What's The Problem?

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What's The Problem?
Bias in the current healthcare model is impacting women's health
The World Health Organization (WHO) found that although women in the European Union live longer than men, they spend more of their lives in poor health (link to https://www.who.int/)
The CDC states that four out of five pregnancy-related deaths in the US are preventable and black women are nearly three times more likely to die from a pregnancy-related cause than white women (link to https://www.cdc.gov/)
Since the coronavirus pandemic started, there has been a significant rise in the proportion of pregnancies ending in stillbirths (link to https://www.nature.com/articles/d41586-021-00578-y)
Including female participants in clinical studies only started in the late 1980s and was only made mandatory in the US in 1993, per National Institutes of Health guidelines
According to Harvard Health, 70% of those affected by chronic pain conditions are women, whereas 80% of pain research is conducted on males (link to https://www.health.harvard.edu/)
This bias exists from 'bench to bedside'. Generations of clinical data actively excludes the female experience
Research on chronic hypersensitive cough shows patients are mainly postmenopausal women, yet animal studies were performed exclusively on male guinea pigs for decades
The reported rate of drug adverse effects is also higher for women, because these substances were developed and tested via the entire research process on male subjects
During 1997 to 2000, ten prescription drugs were withdrawn from the market by the US Food and Drug Administration because they represented greater health risk for women
The ratio of articles reporting on males-only samples versus females-only samples was most skewed for neuroscience (5.5:1), pharmacology (5:1) and physiology (3.7:1). Similar bias towards the use of male subjects was found in laboratory research of pain, diabetes, cardiovascular diseases and surgical methods
And at the bedside, treatment bias is unacceptable
A study analyzing health data for almost 7 million men and women in the Danish healthcare system over a 21-year period showed that women were diagnosed later than men in more than 700 diseases
A 2018 review of 77 articles shows that medical professionals are more likely to dismiss women patients as too sensitive, hysterical, or as time-wasters (link to relevant study)
According to 2020 research, women with moderate haemophilia receive a diagnosis 6.5 months later than men, on average. Women with severe haemophilia face delays of 39 months. For women with VWD, the delay between symptom onset and diagnosis is 16 years (link to https://www.ncbi.nlm.nih.gov/pmc/articles/)
According to a survey from the American Autoimmune Related Diseases Association (AARDA), 62% of people with an autoimmune disease had been labeled "chronic complainers" by doctors. However, 75% of people with autoimmune conditions are women, meaning this dismissive attitude disproportionately affects women
A 2020 review shows that even after controlling for higher rates of mental health conditions in women, women still receive a disproportionate number of mental illness diagnoses and more prescriptions for mood-altering drugs
A 2018 study found that females presenting with a heart attack were more likely to die when a male doctor treated them, compared with a female doctor
Basic questions have been ignored for too long – Menopause as an example
Key research gaps identified by Dr Janine Clayton, Director of the Office of Research on Women's Health, National Institutes of Health:
Diagnosis:
Are there improved diagnostics by which to assign symptoms (e.g., hot flashes, insomnia) to menopause rather than other conditions?
Which biomarkers best predict the timing or duration of menopause and/or menopausal symptoms?
Does the severity of symptoms identify women who may be at risk of disease later in life?
Disease Prevention:
What specific interventions (e.g., medication, nutrition, exercise, mental health) improve the menopausal transition symptoms and better outcomes after menopause?
Therapy:
Are there improved treatments (hormonal and non-hormonal) that can improve quality of life for women during the menopause transition?
Are new hormone formulations and delivery options beneficial?
Timing:
When are interventions of most benefit to women? For early or iatrogenic menopause?
Implementation:
Can we equitably improve education and access to care for all women with symptoms of menopause desiring intervention?
The WHO prioritises 10 areas to improve the female experience & to improve societal wellness and productivity
Cancer: Around half a million women die from cervical cancer and half a million from breast cancer each year. The vast majority occur in low and middle income countries where screening, prevention and treatment are almost non-existent.
Reproductive health: Sexual and reproductive health problems are responsible for one third of health issues for women between ages 15-44. 222 million women globally aren't getting the contraception services they need.
Maternal health: Almost 300,000 women die each year from complications in pregnancy and childbirth.
HIV: Three decades into the AIDS epidemic, it is young women who bear the brunt of new HIV infections.
Sexually transmitted infections: Untreated syphilis is responsible for more than 200,000 stillbirths and early foetal deaths every year, and for the deaths of over 90,000 newborns.
Violence against women: Today, one in three women under 50 has experienced physical and/or sexual violence by a partner, or non-partner sexual violence.
Mental health: Depression is the most common mental health problem for women and suicide a leading cause of death for women under 60.
Noncommunicable diseases: In 2012, some 4.7 million women died from noncommunicable diseases before age 70. They died as a result of road traffic accidents, harmful use of tobacco, abuse of alcohol, drugs and substances, and obesity.
Being young: About 13 million adolescent girls (under 20) give birth every year. Complications from those pregnancies and childbirth are a leading cause of death for those young mothers.
Getting older: Having often worked in the home, older women may have fewer pensions and benefits, less access to health care and social services than their male counterparts.
(Link to https://www.who.int/news-room/feature-stories/ten-top-issues-for-womens-health)
Societal impact
Women spend a disproportionate amount of their time carrying out three quarters of the world's unpaid work: 11 billion hours a day
In the US and the UK, real time surveys in March and April 2020 found that more women than men had lost paid jobs
For every 100 men promoted from entry level to manager, 87 women were promoted. For women of color, only 73 were promoted for every 100 men (link to https://www.mckinsey.com/featured-insights/diversity-and-inclusion/women-in-the-workplace)
Women are twice as likely to be mistaken for someone junior and hear comments on their emotional state
Even in the 59 countries where women are now more educated than men, the average gender income gap remains 39% in favour of men (link to https://news.un.org/)
Only 6 countries give women equal legal work rights as men (link to https://www.weforum.org/)
It will take 108 years to close the gender gap (link to https://www.weforum.org/)
American women earn just 74 cents for every $1 a man earns (link to https://www.cnn.com/)
Only 61% of prime working-age women participate in the labour force, compared to 91% of prime working-age men (link to https://www.unwomen.org/)
A new UN report has found almost 90% of men and women hold some sort of bias against females (link to https://www.bbc.com/news/)
In a nutshell….
"If women were able to participate in the economy equally, it would result in nearly an estimated $160 trillion increase in global GDP or a 21.7% increase in human capital wealth."
(Link to https://www.who.int/news-room/feature-stories/detail/female-health-workers-drive-global-health)