The drive for women’s health equity

The Katz Institute for Women’s Health has been challenging the status quo in medicine and improving the standard of care for women for more than a decade. At their recent Grand Rounds, I spoke about why elevating women’s health matters now more than ever. Here are excerpts from that speech:

Elevating women’s health at a population level makes strategic sense for society and offers a proven return on investment—and yet the science is often siloed and not acted upon. There are several reasons for this seemingly illogical neglect.

First, there is the problem of systemic bias in scientific research. Women are underrepresented in clinical trials. Male-only test subjects, whether human or animal, have long been the norm historically. In 1993, the NIH mandated the inclusion of women in clinical research. Forward progress was not rapid. In 2016, the NIH also mandated that female mice be included in research.

Even still, males continue to take center stage in labs. Male animals outnumber females 5 to 1 in pharmacology studies. Brain disorder studies using males outnumber those that includes females 5.5 to 1.

Indeed, male subjects are favored even when lab scientists are studying diseases that impact women more than men. For instance, the number one killer of women in the U.S. is cardiovascular disease — yet only one-third of participants in clinical trials are female. And A Harvard Health study revealed that while 70% of people affected by chronic pain conditions are women, 80% of pain research is conducted on males.

This systemic bias takes a toll on women’s health across the board because we simply do not know how a wide range of common conditions and drugs impact the female body.

And don’t get me started on the preventable pain and suffering in the space of women’s reproductive and maternal health. Women die from preventable problems during pregnancy and childbirth every single day. In the U.S, four out of five pregnancy-related deaths are preventable. And black women are nearly three times more likely to die from a pregnancy-related cause than white women.

The scarcity of clinical research and data on women’s health issues means that women do not receive the highest quality care. It is impossible to provide your female patient with a targeted, accessible solution that does not exist—and worse, too often there is no sound medical reason for that absence. It stems from bias.

And that brings us to another major problem area across the landscape of women’s health: the lack of financial investment. Just 4% of all biopharma R&D spending goes toward female-specific conditions. Of 37 total prescription drugs the FDA approved in 2022, only two were for female-specific health conditions.

The global pandemic set back women’s health even more. Girls and women lost access to reproductive and sexual health services; millions of girls across the world lost access to school; and domestic and sexual violence soared. I’ll share just two striking data points — one global, and one drawn from U.S. data.

  • Disruptions in access to family planning services and supplies during the pandemic led 12 million women in 115 countries to lose access to birth control – and to as many as 1.4 million unplanned pregnancies, according to the UN Population Fund.
  • Nearly 1 in 3 high school girls in the U.S. reported in 2021 that they seriously considered suicide. Almost 15% said they were forced to have sex, an increase of 27% over two years, according to new findings from the CDC. The report also showed that teens who identify as lesbian, gay, bisexual, and transgender often face extreme distress and suicidal thoughts.

Globally, WEF’s annual report on gender equity found it will now take 132 years to close the gender parity gap.

What can we do to improve the health landscape for girls and women? Here are four ideas:

Making the economic case

The economic case for investing in women’s health is strong. It’s time to share it. Investing in the health of the world’s women and girls is unrivaled in its return on investment for the health of all of society.

One of the flagship sessions at Davos 2023 was on the Economics of Women’s Health. With his signature clarity, Mark Suzman, CEO of the Bill & Melinda Gates Foundation declared: “There is no single investment, or set of investments, beyond investing in the health, education, and agency of girls and women that has a better social and economic payoff.”

Absolutely true. In fact, the Harvard Chan School is working closely with the World Economic Forum on its powerful and ongoing global women’s health initiative, because when we invest in the health of women, we invest in the health of a community. Here are a few standout figures:

Shifting the narrative

We need better messaging. That’s why the Harvard Chan School is working with WEF to create clarity around why it is smart to invest in women and girls’ health. In partnership with global stakeholders, we’ll use this narrative to shift popular thinking.

The narrative is also shifting as savvy businesses see the opportunities that abound in women’s health — although, quite frankly, they still tend to focus on the narrow niche of reproductive health.

Early-stage investors are beginning to recognize the opportunity, especially around digital innovations such as fertility-tracking devices. Funding rose more than tenfold in the last five years, to $1.4 billion in 2022, according to digital health fund Rock Health.

And we even see the pharmaceutical companies coming on board. For instance, the Merck spin-off Organon has completed eight business deals to acquire or license new medicines and products in underserved women’s health areas such as post-partum hemorrhage and endometriosis.

Like the Katz Institute, these entities are ahead of the curve. I believe we are seeing the rise of an ecosystem in which innovation around women’s health will flourish.

Innovating across sectors

Driving collective progress to achieve a healthier world for women, societies and our economies will also require unprecedented collaboration across sectors – partnerships that involve private, public, and academic entities, or as I like to call them, PPAPs. By leveraging diverse perspectives to create smarter investments, break down silos, and initiate global dialogue, we are turning the tide.

For instance, the Harvard Chan School has partnered with Apple and the National Institute of Environmental Health Sciences to launch the first-of-its-kind longitudinal research study into menstrual and gynecological health. We are collecting iPhone and Apple Watch data from tens of thousands of volunteers over a period of decades—anonymized data that’s unprecedented in size and scope.

Our hope is that this study will give us new insights into a range of disorders, including polycystic ovary syndrome and endometriosis, which are very common and yet frequently go undetected or misdiagnosed. We also hope it will help demystify menopause, which continues to be drastically understudied by the medical community.

This study is just one example of the kind of innovation spawned by PPAPs, because the enterprise of women’s health is so much bigger than the part of it each of us works on. The reality is the interventions and partnerships must be as intersectional as the issues themselves.

Tackling the social determinants

Finally, we know that advancing women’s health is about more than investing in healthcare innovation – it’s about on-the-ground equity and wellness efforts.

Eighty to 90 percent of a person’s overall health is determined by factors outside of clinical medical care. And yet we as a society do not invest in those factors. Only 2.5 percent of our health expenditures support public health programs.

That has to change — for everyone, and especially for women.

To improve women’s health, we need invest in upstream prevention as well as downstream cures: housing, education, food access, economic opportunity, and wellness programs.

Women—and particularly women of color—are overrepresented in low-wage jobs, which hurts their economic security, their access to health care, and their mental well-being.

Women-led families are among the fastest growing segment of the homeless population—putting them at high risk of injury and illness.

And women are far more likely to be the victims of intimate partner violence, which impacts not just physical, but mental, sexual, and reproductive health, too.

Everything we are learning about the connection between racial disparities, gender bias and socioeconomic realities reinforces a central fact: Improving women’s health necessitates addressing the social determinants of health.

That means respecting the bodily autonomy of girls and women, including their right to make informed sexual, reproductive, and health care decisions.

It means promoting equitable gender norms to reduce many forms of violence against girls and women and promote safety at home and in the workplace.

And especially now, it means transforming women and girls’ understanding of their human rights and self-worth, so they can both thrive and expect the world to value them.