In January 2024 the World Economic Forum and the McKinsey Health Institute shared a report that focuses on the economic implications of an identified “women’s health gap” and presents the “business case” for closing it.
“Beyond the societal impacts of healthier women, including more progression in education and intergenerational benefits, improving women’s health could also enable women to participate in the workforce more actively. This would potentially boost the economy by at least $1 trillion annually by 2040.”
A note on language
“This report reflects women’s health as a market segment. The authors acknowledge the importance of healthcare to the transgender, non-binary, and gender-fluid communities, and that not all people who identify as women are born biologically female. The authors have often used the term ‘sex and gender’ to reflect inclusive language and recognise the need for future research into health issues that is inclusive of the transgender, non-binary, and gender-fluid communities. They also acknowledge the profound differences for women based on factors such as race, ethnicity, socioeconomic status, disability, age, and sexual orientation.”
The authors consider the frequent simplification of “women’s health” to include only sexual and reproductive health (SRH), which “meaningfully under-represents women’s health burden”. In the report women’s health addresses both sex-specific conditions and general health conditions that may affect women differently or disproportionately.
A lifetime of poor health
- The report states that “a woman will spend an average of nine years in poor health”, with associated consequences for productivity at home, in the workforce, and in the community. This is an additional 25% time spent in “poor health” compared to men.
- The women’s health gap equates to 75 million years of life lost due to poor health or early death per year. This is equivalent to 7 days per woman per year.
- Addressing the gap could generate the equivalent impact of 137 million women accessing full-time positions by 2040.
The role of science: inequality hinders knowledge
“Biomedical innovation builds on the basic understanding of science around body function and the cellular and molecular pathways involved in disease development and progression.”
Historically, men have “both led and been the subject of” the study of medicine and biology; even the “majority” of animal models have been based on male specimens. Sex-based differences were “rarely investigated or recorded” under the false assumption that the organs and systems in men and women have “few important differences”.
“To understand basic female biology better, fundamentally new research tools should be developed.”
The report offers examples of where women and men experience important differences in the uptake or effectiveness of an intervention that has been designed and approved for both.
High mortality vs disability
A key concern for the authors is the research emphasis on diseases with high mortality rates over diseases that lead to disability; this can be assessed in pipeline assets. They identify “up to a 10-fold higher volume” of new therapies in development for some of the most common women’s cancers compared to “debilitating gynaecological conditions”. A suggested reason is the higher mortality rate of oncologic conditions.
“The solution is not to trim cancer funding, but to recognise the possibilities for advances in research related to other women’s health conditions.”
Furthermore, maternal conditions deserve “more attention”; they contribute “a similar share to overall suffering” among women compared to women-specific cancers, yet there is a “large discrepancy in the pipeline of therapies.
“In all, when tackling women’s health, the solution is not to divide more slices of one pie: it’s to make more pie.”
A lack of data
The authors note that a lack of sex- or gender-specific data and research affects safety: since 2000, women in the US have reported total adverse events from approved medicines 52% more frequently than men, and serious or fatal events 36% more frequently. Indeed, an analysis of medicines withdrawn for safety reasons revealed that, since 1980, products have been 3.5 times more likely to be removed because of safety risks in women patients compared to men.
There is a “systematic lack of disease understanding” that has created a women’s health gap of 40-45 million DALYs (disability adjusted life years) per year, or four days per woman per year.
“Shining a light on the interventions for which this information was not reported would benefit both men and women, by enabling innovators to develop interventions that are better suited for specific subpopulations.”
Data gaps
“Data can quantify problems and measure the impact of potential solutions. It is the critical ingredient of robust, evidence-based analysis and decision-making. Yet many of the datasets (epidemiological and clinical) widely used today fail to provide a complete picture of women’s health, both undercounting and undervaluing the health burden.”
A given example is the “emerging body of evidence” that suggests a potential gender bias in pain measurement, which has clinical and psychological outcomes.
Gaps at every stage
- Pre-data generation – The data gap starts at the very definition of women’s health with a lack of consistent and aligned definitions and measurement scales for conditions and symptoms affecting women.
- Data generation – This encompasses both epidemiological and clinical data, including the documentation of women’s specific symptoms and markers for diagnosis, with little understanding of how some diseases manifest differently in women and a lack of data on the health-related burden associated with some women-specific conditions.
- Data aggregation – Sex-disaggregated results are available in the public domain for only 50% of the interventions analysed and clinical trial designs and end-point selection can fail to consider potential sex differences. Evidence for intervention effectiveness may be drawn from unrepresentative populations due to recruitment failures.
- Data analysis – The metrics selected for analysis and publication may hide or dilute the experience of specific groups compared to others, and datasets gathered in the digital age have led to growth in machine learning algorithms. Neither the data nor programmes applied to it are de facto neutral, which means that the technology could perpetuate structural disparities.
Barriers to diagnosis
“There is evidence of significant and systematic differences in diagnostic assessments between men and women, which has an impact on the calculation of the accurate prevalence and burden for several diseases affecting women.”
A study in Denmark found that women were diagnosed later than men in at least 700 diseases. For cancer, it could take over two and a half years to get a diagnosis. For diabetes, the delay was four and a half years. WHO estimates that around 10% of women of reproductive age are living with endometriosis, yet the Global Burden of Disease estimates the figure to be between 1% and 2%. The discrepancy means that there could be anywhere between 24 million and 190 million women affected worldwide.
Difficulty in getting a diagnosis not only creates a barrier to care, but the consequent lack of recorded diagnoses informs investor and researcher priorities and analyses of potential.
Clinical evaluations
An example of the gap in clinical evaluations is the US clinical trial scene. Although FDA policies that required investigations of gender differences in clinical evaluation of medicines have translated into an improvement in women’s participation. However, when comparing women’s participation to their share of the disease burden, they remain “under-represented”. Furthermore, equitable representation of different races and ethnicities has “long lagged”.
Sex-differentiated results
Although representative clinical studies that produce stratified results might demand more resources and time, the results would “likely lead to more effective interventions with higher uptake among patients”. With payers and regulators insisting on cohort-specific impact evidence, the “risk/reward equation” becomes more balanced.
Responsive care delivery systems
“Several studies have indicated that women are more frequent users of health services than men. These differences, however, may be reduced substantially when adjusted for different levels of need, such as reproduction or differences in disease prevalence.”
The McKinsey analysis found that some of this imbalance may be due to “inadequate service”. For example, women who present the same condition as men may not receive the same evidence-based care, with delays putting “unnecessary” pressure on health systems and patients.
The full pathway
“The care pathway runs from awareness of a health issue to access to services and preventative care, timely and accurate diagnosis, and effective treatment and follow-up.”
Awareness and prevention
Health education is “one of the most effective ways” to empower women with understanding of their bodies. Despite country level variations in the quality and quantity of health education, women around the world “may have limited awareness of what is normal and when to seek medical advice”.
“Prevention and promotion are also needed for better health.”
The HPV vaccine is an example of an intervention that is proven to reduce the incidence of cervical cancer, particularly if vaccination happens early. Despite WHO targets, there are “great disparities among countries”.
“The importance of increasing awareness goes beyond patients – many doctors are not aware of how diseases can affect or manifest differently in women, preventing them from providing proper care to many patients.”
Accessibility and affordability of care
It is noted in the report that “healthcare spending and insurance premiums have historically been higher for women”. For women in Switzerland, healthcare insurance premiums are more expensive as they are considered to have higher healthcare costs; they pay an average of more than 12% extra for supplementary hospital insurance. In India, private insurers employ gender-based premiums.
Affordability goes beyond paying for direct healthcare services; it also means being able to afford hygiene products. Around 500 million people across the world lack access to menstrual products and hygiene facilities. A study conducted by HERproject in Bangladesh revealed that 73% of women missed work for an average of six days a month in a textile factory, with absenteeism affecting business but also lives and livelihoods. When the HERproject provided pads and other interventions, absenteeism dropped to 3%.
Family planning is another “highly relevant” factor, with women of childbearing age who are sexually active having to evaluate the cost of contraceptives, which are often not covered by insurance. It is estimated that 257 million women in developing regions who want to avoid pregnancy are “not using safe and effective family planning methods” because of lack of access and support. A lack of contraception can lead to sexually transmitted diseases or unintended pregnancy, which then leads to “job loss, career setbacks, diminished ability to support oneself or one’s family”, and higher levels of “family dysfunction”.
Timely diagnosis
The “male-centric” models of disease contribute delays in care and lower quality treatment decisions when a woman enters the care system. For example, women are seven times more likely than men to have a heart condition misdiagnosed or be discharged during a heart attack.
Choice of treatment
Sex and gender can affect care, “even for common conditions”. The stated example is that, upon discharge, women cardiac patients are less likely to be prescribed secondary prevention, contributing to women being “twice as likely to die from a serious heart attack”.
Creating solutions
The gap in care delivery contributes 34% to the women’s health gap, so sex- and gender-appropriate care delivery could reduce the women’s health burden by 25 million DALYs per year globally, or 2.5 days per woman per year. Encouragingly, global public health programmes are “increasingly being designed and improved from a sex- and gender-informed perspective”.
Improvements to diagnostic tools that are available would “represent a major step forward for patients”. However, even without these tools it would be possible to “bridge the gaps” in diagnosis with “more consistent and standardised screening and data collection”.
Value based care is an approach recommended for counteracting the rise in healthcare costs while benefiting patients and insurance providers. It “aims to link healthcare payments to the quality of outcomes”, which shifts incentives for healthcare providers from quantity to quality.
“Ultimately, a combination of innovation, investment, and ability to scale could unlock better care delivery solutions for women.”
Directing investments
“There has been a historical underinvestment in women’s health research, from the public, social, and private sectors. When there is funding, it overlooks the fact that many conditions manifest differently in each sex, creating variances in outcome.”
To close the health gap, increased investment is needed for understanding sex-based differences and addressing unmet needs.
Research funding
Public funding “continues to be one of the primary sources for scientific research”, yet the data are disappointing. For example, the NIH allocates 11% of its budget to women’s health specific research in the US, and despite women having a 50% higher mortality rate the year following a heart attack, only 4.5% of the NIH’s budget for coronary artery disease supports women-focused research.
“Underfunding certain research leads to and augments the women’s health gap.”
Increasing investor excitement
As opportunities in women’s health become clearer, private equity and venture capital investments are “starting to grow quickly”. More female technology (FemTech) start-ups are attempting to “disrupt the healthcare market” with a concentration of activity on maternal health patient support, consumer menstrual products, gynaecological devices, and fertility solutions.
“Investors may be starting to see the potential.”
Money matters: boosting the economy
“The disparities in women’s health affect not only women’s quality of life but also their economic participation and ability to earn a living for themselves and their families. Health is intricately linked to economic productivity, prospects for prosperity, and contribution to economic output.”
Over the past 70 years, economic growth has been “closely tied” to an increase in women’s labour force participation. The report states that addressing the additional health burden women face could “boost” the global economy with an extra $1 trillion by 2040. This would mean a 1.7% increase in the average per capita GDP generated by women.
Call to action
“Women’s health has been under-researched, and women face different challenges from men in affordability and access to treatment. This health gap creates unnecessary suffering and preventable economic losses. It does not have to be this way.”
The report demands “collaborative efforts on five fronts”:
- Investing in women-centric R&D
- Strengthening the collection and analysis of sex- and gender-disaggregated data
- Enhancing access to gender-specific care
- Encouraging investments in women’s health innovation
- Examining business policies to support women
A moral imperative
“If health equity efforts sit within a tree of principles, they can be watered by research, flourish in the sun of business investments, and grow far-reaching branches that stretch into the economy.”
“The question is not whether this wealth of opportunities exists but rather who will take the initiative to seize it and drive change.”
What do you make of the report, and how might it inform your work? Join the conversation in our LinkedIn community or come to the Congress in April for a special plenary on the women pioneering health progress in the vaccine space. Don’t forget to subscribe for more insights here.
