheri, Ali title: Women's health: A revised global agenda in the COVID-19 era? date: 2021-02-05 journal: Case Rep Womens Health DOI: 10.1016/j.crwh.2021.e00292 sha: d6ce20f88b0f235524d3d9390df32f991118bcec doc_id: 731132 cord_uid: fdd2bqms nan violence, conflict, poverty, discrimination, social isolation and psychological trauma. A very brief analysis of both gender and race in the context of the global pandemic highlight a number of issues that emerge as being significant, and worthy of further discussion and debate. A higher proportion of women are deployed as "frontline" services in all professions [17] . This means that women play a disproportionate role in frontline health and social care roles and perform the majority of caregiving responsibilities and they are more exposed to COVID-19, and at a much higher viral load than men [17] . We do not yet know the long-term health consequences of this level of exposure, although we do know that women make up a smaller percentage of the severe COVID-19 cases presenting in hospitals [18] . There are also serious issues regarding the impact of COVID-19 on the Black, Asian and Minority Ethnic (BAME) community. A recent systematic review of the published literature on COVID-19 articles (including pre-prints) suggests that BAME individuals have an increased risk of infection with SARS-CoV-2 and may experience worse clinical outcomes, including higher intensive care unit (ICU) admission and mortality compared with White patients [19] . The experience of women during the COVID-19 lockdowns, curfews and quarantines will be determined by their socio-economic status, their religious and cultural affiliations, education, ethnic background, and employment and parental status, specifically the age of their children. Quarantine decisions by governments have had a direct impact on women's freedom and their ability to exercise and maintain their physical and mental health. The current school closures and pressures of home schooling, particularly of primary-age children, is impacting more on women, reducing their earnings and their financial independence. Maintaining work-life balance is much harder for women in the COVID-19 pandemic. The diverse responses of different governments to COVID-19 affects different demographic groups in the short, medium and long term and this is crucial for understanding the immediate and longterm socio-economic impacts of the 2020 pandemic [20] [21] [22] [23] [24] . Health outcomes are directly linked to socio-economic factors. Poverty, poor education, tobacco use, unhealthy diets, physical inactivity and excessive consumption of alcohol are factors that determine poor health outcomes [25] . One of the biggest challenges facing women under the present COVID-19 lockdown is the ability to seek medical advice from a primary healthcare practitioner. Telephone interviews are certainly possible, and more serious health complications may be dealt with, but for the majority of women the unique issues that they face, including pregnancy, menopause, and maintaining healthy female organs, are far more awkward and complex to deal with in a pandemic through consultation with health care practitioners on the telephone. The real concern is the rise in morbidity among women. Before the pandemic women were already more likely to die following a heart attack than men [26] . Women are more likely to show signs of depression and anxiety compared with men [27] and they are also more susceptible to developing osteoarthritis than men after menopause [28] . Global efforts to improve women's health have largely focused on improving sexual and reproductive health. However, the global burden of disease has changed significantly over the past few decades and the greatest burden of death and disability among women is now attributable to non-communicable diseases (NCDs), such as cardiovascular diseases, cancers, respiratory diseases, diabetes, dementia, depression and musculoskeletal disorders [29] . The sustained increase in women's life expectancy over the last few decades has created the challenge of making those extra years of life healthy, happy and productive. However, the current pandemic is disrupting all the ongoing efforts to improve women's health, exacerbating existing health inequalities. In summary, the pandemic is setting us back in every previously established initiative to improve the health and welfare of women, highlighting the need for a revised global health agenda in the COVID-19 era. Outlining the key priorities in such an initiative is clearly beyond the scope of this editorial and the efforts of a single author. The need for urgent action and providing additional physical and mental health support to women in the COVID-19 era has already been highlighted [30] . Nevertheless, this concise editorial is intended to add to the collective ongoing efforts. Ali Mobasheri contributed exclusively to the preparation of this editorial. The author is President of the Osteoarthritis Research Society International (OARSI). He has no conflict of interest regarding the publication of this editorial. No specific funding was sought or secured in relation to this editorial. This editorial was commissioned and not externally peer reviewed. 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