Inspiring Inclusion: Women’s Access to Medicines on International Women’s Day 2024

Introduction

This year, the focal theme of International Women’s Day 2024 is “Inspiring Inclusion”, emphasising the significance of creating an inclusive society where women are valued, respected, and empowered to participate fully in all aspects of life. What better way to begin this mission than addressing the challenges women face in gaining equal access to healthcare across the globe? March 8th 2024, offers time and space for reflection on past achievements and strategising for future endeavours. However, one might question the real advancements made in bridging the gender gap over the past ten years. Have countries directed sufficient efforts and resources toward elevating women's social standing and enhancing their health and overall well-being? Worldwide, women are fundamental to the healthcare industry, representing a significant portion of the workforce (70%) but only 25% hold senior roles (1) and a striking disparity exists between their contributions and the healthcare they receive.

Women encounter numerous challenges within the healthcare system, including differences in diagnosis, access to care, and treatment biases. Historically, the healthcare system has been developed without fully considering gender differences, leading to a neglect of women's specific health requirements, which is evident from the design of research studies to the implementation of clinical practices. In an era where women’s health is finally being recognised as a priority (e.g. Ruth Devlin’s “Let’s Talk Menopause” (2)), it is vital for national health leaders to call for systemic reforms and utilise the voice of women to tackle gender inequity in healthcare. In celebration of International Women’s Day 2024, Decisive Consulting are proud to explore and provide insight for our community on the importance of advocating for inclusion in healthcare and academia.

Gender inequity in healthcare

Over twenty years of studies have shown that women consistently face barriers to accessing crucial medical treatments. Research from Deloitte estimates that in the United States, the healthcare expenses for working women surpass those of working men by $15 billion, even after accounting for services related to maternity (3). A systematic review on bias in healthcare professionals shows that the valuation of healthcare options is influenced by inherent gender biases and deprioritisation of women's healthcare needs (4). For example, vital treatments, such as organ transplantation, are affected by gender inequalities and have remained unchanged for over twenty years (5). Legislation or policies to address these are non-existent. In fact, disparities were amplified since?the introduction of the Model for End-Stage Liver Disease (MELD)-based liver allocation system in 2002 (5). Furthermore, women with kidney diseases are less frequently recommended for transplant evaluations and consequently have lower transplantation rates, even though they constitute the majority of living kidney donors (5). Similar biases are also present in other medical specialities, such as cardiology, where women receive suboptimal care for cardiovascular disease-related conditions and are exposed to potentially harmful drug-disease interactions (6).

A worldwide study analysing the gender gap using survey data from 59 nations, revealed that women consistently report worse health than men across all self-assessed health metrics. Women had a 15% higher rate of reported health issues related to functioning and chronic conditions (7).

An additional window into the apparent gender inequity in healthcare is through the clinical practice guidelines. The British Medical Association (BMA) report that historically men have been treated as the default patient in the context of clinical practice and research, but to what extend does this still play a role? (8). With underrepresentation of female patients’ data to underpin clinician recommendation for diagnosis and treatment, there is risk of developing suboptimal treatment pathways that do not account for how women experience disease. A key example of this is in the treatment of multiple sclerosis (MS). As recently as 2019, when women with MS became pregnant, the Association for British Neurologists (ABN) guidelines advised clinicians to stop treatment with disease-modifying therapies (DMTs), which would eventually result in a relapse of MS. However, a change to the clinical MS guidelines on the use of DMTs in pregnancy, fuelled by patient-specific data, means fewer clinicians are unnecessarily stopping treatment early (9). As a result of this update to the guidelines, the MS patient and clinician community can expect improved outcomes for pregnant women with MS. This step change in the tailoring of the treatment pathway for women is vital to achieve inclusivity in healthcare.

Gender inequity in academia

In academia, the gender citation gap highlights a significant issue of bias, where research by male scholars tends to receive more acknowledgment than that of their female peers. Citation metrics, vital for evaluating productivity and influencing academic decisions like hiring, tenure, and grant awards, often favour men, sidelining equally significant research led by women. This discrepancy is partly due to men citing other men more frequently than they cite women and engaging in more self-citation (10).

A 2017 National Institute of Health (NIH) report revealed that among 16 NIH directors, only one was a woman and among the top 10 US research institutes a maximum of 26% tenured professors were female (11). Additionally, despite women constituting 57% of PhD program applicants in 2016-2017, only 30% of PhD enrolments were of women. Furthermore, NIH reported alarmingly high rates of sexual harassment in academia, with up to 58% of faculty and staff and 20 to 50% of students affected. Such challenges not only hinder women's advancement in academia but also impact healthcare innovation (12). In Europe, the European Research Council reported only 32% female panel members and 27% female grantees during the Horizon 2020 program.

These data indicate a widening gender gap across all academic facets, from citations to awards and tenure decisions, leading to a decrease in women pursuing scientific careers at higher levels.

Effect of gender inequality: Healthcare workforce

Despite constituting the majority of the healthcare sector's workforce, women are underrepresented in senior leadership positions. Initiatives like administrative fellowships for early-career professionals have been proposed to accelerate gender equity in leadership roles. However, a longitudinal investigation into career advancement over time among individuals with similar levels of educational achievement has demonstrated that such programs tend to favour men more than women.? Consequently, bridging the gender gap in leadership positions might necessitate not just general but also targeted career development interventions (13).

In several countries, employers are required to disclose their gender pay gaps. A mandate initiated by the UK government in 2017 for organisations with 250 or more employees is credited with making some progress in narrowing the gender wage disparity (14). The 2022 data showed a median gender pay gap of 10.9%. Between 2022-23, the median hourly wage gap decreased by 0.6 percentage points, and the mean wage gap was reduced by 0.2 percentage points (14). Despite these improvements, progress is slow, and a greater push for transparency is necessary. According to Global Health 50/50, which evaluates the gender equality policies of nearly 200 global health organisations, only one in four organisations publicly shared their gender pay discrepancies in 2023. Most of these disclosures were from UK-based organisations, highlighting the impact of mandatory reporting laws.

Moreover, the female workforce within health policy research is earning on average 3.2% less than their male counterparts, a discrepancy already prevalent among clinical practitioners. This shows the necessity for those involved in the development of health policies to bear responsibility and address gender imbalances within the sector as merely advocating for transparency is insufficient (15).

Effect of gender inequality: Market access through a patient lens

Gender inequality also has a significant impact on patient access to innovations and future treatments. With women underrepresented in prevalence estimates for diseases that impact both women and men, there is a downstream effect when building the patient burden and cost-effectiveness case for new healthcare intervention submissions. For instance, gender biases in the context of pain management have profound impact on treatment of pain disorders that women primarily experience. As previously discussed, research indicates that physicians are more likely to interpret men’s symptoms as organic and women’s as psycho-social, and female patients are assigned more nonspecific symptom diagnoses. An example of where this has taken its toll is in the undertreatment of dysmenorrhea, which has implicated a challenge in realising the market potential for dysmenorrhea medications, leading to limited investment and treatment availability for women. The effect of this risk is suboptimal access to life-changing medications for both men and women as national health technology assessment bodies evaluate the clinical, health-related quality of life (HR-QoL) and cost-effectiveness of a treatment. This demonstrates the requirement for national health leaders, clinicians, and researchers to reassess gender bias through a patient access lens to better represent female patient data and enable increased access to innovative medicines.

Solutions and initiatives

The Women’s Health Strategy for England (16) is making significant steps toward gender inclusivity in healthcare by proposing a gender-neutral, needs-based healthcare system in order to improve both men and women’s health. Additionally, the Global Alliance for Women’s Health (17) was initiated by the World Economic Forum in January 2024 in Davos to transform the funding and prioritisation of women’s health. Even MDPI, a scientific publisher of open access Journals, are on an active mission to highlight research focusing on women’s access to healthcare and healthcare treatments tailored to gender inclusivity, by creating a collection of open access articles focusing on women’s healthcare. Building awareness and policy updates such as these are the stepping stones to bridging the gap of gender inequality in healthcare access.

There are no simple solutions to combat gender inequality. Despite numerous initiatives aimed at reducing gender bias over recent years, comprehensive evaluations of their effectiveness in promoting diversity have concluded insufficiency. Diversity training is often proposed as a strategy to diminish gender bias, as well as enhancing the presence of women in various roles within scientific organizations—such as on hiring committees, review panels, and in mentorship roles. It's critical to acknowledge, however, that merely increasing female representation does not fully solve the issue of gender bias. Sometimes, women themselves can harbour gender stereotypes, even against their own gender. Therefore, it's critical not just to boost women's numbers but also to implement and monitor governance models that assess the effectiveness and implementation of anti-bias measures, ensuring that they truly address and reduce gender bias.

Conclusion

To conclude, the journey toward gender equality necessitates a unified approach from all involved parties, including government officials, medical professionals, researchers, and the wider community. Acknowledging and actively addressing biases and inequities within the system is essential for cultivating an environment that equally benefits individuals of all genders.?Education and learning are the most powerful tools to empower women around the globe, therefore?expanding fellowship opportunities for women is a critical step towards closing the leadership gender gap. Moreover, the recruitment and selection processes by educators and employers should be scrutinised for gender bias. Educators must examine the gender dynamics within fellowship programs, while employers should evaluate their procedures with a gender perspective to uncover unconscious biases and enhance inclusivity. Organisations are also encouraged to collaborate more effectively with stakeholders to gather demographic information. This data collection will enhance the monitoring of progress and indicate necessary actions towards achieving gender equity in healthcare, ultimately leading to a more inclusive, equitable, and effective healthcare system for all.

References

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