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Closing the Women’s Health Gap: Research, Investment, and Eliminating Inequities
January 29, 2025 By Deekshita Ramanarayanan“The longstanding underrepresentation or exclusion of women in clinical trials and the continued need to understand sex as a biological variable have resulted in still knowing too little about how to effectively prevent, diagnose, and treat a range of health conditions in women,” said Dr. Carolyn M. Mazure, former Chair of the White House Initiative on Women’s Health Research in her keynote address at a recent Wilson Center event: Bridging the Gap in Women’s Health Research. The event was held in partnership with EMD Serono, the healthcare business of Merck KGaA, Darmstadt, Germany, as the first-ever Women’s Health Research Summit at the Wilson Center.
“We [the National Institutes of Health (NIH)] think that studying sex strengthens science by, up front, considering how sex might affect what you’re studying,” said Dr. Janine Austin Clayton, NIH Associate Director for Research on Women’s Health and Director of the Office of Research on Women’s Health. Dr. Clayton is the architect of a NIH policy that sex as a biological variable must be factored into all research, design, analysis, and reporting.
“When we think of the conditions that really drive the women’s health gap, they are the things that affect women differently, disproportionately, or specifically,” said Dr. Caroline Berchuck, Associate Partner at McKinsey & Company. These conditions, such as premenstrual syndrome, menopause, polycystic ovarian syndrome (PCOS), and other diseases that impact women more severely than men, contribute to women globally having 25% more years of poor health compared to men. This gap is even more pronounced across races and ethnicities.
Because women typically live longer than men, a common myth is that these years in poor health must occur later in life. “Turns out, that’s not the case,” continued Dr. Berchuck. “Actually, most of these years of disability are really focused in our working years.”
Assessing Racial Inequalities
“We all know that the healthcare system is not equal,” said Dr. Irene Aninye, Chief Science Officer at the Society for Women’s Health Research. “There are health disparities that rise from biological factors, from sociocultural factors, and influence.”
Addressing health disparities begins at the research and clinical levels. “When you’re designing a study, it should really consider the women, the different populations, the diversity of those backgrounds,” said Dr. Aninye. “We need as many perspectives coming to the table to converge on problems to address issues from a different vantage point.” She added that failing to include these perspectives creates solutions that prove inaccessible or inapplicable to many groups of women.
Medical mistrust often can pose an additional barrier to including diverse viewpoints. “One challenge that we often have is that in many cases, those who are the most marginalized tend to be the most questioning of medicine and of research,” said Dr. Sabra Klein, Co-Director of the Women’s Health, Sex, and Gender Research Program at Johns Hopkins University (JHU). “And so, I do think there’s a gap there between the researchers’ desire to enroll very diverse populations and trust in the medical system of those [diverse populations] and their lack of desire to sometimes participate in research.”
Exploring Overlooked Areas
Menopause, a critical health inflection point for women in their prime working years (and also later in life), is commonly overlooked in women’s health and women’s health research. Around 20% of women in menopause consider leaving their jobs due to the symptoms related to it, said Dr. Berchuck.
However, menopause and its symptoms are not generally taught in medical school nor included in clinical training. The resulting lack of understanding prevents practitioners from adopting a whole person approach for women in midlife menopause, observed Dr. Clayton.
She shared the example of a 51-year-old woman who goes to the doctor with brain fog. Is she experiencing new onset multiple sclerosis, or is it due to menopause? Menopause symptoms also can present in ways such as muscle atrophy, bone loss, cardiovascular disease, metabolic dysfunction, weight gain, anxiety, and hot flashes, added Dr. Clayton. “In actuality, we need to address every single one of these [symptoms]—not separately, but together.”
Another area where the women’s health gap is often misunderstood is in immune responses to disease. Women tend to mount greater immune responses than men, noted Dr. Klein, yet this fact does not inherently lead to better health for women.
“The downside of some of that greater immunity,” added Dr. Klein, “is we’re more likely to have inflammation; we’re more likely to have chronic diseases associated with inflammation, including those autoimmune diseases when your immune system is attacking yourself.” As most autoimmune diseases are diagnosed when women are of reproductive age, these illnesses contribute to the time that women spend in poor health during their prime working years.
Closing the women’s health gap means looking at it from multiple angles. Dr. Berchuck identified a three-fold challenge: “There’s a data gap; we don’t count women. There’s a treatment efficiency and effectiveness gap; we don’t study women. And there’s a care delivery gap; we don’t care for women, [and] we don’t include all women when we do care for them.”
Addressing all these areas together might yield a $1 trillion increase in annual GDP by 2040. But tackling the task of closing the gap will require a broad and sustained effort.
“If we do not grow the scope and depth of women’s health research, women will continue to have high rates of adverse health outcomes that inflict a personal toll on women and families, as well as a toll on the economy,” said Dr. Mazure. “However, if we do improve the health of women through the working years alone… the opportunity, economically, is extraordinary.”
Sources: Johns Hopkins Center for Women’s Health, Sex, and Gender Research, McKinsey Institute, Office of Research on Women’s Health, Society for Women’s Health Research.
Photo Credit: From left to right: Sarah B. Barnes, Dr. Sabra Klein, Dr. Janine Austin Clayton, Dr. Irene Aninye, & Dr. Caroline Berchuck. Credit: The Wilson Center.