Balancing the scales in women’s health

Balancing the scales in women’s health

The health of women is not a woman’s problem, it is a universal societal problem,” – Dr Stacey Rosen, senior vice president, Kazt Institute for Women’s Health Northwell Health, US

Modern-day advances in science and medicine have transformed health outcomes. Many diseases previously considered life-limiting, like HIV-acquired AIDS, can now be managed as chronic conditions. Effective global health vaccination programmes have eliminated deadly viral infections like childhood smallpox. The result – on a population level, people today are leading healthier and more active lives for longer. However, inequities still exist that have a detrimental effect on the diagnosis, treatment and care that women receive.?

As a female health leader, a sister, a mother of two teenagers and a daughter to my mother, who lost her life to colorectal cancer in the midst of the COVID-19 pandemic, the current state of healthcare for women is one of deep personal concern. Now is the time for action to protect, preserve, and in some cases restore, women’s fundamental human rights to adequate healthcare. That’s one of the reasons why I’m so proud to work at Roche, which is at the forefront of this work .?

So much data fails to take into account gender - because it treats men as the default and women as atypical - bias and discrimination are baked into our systems.” - Caroline Criado Pérez, Author of Invisible Women

The root causes of inequalities for women can be seen at every step of the healthcare journey, from bench to bedside and into the community:?

Under-representation in R&D: It is less than 30 years since the U.S. Food and Drug Administration allowed women to participate in clinical trials. This means the vast majority of historical disease and treatment insights are through the lens of men and fail to take into account the characteristics of female biology. Additionally, many diseases and conditions that are not linked to male or female anatomy, like visual impairment, blindness and lupus, have a disproportionate prevalence in women vs. men.[2,9] It is not only clinical trial participants who experience unfair bias, female principal investigators are less successful in securing funding than males, and, on average, funding for research in diseases that primarily affect women lags behind male-driven diseases.[8,10]

Access to frontline healthcare services: Barriers to accessing healthcare are complex and unique across distinct communities of women. For example, healthcare systems do not adequately serve women in the poorest socio-economic brackets; sexual health is often associated with taboo and stigma; and the pressures of juggling work and family life means that women often deprioritise their own health needs for the family. I saw this first-hand when I visited Tanzania as part of NJIA , a leadership development programme aimed at improving cervical cancer prevention and care in the country, where one of the biggest barriers to disease awareness was people simply being uncomfortable with discussing it openly.???

Experience of the care pathway: A poor experience of the care pathway can not only delay accurate and timely diagnosis and treatment, but it can also stop women from accessing healthcare services in the future. Sadly, unconscious bias is a key driver of dissatisfaction with care pathways. Chronic pain is often considered exaggerated among women, and while men are perceived as ‘brave’, women are ‘emotional’ or ‘hysterical’. In emergency rooms, women wait on average 16 minutes more than men to receive pain relief.[6]?

Outcomes reporting: Despite subsequent improvements in the representation of women in clinical trials, sex-based reporting still falls far behind. Only approximately a quarter of clinical trials conducted in the US in 2015 categorised outcomes according to men and women.[11] As a result, the picture of how emerging treatments affect women is incomplete, and vital opportunities to feed sex-based insights back into the healthcare loop are missed.?

If you believe in your idea of change and are willing to work hard, sooner or later that dream will be a reality,” - Naomi Tulay Solanke, Founder/Director of the Community Healthcare Initiative INC, Liberia

Narrowing the gap in women’s health is a collective responsibility among industry, healthcare systems and governments. Partnering is key to making meaningful change happen. At Roche, we are prioritising women’s health by working with individuals, organisations and policy-makers to integrate sustainable healthcare provision for the most under-served and overlooked women.??

In my previous role as Area Head in the Asia-Pacific region, I was a founding member of 2030 Mission Leapfrog , a collaboration between Roche and ecosystem partners to accelerate transformation in healthcare outcomes in Asia that improve the lives of people and strengthen society. In partnership with people across the region, we are working to find new ways to expand access, improve outcomes and provide more options for people affected by diseases and healthcare gaps. The team, including Diana Edralin, MD, DPCOM , Marco Valencia Sanchez , Farid Bidgoli , Pichetpong srisuwankul , Lance Little , Ahmed Elhusseiny , Mark Burrell , Antonio Estrella and Ankit Tandon , is already making a tremendous difference:

Educate -> equip -> empower

  • In Bangkok, a healthcare system weighted in favour of treatment versus prevention means many eligible women are not being screened for cervical cancer. A pilot project with the Thailand National Cancer Institute and beauty brand, Wacoal, simplified screening access via ‘Health Wallet’, a smartphone app. From 242 pilot participants, 18 positive results were found and 99% of women said they would recommend the service to others?
  • In 2020, zero human papillomavirus (HPV) DNA tests were administered in the southern provinces of Thailand.[12] A pilot project educating women on how to use self-collection HPV tests led to more than 12K samples collected by March 2022, with plans for scaling clinics in progress??
  • In the Philippines, female teachers are seen as trusted voices for the community, educating girls and women inside and outside of schools. A four-step programme of education -> screening, diagnosis and treatment -> financial support -> integration into health policy is helping identify teachers at risk of breast or cervical cancer, creating a halo effect for other generations?

Representation of women in clinical trials is a key issue to address for future generations. Take lupus, approximately 90% of people affected are women, and there is a disproportionate prevalence among women of colour.[9,13] However, historically clinical trials have not reflected the racial epidemiology of this disease. At Roche we have employed new strategies to encourage more women of colour to join clinical studies. Additionally, I’m proud that Roche has further prioritised women’s health by launching XProject earlier this year, a long-term commitment and ongoing initiative to drive meaningful change through partnerships, funding and action to help close the gaps across all fields in women’s health.??

The ideal future is one where the current gaps in knowledge, and systemic and societal barriers to equitable healthcare are bridged, and women can consistently and confidently expect the same experience of the care pathway and outcomes as men. The first step to achieving this is facilitating worldwide acceptance of the challenges faced and a collective commitment from all stakeholders to prioritise the needs of women and move health equity from an aspiration to reality for future generations.??

References

  1. Angum F, et al. The Prevalence of Autoimmune Disorders in Women: A Narrative Review. Cureus. 2020;12(5):e8094.
  2. Doyal L, et al. Sex, gender and blindness: a new framework for equity. BMJ Open Ophthalmology. 2018;3:e000135.
  3. van Vollenhoven RF. Sex differences in rheumatoid arthritis: more than meets the eye... BMC Medicine. 2009;7:12.
  4. Cephus JY, et al. Testosterone Attenuates Group 2 Innate Lymphoid Cell-Mediated Airway Inflammation. Cell Reports. 2017;21(9):2487-99.
  5. Richardson LC, et al. Patterns and Trends in Age-Specific Black-White Differences in Breast Cancer Incidence and Mortality – United States, 1999–2014. Morbidity and Mortality Weekly Report. 2016;65(40):1093–98.
  6. Chen EH, et al. Gender disparity in analgesic treatment of emergency department patients with acute abdominal pain. Academic Emergency Medicine. 2008;15(5):414-8.
  7. Hull R, et al. Cervical cancer in low and middle-income countries. Oncology Letters.?2020;20(3):2058–74.
  8. Mirin A, et al. Gender Disparity in the Funding of Diseases by the U.S. National Institutes of Health. Journal of Women's Health.?2021;30(7):956–63.
  9. Lupus Foundation of America. Lupus facts and statistics [Internet; cited 2022 October]. Available from: https://www.lupus.org/resources/lupus-facts-and-statistics .?
  10. Witteman H, et al. Female grant applicants are equally successful when peer reviewers assess the science, but not when they assess the scientist. The Lancet. 2019;393(10171):531-40.
  11. Geller S, et al. The More Things Change, the More They Stay the Same: A Study to Evaluate Compliance With Inclusion and Assessment of Women and Minorities in Randomized Controlled Trials. Academic Medicine. 2018;93(4):630-5.
  12. Roche data on file.
  13. Pons-Estel G, et al. Understanding the Epidemiology and Progression of Systemic Lupus Erythematosus. Seminars?in?Arthritis?and?Rheumatism. 2010;39(4):257.

Absolutely, the dialogue on universal healthcare coverage and bridging the gap for women is crucial. ???? As the wise Mahatma Gandhi once said, “It is health that is real wealth and not pieces of gold and silver.” Let's work together to enrich our greatest asset by ensuring equitable health access for all women. It’s not just about making history; it’s about crafting a fairer, healthier future. ????? #WomensHealth #EqualityInHealthcare #FutureGenerations

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Farid Bidgoli

GM for Roche Türkiye

2 年

I loved your bench to bedside representation of the challenges faced by women across the Healthcare ecosystem. Congratulations on a fantastic article and for raising awareness of the challenges that exist.

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Wonderful message Rachel, I’m with you 100%. And Yvette Miata Petersen PhD, PMP, you are a driving force in advancing R&D!

Kara Brotemarkle

Enterprise Leader for Commercialization Excellence

2 年

Thanks for highlighting the sobering statistics (I recall it blew my mind to find out that after over a decade in Pharma, I was only just realizing how underrepresented women had been in our most historical and fundamental steps toward medical innovation). I appreciate that you bring not just your voice to the issue but also catalyze action to find solutions to address this on a larger scale and support better care for women. I'm so happy to have been (and continue to be!) a part of that mission!

Mark Burrell

Systems Leadership / Team Coaching / Leadership Impact

2 年

Terrific article Rachel. Thank you for laying out th challenge and possibility. Im so pleased that www.missionleapfrog.com is playing its part.

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