The Missing Half: Closing the Gap in Women’s Health Research
75 million – that is the number of years of life lost due to the long-standing gender gaps in health research. Not only does this number reflect a major health crisis, but also a deeply undervalued area of research and investment: the missing half of medicine, where women’s health needs have been historically overlooked.
A lack of inclusive clinical trials and investment in women’s health research limits the development of evidence-based care, undermining their right to the highest attainable standard of health. These consequences extend far beyond the healthcare system, as these research disparities contribute to poorer health outcomes, reducing women’s ability to fully participate in leisure, work, and everyday life. With good health being directly correlated with economic prosperity, completing the missing half presents a great economic opportunity.
It was only in 1997 that the Government of Canada formally acknowledged the need for more inclusive clinical trials and that gender played a role in differing responses to drugs. Before then, women were excluded from clinical trials for a number of reasons. One prevailing assumption was that clinical testing for one half of the population was enough; that the symptoms, treatment, and reactions faced by biological men were equivalent to those faced by biological women. Today, we know that this assumption is false and women around the world are bearing the consequences: they are twice as likely to develop Alzheimer's Disease, experience higher mortality following a heart attack, and are 14% more likely to experience chronic pain. These are only a few of the many discrepancies in statistics that reflect the gender health gap. Additionally, there was the ethical dilemma surrounding clinical trials: should women of child-bearing potential be included in early stage clinical trials? Well, in 1977 the FDA recommended against it. This recommendation was followed by a series of protests advocating that women should be able to choose whether to take on the risk of participating in research. Nevertheless, women continued to be excluded from these trials, leading to incomplete data on half of the world’s population.
Of course, research and development can’t take place without financial reinforcement, and yet women’s health research only accounts for 7% of funded grants in Canada across the past 15 years. The issue is not only the lack of funding but the narrowness of the scope. Only 1% of all research and development funding globally focuses on non-cancer related women’s health. With this 1% mainly going towards gynecological, fertility, and maternal health, very little funding goes towards studying the actual gender-based differences in the drugs used by women daily.
Addressing the gender-based health gap will require a multifaceted approach: increasing women’s representation in clinical research leadership, improving education, and expanding research investment. Increasing female representation in clinical trials starts from the top down, as clinical trials led by women have been proven to attract more female participants. Greater representation in leadership helps foster trust, improves strategies for attracting female participants, and encourages research teams to consider the unique needs of women when designing the trials; ultimately increasing female enrollment. In addition, the key differences in the diseases and symptoms experienced by women as well as the best course of treatment for them should also be embedded into our education system for healthcare professionals. Likewise, we need to ingrain the importance of inclusive trials into the minds of clinical researchers to ensure complete data that is reflective of the entire population. To improve research activity in the neglected areas of women’s health, further investment is imperative. Investors and innovators who use gender-informed approaches to medical innovations should be targeted by public investment by governments. To attract private sector investment, incentives such as tax credits or prize-based funding should be implemented.
Closing the gap also presents a significant economic opportunity: an estimated $100 billion USD or more in potential market value in the United States through improved diagnostics and treatment of just some of the common health conditions faced by women.The economic implications extend far beyond this estimate, as ensuring women receive evidence-based care on a global scale could unlock significant gains in productivity, participation, and economic growth. This can be attributed to the fact that healthier women create a healthier work force, benefitting not only women themselves but also the employers, families, and economies that depend on their participation. Furthermore, closing the gap means healthcare system savings with fewer hospitalizations and long-term care costs. Additionally, closing research gaps leads to opportunities for new pharmaceuticals, medical devices, diagnostics, and digital health technologies, expanding the market and creating new commercial opportunities within the healthcare sector.
Closing the gender-based research gap is a major undertaking with major benefits. It will require the collective effort of governments, healthcare leaders, educators, clinical researchers, investors, and society as a whole to continue to challenge historical biases and build a future where everyone can receive equitable and evidence-based care. With further representation, education, and investment, we can close the gender-based health research gap, improving health outcomes while unlocking economic opportunities through innovation, productivity, and a healthier work force.