Unlocking the Health and Economic Returns of Closing the Women's Health Gap
Disclaimer: The following article strives to be inclusive and specific in its discussion of gender- and sex-based dynamics in healthcare. The authors acknowledge the importance of healthcare to the transgender, nonbinary, and gender-fluid communities and that not all people who identify as women are born biologically female. It is important to note that the women’s health gap affects anyone who identifies as a woman due to sociocultural influences, and any people who are chromosomally female due to physiologic ones. Thus, this discussion applies across intersectional gender and sex spectra.
If you are a woman, can you recall the last time you went to the doctor with a medical concern? What was the experience like – did you feel heard? Cared about? Women often do not receive gender-specific care, leading to challenges in navigating treatment that lead to disparities in treatment and outcomes. This article explores the reasons behind the global women's health gap and proposes actionable steps to bridge this divide by 2040.
Despite living longer than men, women, on average, spend 25% more of their lives in poor health. Much of this disparity can be attributed to the way science and healthcare have, for much of history, treated women as though they are small men. They are not. Supporting sexual and reproductive health (SRH) is critical for women to stay healthy, and biology beyond sexual and reproductive organs – down to our cell structure – is also distinct from the male body. These differences, left unexplored, have led to a scenario where in 2023 the it is not uncommon for a woman to wait for up to 10 years to receive a diagnosis for endometriosis – which affects 1 in 10 women. Many drugs, tested on male animal models, have never been tested on female biology, leading to serious questions about their efficacy. With limited focus on how symptoms of conditions such as heart attacks present differently between the genders, many women will have their symptoms dismissed by doctors, sometimes fatally so. The list goes on.
Research released earlier this year by the World Economic Forum and the McKinsey Health Institute detailed the health and economic case for closing the women’s health gap. The analysis shows that addressing the root causes of the gap could help unlock a $1 trillion annual GDP opportunity globally. Most importantly, it would help women live 7 extra days of healthy life every year.
Here is a deeper look at how this disparity began – and the steps that could help close the women’s health gap.
A lack of female-specific data is at the core of women’s healthcare disparities.
One of the most substantial barriers women encounter in healthcare is the absence of diagnostic and treatment practices designed specifically for their physiological needs. Historically, most of the medical and pharmaceutical research has been predicated on male physiology, neglecting the unique aspects of female health. This oversight means that biological pathways, diseases, and medications are infrequently studied in female physiology, leading to a scant collection of data on how various conditions affect female bodies differently.
The problem starts with funding and research. Despite the US Congress passing a law requiring inclusion of women in clinical research in 1993, a gender gap remains – for example, only 11% of the NIH’s health budget is spent on women-focused research, which creates gender disparity before a patient even begins to seek care. Women continue to be underrepresented in clinical trials, with the lowest female participation observed in cardiovascular trials at only around 41%, despite heart disease being the No. 1 cause of death in women. Although post-menopausal women are often the most affected by heart disease, they also have the lowest study participation rates (26%). In some cases, this underrepresentation may start even before human trials, as historically, stem cell and animal models also have lacked female representation. Further, literature reviews show that less than 50% of clinical trials have sex-disaggregated data. Sex should be factored into the foundational design of trials, rather than being considered only when discrepancies in outcomes arise. For instance, between 1997 and 2000, the Food and Drug Administration withdrew ten pharmaceuticals from the market because of severe side effects, with eight affecting women more adversely.
Academia also plays a role in perpetuating these disparities: in one survey of over 40 medical schools in Canada and the US, 70% did not formally include sex- or gender-specific content in their curriculum. One 2023 survey of ob-gyn residency programs found that only a third had menopause curriculums. This dynamic narrows the definition of women’s health focus to reproductive health alone and significantly limits our understanding of women’s health at the person, not organ-system, level, perpetuating a cycle of male-centric care practices that fail to meet the needs of female patients. Women’s health needs to be redefined as the understanding of all conditions that impact women uniquely, differently, or disproportionately compared to men.
The information deficit not only affects treatment efficacy, but also influences how women seek medical attention. Many health conditions manifest differently in women, yet a general lack of awareness among both patients and healthcare providers about these gender- and sex-specific symptoms can restrict timely and accurate medical intervention. For instance, male patients typically experience sharp chest pain and shortness of breath during a heart attack, which is the dominant paradigm of heart attack symptomatology. Female patients, however, more often suffer symptoms like arm, back, or jaw pain, along with indigestion, nausea and fatigue. Lack of awareness of female heart attack symptoms can lead to critical delays in care seeking, diagnosis and treatment, with a median delay in care seeking of 54 hours from symptom onset in women versus just 16 hours in men. This disparity exemplifies the urgent need for a healthcare system that acknowledges and accommodates the unique medical requirements of women.
Women face more barriers than men in accessing healthcare services, and when they do seek care, they frequently face underdiagnosis, misdiagnosis and suboptimal treatment.
Beyond the lack of gender- and sex-specific data and awareness, societal expectations also discourage women from seeking timely medical treatment. Sociocultural barriers that reduce women’s likelihood to seek necessary care include the way women are often discounted and disbelieved when they seek care, with providers consistently underestimating female patients’ pain and nearly 30% of women stating they’ve had their health concerns dismissed by a provider. Women, on average, have less time than men to prioritize their own health concerns, with employed women spending 44% more time on household responsibilities than their employed male counterparts. These barriers contribute to delayed diagnoses, and even when women do seek care, they are often under- or misdiagnosed and undertreated.
Endometriosis represents another prime example of how gender bias leads to delayed treatment, misdiagnosis, and poor health. Endometriosis is a common condition in which uterine tissue grows uncontrolled outside the uterus, often resulting in severe – sometimes debilitating – menstrual pain and bleeding. Despite affecting 1 in 10 people with uteruses worldwide, it can take years to receive an endometriosis diagnosis. Among the factors are the invasive nature of diagnostic procedures, a lack of extensive gynecological research, and societal norms that mean some women may view severe menstrual pain as a normal aspect of female health. To compound these dynamics, endometriosis often presents as abdominal pain, which, combined with a systemic discounting of women’s pain, leads many providers to misdiagnose it as irritable bowel syndrome (IBS), a common neurogastric condition that disproportionately affects women and has few researched treatments. A more patient-centric standard of care for endometriosis diagnosis and treatment – including less-invasive, non-surgical diagnostic methods – could help increase diagnosis rates and alleviate the associated physical and emotional distress. Increased funding and clinical research initiatives could potentially spare young women the need for hysterectomy.
Lack of treatment efficacy in female patients pose another barrier to quality care.
Even when therapies are effective and safe for women, there is disparity in how frequently or how long it takes for women to receive them when compared to men. For example, men are more than three times as likely to receive cardiac resynchronization therapy for arrhythmias, a treatment that can significantly enhance quality of life, highlighting a gender bias in treatment availability and application. Further, women wait 11 minutes longer on average than men when seeking care for chest pain, which can result in life-threatening consequences for those patients experiencing a heart attack. This dynamic contributes significantly to the distressing statistic that women are 50% more likely to die within a year of a heart attack compared to men. Despite this, in 2019, only 4.5% of the NIH budget for coronary artery disease was allocated to women-specific research.
Despite its widespread prevalence, investment in developing endometriosis treatments is disproportionately low compared to investment in treatment development for other conditions with similar prevalence. There are less than 30 biopharmaceutical products currently in clinical development. In stark contrast, diabetes mellitus, which affects 1 in 10 adults worldwide, has a robust pipeline of more than 500 products in development.
Endometriosis exemplifies the broader issue of underdiagnosis and undertreatment that many women face. However, the problem extends further when treatments do exist, but in some instances, they are neither as effective nor as safe for women as for men. One example is heart disease, the leading cause of death for women in the US. Take digoxin, a drug approved in 1954 to treat heart failure and arrhythmias. It was not until nearly half a century after its approval for use in all sexes that digoxin was found to increase the risk of death from heart failure in females, despite having no such effect on males.
Closing the women’s health gap.
Based on these facts, key initial steps at the health system level to enhance women’s health equity include:
Expanding knowledge of gender- and sex-specific science: Clinical researchers should be educated on the importance of collecting data that includes sex attributes, from basic research through human clinical trials. This data should be incorporated as a standard study design and results reporting component in publications. The scientific community needs to incorporate this data into further research to understand sex-based differences and study interventions that are effective for each gender.
Developing gender- and sex-specific treatments: This involves creating therapeutic protocols tailored specifically to women and female patients and ensuring that women are adequately represented in clinical trials to verify the effectiveness and safety of treatments in all genders and sexes.
Enhancing provider education on sex- and gender-sensitive provision of care: Healthcare providers should deepen their understanding of the physiological and pharmacokinetic differences between sexes. They should be trained to recognize and understand both the symptoms associated with female-specific conditions and how presentations of common conditions vary across gender and sex. This training can also address gender- and sex-based biases that could affect diagnostic and treatment decisions. Further, providers should incorporate sex- and gender-specific data into their treatment practices to ensure women and females receive the highest standard of care.
It is essential to acknowledge that bridging the women's health gap demands a unified effort from all involved parties. Just as crucial is the understanding that even modest initiatives can have a profound impact on lives. Therefore, whenever a woman or caregiver goes to a medical appointment, take time to read up on women's health and gender- and sex-specific care. This information can help individuals become effective advocates for women’s health. By collectively taking informed steps, everyone can make significant strides towards eliminating the women's health gap.
About the Authors:
Megan Greenfield, PhD is a Partner with McKinsey & Co. and Affiliated Leader of the McKinsey Health Institute. She co-leads the Firm’s work on women’s health in the US and is a leading expert in healthcare and health equity.
Lucy Perez, PhD is a Senior Partner with McKinsey & Co. and Affiliated Leader of the McKinsey Health Institute, where she leads the Institute’s work on health equity. She is a leading expert in healthcare and life sciences, and the lead author of Closing the women's health gap: A $1 trillion opportunity to improve lives and economies.
Lucy and Megan recently published “Bridging the women’s health gap: A country-level exploration” and “The state of US women’s heart health: A path to improved health and financial outcomes” with the American Heart Association. The latter was featured on Good Morning America.