The invisible gap in women's health

Thanks to the push of international organizations, health inequality affecting women has become one of the priority issues on the political agendas of governments in several countries. I spoke about it In this column we analyze cases of good practices, such as the strategy adopted by the UK Department of Health and Social Services to promote women's health. Today's article focuses on a more global perspective to characterize the magnitude of the problem, its causes, economic impact and possible solutions.

Although, globally, women live 8% longer than men (life expectancy of 73.8 versus 68.4 years), according to thereport According to a study by the World Economic Forum and the McKinsey Institute for Health, women live 25% longer in poor health or with varying degrees of disability than men. More than half of these differences appear in the working age (20-64 years) and are therefore unrelated to the greater longevity of women.

There are three causes that explain this inequality in health: the lack of scientific evidence, the differences in the effectiveness of treatments, and the bias in access and quality of medical care. These three elements are not independent, but rather reinforce each other. The inequality originates from the lack of data on the incidence of diseases and the effectiveness of medications for women. For example, although women make up 50% of cases of coronary disease, we only represent 25% of the participants in the clinical trials. The low participation of women is the reason why most studies do not show the results disaggregated by sex. At the same time, the lack of data makes the differential aspects that affect women's health invisible and reinforces their underfunding within the totality of biomedical research funds. This includes both diseases that affect the entire population as well as health problems that only affect women. From the National Institute of Health, the main source of public funding in the United States, the focused studies Five times more studies are funded for erectile dysfunction than for premenstrual syndrome.

Consequences of scientific bias

The combination of the lack of gender-differentiated scientific data and the lower representation of women in clinical trials results in significant differences in the effectiveness of treatments. Since 2000, adverse effects of medications The number of drugs that have already been approved by the US Food and Drug Administration affects 52% more women. The figure is still high, 36%, if we restrict ourselves to adverse effects with serious or fatal consequences.

These two elements lead to the third, the bias in access and quality of medical care, which manifests itself in the barriers that female patients encounter when receiving a diagnosis. One study The study, which uses data from the past 21 years in Denmark, shows that most women are diagnosed late in the 700 diseases analysed. In the case of cancer, women are diagnosed 2.5 years later than men, while in diabetes the delay is 4.5 years.

These health inequalities affect women's well-being, but also their labour participation, productivity, likelihood of promotion and, ultimately, their wages. According to the most recent estimates, the complete elimination of these inequalities would result in a 1.7% increase in global GDP. Despite the costs that this exercise would entail, the economic return on this investment in women's health is clearly positive: every dollar invested generates an economic gain of 3 dollars.

The policies that can be implemented to reduce these inequalities have clear parallels with their causes. The availability of sex-disaggregated data on the incidence of diseases and the effectiveness of treatments is crucial. If the prevalence of certain diseases, such as endometriosis, is underestimated, the market potential of potential drugs and the investment of public and private entities are reduced. At the same time, favouring the elderly is a major disadvantage. women-led research projects implies, de facto, a prioritisation of research into women's health, due to the areas of specialisation of the scientists who carry out medical research. The inclusion of gender differences in the manifestation of disease symptoms within medical education and practice curricula would also be a crucial step forward. Much remains to be done, but much to be gained.