Why gendered health promotion for non-communicable diseases prevention matters : older Zanzibari women and their reluctance to the doctor’s advice

Public Health professionals are warning about the serious cardiovascular and other complications of obesity and diabetes, as well as about further non-communicable diseases (NCDs), which could overwhelm developing countries, that are already straining under the burden of communicable diseases. Especially in urban areas and among older people an increase of NCDs can be observed. States and non-governmental organizations (NGOs) wish to improve programs, design laws and policies that respond effectively to the different situations of older women, compared to men. These governmental and NGO actors would like to foster older peoples’ participation in health promotion to reduce the burden of NCDs, but often lack ‘key indicators and data disaggregated by age and sex’ (UNFPA and HelpAge International 2012). Furthermore, the perspectives and experiences of the older people themselves suffering from NCDs that would allow adapting interventions to cultural circumstances is often missing. A medical anthropological research on the health of people above 60 years of age in the city of Zanzibar has shown that older women especially, often seemed reluctant to follow the doctors’ advice to change their health behaviour. Medical staff in Zanzibar’s urban hospitals gave ‘gender-neutral’ health advice to older patients but older men and women translated them differently into their everyday health practices. While for example men often adhered to recommendations of doing walking exercises to mitigate NCDs and their consequences, older women frequently disregarded the advice. Older women mostly agreed with the doctors that it was important to stay physically active but did not feel comfortable to go for a walk outside as it was recommended – since many of them were not used to leave their house to walk alone in the streets. An easy solution to this culturally inappropriate suggestion to do sports outside the private space could be to propose exercises that the women are able to do at home or together in groups with other older women in a more shielded place. The paper thus argues for the need of gender sensitive approaches to enhance the participation of older men AND women in engaging in health promotion for NCD prevention, acknowledging their different ways of health practices in old age/their different ways of living. Such approaches can only be achieved by studying local constructions of gender norms related to age and the socio-cultural context.