1、Closing the Womens Health Gap:A$1 Trillion Opportunity to Improve Lives and EconomiesI N S I G H T R E P O R TJ A N U A R Y 2 0 2 4In collaboration with the McKinsey Health InstituteImages:Getty Images 2024 World Economic Forum.All rights reserved.No part of this publication may be reproduced or tra

2、nsmitted in any form or by any means,including photocopying and recording,or by any information storage and retrieval system.Disclaimer This document is published by the World Economic Forum as a contribution to a project,insight area or interaction.The findings,interpretations and conclusions expre

3、ssed herein are a result of a collaborative process facilitated and endorsed by the World Economic Forum but whose results do not necessarily represent the views of the World Economic Forum,nor the entirety of its Members,Partners or other stakeholders.ContentsForeword 3Executive summary 4Introducti

4、on 51.The role of science in addressing health disparities 92.Data gaps underestimate womens health burden,limiting innovation and investment 133.Creating sex-and gender-responsive care delivery systems 164.Directing investments towards womens health 205.Closing the womens health gap could boost the

5、 global economy 246.Call to action:How to close the womens health gap 30Conclusion 34Contributors 35Endnotes 36Closing the Womens Health Gap:A$1 Trillion Opportunity to Improve Lives and Economies2ForewordLucy Prez Senior Partner,McKinsey&Company;Affiliated Leader,McKinsey Health Institute,USAShyam

6、Bishen Head,Centre for Health and Healthcare;Member of the Executive Committee,World Economic ForumClosing the Womens Health Gap:A$1 Trillion Opportunity to Improve Lives and EconomiesJanuary 2024Closing the Womens Health Gap:A$1 Trillion Opportunity to Improve Lives and Economies3For all the effort

7、s to improve gender equity over the past century,the gap between mens health and womens health remains wide,whether its in research,data,care or investment.And every person on the planet is affected by the womens health gap,whether they know it or not.When we consider the impact of closing the gap,w

8、e are not just talking about womens lives,but those of people we love,our communities and the world at large.We know its possible to reach equity in health for men and women.In this report,Closing the Womens Health Gap:A$1 Trillion Opportunity to Improve Lives and Economies,were pleased to showcase

9、how the narrowing of the womens health gap would allow 3.9 billion women to live healthier,higher-quality lives.It could also allow at least$1 trillion to be pumped into economic productivity annually,which reflects how narrowing the gap would lead to fewer early deaths,fewer health conditions,exten

10、ded economic and societal capacity to contribute,and increased productivity.Of that,the largest impact would be created from women having fewer health conditions,letting them avoid 24 million life years lost due to disability and boosting economic productivity by up to$400 billion.Womens health enco

11、mpasses more than women-specific conditions,and achieving health equity is possible with intentional,coordinated efforts.While there are many ways,large and small,for a wide range of organizations to improve womens health,specific actions could create meaningful impact.Among these are investing in w

12、omen-centric research;collecting and analysing sex-,ethnicity-and gender-specific data;enhancing access to gender-specific care;creating incentives for new financing models;and establishing business policies that support womens health and strengthen womens representation in decision-making.We invite

13、 leaders from the public,social and private sectors to review this report and find ways to bring their own contributions to filling the gap in womens health outlined here.We are excited to see recent momentum in addressing this gap,such as the debut of the Womens Health Innovation Opportunity Map;1

14、the recent creation of the White House Initiative on Womens Health Research;the launch of the Womens Health Interest Group from the European Institute of Womens Health;and news that Australia is on track to become one of the first countries to eliminate cervical cancer.In this multi-year research ef

15、fort,the analysis backs up one of the core beliefs of everyone involved:that we all have a role to play in improving womens lives.As Nobel Prize winner Malala Yousafzai once said,“We cannot succeed when half of us are held back.”Executive summaryClosing the Womens Health Gap:A$1 Trillion Opportunity

16、 to Improve Lives and Economies4Investments addressing the womens health gap could add years to life and life to years and potentially boost the global economy by$1 trillion annually by 2040.When discussing the challenges in womens health,a common rejoinder is that women,2 on average,live longer tha

17、n men.But this neglects the fact that women spend 25%more of their lives in debilitating health.Addressing the gaps and shortcomings in womens health could reduce the time women spend in poor health by almost two-thirds.This has the potential to help 3.9 billion women live healthier,higher-quality l

18、ives by adding an average of seven days of healthy living for each woman annually,adding up to potentially more than 500 days over a womans lifetime.Beyond the societal impacts of healthier women,including more progression in education and intergenerational benefits,3 improving womens health could a

19、lso enable women to participate in the workforce more actively.This would potentially boost the economy by at least$1 trillion annually by 2040.These estimates while significant are likely an underestimation given data limitations.In this report,womens health is defined as biological conditions and

20、general health conditions that often affect women uniquely,differently or disproportionately.There are many efforts to improve womens health globally;however,this report focuses on the economic implications of the womens health gap and the business case for closing it.The root causes of the gapThere

21、 are four primary areas that need to be addressed to close the health gap:1.Science:The study of human biology defaults to the male body,which hinders understanding of sex-based biological differences and results in fewer available and less effective treatments for women.2.Data:Health burdens for wo

22、men are systematically underestimated,with datasets that exclude or undervalue important conditions.3.Care delivery:Women are more likely to face barriers to care,and experience diagnostic delays and/or suboptimal treatment.4.Investment:There has been lower investment in womens health conditions rel

23、ative to their prevalence.This drives a reinforcing cycle of weaker scientific understanding about womens bodies and limited data to de-risk new investment.These factors play out in many different ways and to varying extents across regions and income levels.However,the evidence suggests that no geog

24、raphic region or age group is unaffected.Charting the way forwardMoving forward requires understanding the broader effects of the womens health gap,and driving action on five fronts:Invest in women-centric research across the research and development(R&D)continuum to fill the gaps in under-researche

25、d,often undiagnosed women-specific conditions(for example,endometriosis,and pregnancy and maternal health complications),as well as diseases affecting women differently and/or disproportionately(for example,cardiovascular disease).Strengthen the systematic collection,analysis and reporting of sex-an

26、d gender-specific data to establish a more accurate representation of womens health burden and evaluate the impact of different interventions.Increase access to women-specific care in all areas,from prevention to treatment.Create incentives for investment in areas of womens health innovation and dev

27、elop new financing models.Implement policies supporting womens health,such as academic institutions adapting medical school curricula and employers creating pregnancy-and menopause-friendly workspaces.An ecosystem approach,involving multi-sectoral stakeholders,is needed to accomplish these goals.It

28、is possible to create better health for women,allowing greater workforce participation and,most importantly,the ability to live healthier lives.Closing the Womens Health Gap:A$1 Trillion Opportunity to Improve Lives and Economies5IntroductionWomen spend 25%more time in“poor health”than men.Over the

29、past two centuries,the rise in life expectancy for both men and women has been a tremendous success story.Global life expectancy increased from 30 years to 73 years between 1800 and 2018.4 But this is not the full picture.Women spend more of their lives in poor health and with degrees of disability(

30、the“health span”rather than the“lifespan”).A woman will spend an average of nine years in poor health,affecting her ability to be present and/or productive at home,in the workforce and in the community,and reducing her earning potential.Terminology BOX 1:This report reflects womens health as a marke

31、t segment.The authors acknowledge the importance of healthcare to the transgender,non-binary and gender-fluid communities,and that not all people who identify as women are born biologically female.The authors have often used the term“sex and gender”to reflect inclusive language and recognize the nee

32、d for future research into health issues that is inclusive of the transgender,non-binary and gender-fluid communities.They also acknowledge the profound differences for women based on factors such as race,ethnicity,socioeconomic status,disability,age and sexual orientation.Additional work and resear

33、ch should reflect how to tackle these barriers alongside the overall womens health gap.In this report,the term“woman”includes those under age 18.Building on previous work from the McKinsey Health Institute and the McKinsey Global Institute,5 analysts quantified this health gap in terms of disability

34、-adjusted life years(DALYs),6 and the extent to which this difference is due to the structural/systematic barriers women face(Box 2,“Research methodology”).Addressing the 25%more time spent in“poor health”by women versus men would not only improve the health and lives of millions of women,but it cou

35、ld also boost the global economy by at least$1 trillion annually by 2040.This estimate is probably conservative,given the historical under-reporting and data gaps on womens health conditions,which both undercount the prevalence and undervalue the health burden of many conditions for women.Critically

36、,better health is correlated with economic prosperity.The womens health gap equates to 75 million years of life lost due to poor health or early death per year(Figure 1),the equivalent of seven days per woman per year.Addressing the gap could generate the equivalent impact of 137 million women acces

37、sing full-time positions by 2040.7 This has the potential to lift women out of poverty and allow more women to provide for themselves and their families.Addressing the drivers of this gap,namely lower effectiveness of treatments for women,worse care delivery and lack of data,would require substantia

38、l investment,but also reflect new market opportunities.While improving womens health has positive economic outcomes,it is foremost an issue of health equity and inclusivity.Addressing the womens health gap could improve the quality of life for women,as well as creating positive ripples in society,su

39、ch as improving future generations health and boosting healthy ageing.Note:Missed value from undercounting was calculated by adding the underestimated disease burden for endometriosis(difference between real endometriosis disease burden based on WHO prevalence and IHME disease weight and IHME report

40、ed endometrioses burden)and menopause(difference between real disease burden based on prevalence sizing and PMS disease weight).Source:University of Washingtons Institute for Health Metrics and Evaluation,“Global Burden of Disease Study 2019”,womens health model,used with permissionGender health gap

41、 of 75 million DALYsEquivalent to seven days per woman per year of additional health burdenGender health gap7558%34%8%Effectiveness gapCare delivery gapData gap1.Additional healthy life years of women by closing the gender health gap by 2040.Source:University of Washingtons Institute for Health Metr

42、ics and Evaluation,used with permission;Oxford Economics;International Labour Organization ILOSTAT database;Organisation for Economic Co-operation and Development(OECD);Eurostat;National Transfer Accounts project;McKinsey Global Institute analysis Womens GDP impact by age group,GDP impact in$billion

43、sAdditional healthy life years1 lived in 2040,in DALY millionsAge group08.604621056172451,0257.29.09.39.710.29.1 74.96.72.13.60708090+Total80%of the GDP impact generated in working age groupAround 60%of additional healthylife years gainedin working ageClosing the Womens Health

44、Gap:A$1 Trillion Opportunity to Improve Lives and Economies6The womens health gap 2040FIGURE 1:The challenges women face when seeking healthcare play out in multiple different ways and in different diseases and sectors of society.When looking at the potential economic impact of addressing these chal

45、lenges,all age groups and geographies could benefit,with most of the potential coming from women in the working age group(Figure 2).Womens health gap and GDP impact by age groupsFIGURE 2:1.Conditions that affect women disproportionately are defined as conditions with a higher prevalence in women com

46、pare to men but not a higher disease burden per case.2.Conditions that affect women differently are defined as conditions with a higher disease burden per case in women compared to men.3.Including maternal conditions such as maternal haemorrhage,maternal sepsis and other maternal infections,hyperten

47、sive disorders of pregnancy,obstructed labour and uterine rupture,abortion and miscarriage,ectopic pregnancy,indirect maternal deaths,late maternal deaths,maternal deaths aggravated by HIV/AIDS,gynaeco-logical diseases such as uterine fibroids,polycystic ovarian syndrome,womens infertility,endometri

48、osis,genital prolapse,premenstrual syndrome and womens-specific cancers such as uterine cancer,ovarian cancer and cervical cancer.Source:McKinsey analysis based on the University of Washingtons Institute for Health Metrics and Evaluation,“Global Burden of Disease Study 2019”,womens health model,used

49、 with permission43%are conditions that neither affect women disproportionately nor differently(e.g.ischaemic heart disease,tuberculosis)47%are related to conditions that affect women disproportionately(e.g.headache disorders,autoimmune disease,depression)1 4%are related to conditions that affect wom

50、en differently(e.g.atrial fibrillation,colon cancer)2 5%are related to womenspecific conditions(maternal and gynaecological)3Total global womens suffering47%43%4%5%Breakdown of conditions,%Nearly 50%of burden affects women of working age2064065+11.In 2016 the average pension age for a wom

51、an retiring that year was 63.7 years.Source:Disease burden from University of Washingtons Institute for Health Metrics and Evaluation,“Global Burden of Disease Study 2019”,used with permission;OECD,“Current Retirement Ages”,Pensions at a Glance,OECD and G20 Indicators,OECD Publishing,2017Closing the

52、 Womens Health Gap:A$1 Trillion Opportunity to Improve Lives and Economies7Embracing the full definition of womens healthWomens health is often simplified to include only sexual and reproductive health(SRH),which meaningfully under-represents womens health burden.This report defines womens health8 a

53、s covering both sex-specific conditions(for example,endometriosis and menopause)and general health conditions that may affect women differently(higher disease burden)or disproportionately(higher prevalence).Research shows that SRH and maternal,newborn and child health(MNCH)account for approximately

54、5%of womens health burden,9 although this is probably an underestimate.An additional estimated 56%of the burden is due to health conditions that are more prevalent and/or manifest differently in women.The remaining 43%are from conditions that do not affect women disproportionately or differently(Fig

55、ure 3).Women are most likely to be affected by a sex-specific condition between the ages of 15 and 50.Other conditions occur throughout womens lives,but nearly half of the health burden affects women in their working years,which often has an impact on their ability to earn money and support themselv

56、es and their families(Figure 4).Total global womens health burdenFIGURE 3:FIGURE 4:How health burdens affect women over their livesPregnancy complications can increase risk for chronic illnesses(for example,gestational hypertension can portend chronic hypertension,10 and women who have had gestation

57、al diabetes have a 50%risk of developing type 2 diabetes 710 years after the birth of the child).11 Good maternal health helps the mother and baby,with benefits extending beyond pregnancy and birth.Health Closing the Womens Health Gap:A$1 Trillion Opportunity to Improve Lives and Economies8Research

58、methodology BOX 2:Assessment of the womens health gap and the potential to reduce it:Analysts used the Global Burden of Disease data from the University of Washingtons Institute for Health Metrics and Evaluation(IHME)to forecast disease burdens up to 2040.This includes diseases leading to death and

59、poor health conditions such as infectious diseases and chronic conditions.To gauge how much the disease burden could be reduced,McKinsey thoroughly reviewed clinical evidence for the top 64 diseases affecting women,which account for nearly 86%of the global disease burden.12 It focused on around 180

60、interventions,based on guidelines from leading institutions such as the World Health Organization(WHO)and The Lancet.For each intervention related to the 64 diseases,McKinsey examined the following factors:Identification of potential reduction of morbidity and mortality,13 scaled up to all diseases,

61、considering the differences between men and women to identify the womens health gap Projection of total population and working population baselines with the expansion from health interventions and labour-force capacity interventions Estimation of the duration to realize the full benefits,considering

62、 both implementation time and the lag before health benefits appearCases with limited adoption data and correlated assumptions are detailed in the technical appendix.Quantification of the economic impact:To determine the potential economic effects of the proposed health interventions,analysts used p

63、opulation14 and labour force15 predictions up to 2040.These health gains were converted into labour force involvement,productivity and economic gains through four avenues:fewer early deaths;fewer health conditions;extended economic capacity to contribute;and increased productivity.The assumptions fo

64、r estimating the impacts were based on academic studies and verified by experts.This analysis acknowledges:Disease burden evolution:Unexpected events such as COVID-19 can change projections.The IHMEs disease burden data reflects the best available data.Intervention effectiveness:Given that evolving

65、scientific evidence may be inconclusive,the research included input from academic and clinical experts.Future innovations:McKinsey focused on advanced-stage technologies and consulted field experts.Addressing the womens health gap:Analysts assumed that if existing interventions are more effective fo

66、r or more frequently adopted by men,the same rates could be achieved for women.If gender-based efficacy wasnt monitored,it was assumed a similar gender gap to the ones for which data was available.Economic implications:This economic analysis makes assumptions about labour market choices.For instance

67、,how age and health affect labour force participation.Evidence such as current labour force statistics and potential labour market changes were considered.Data gap:Undercounting and undervaluing of diseases and their health burden on women likely leads to an underestimation of the womens health gap.

68、How to read this report The analysis presented in this report includes an assessment of the health burden associated with the womens health gap as measured in potential years of healthy life.16 This health improvement potential was then translated to economic potential,measured as contribution to gr

69、oss domestic product(GDP).Sections 24 of this report are focused on health improvement potential(measured in DALYs),broken down by three root causes related to disparities in science,data and care delivery.The economic value of this combined health improvement potential is presented in section 6,whe

70、re economic impact is measured in additional GDP.While this report focuses on the potential economic benefits of closing the womens health gap,there is also a moral imperative to close the womens health gap and to improve the lives of millions of women worldwide.equity encompasses access to the inte

71、rventions and options that are right for each individual,regardless of their gender,sex,sexual identity,sexual orientation,age,race,ethnicity,religion,disability,education,income level or any other distinguishing characteristic.For women,this can start with a better understanding of and access to in

72、terventions that lead to the best outcomes.The role of science in addressing health disparities1Inequality hinders knowledge.Closing the Womens Health Gap:A$1 Trillion Opportunity to Improve Lives and Economies9Researchedinterventions50%64%10%26%50%WomendisadvantagedMen disadvantagedEqual resultsFro

73、m the interventions that have sex-disaggregated data,64%were found to put women at a disadvantage due tolower efficacy,lack of access or bothNo sex-disaggregated dataWith sex-disaggregated dataSource:McKinsey analysisClosing the Womens Health Gap:A$1 Trillion Opportunity to Improve Lives and Economi

74、es10Biomedical innovation builds on the basic understanding of science around body function and the cellular and molecular pathways involved in disease development and progression.Historically,men have both led and been the subject of the study of medicine and biology.17 The majority of animal model

75、s have been based on male specimens.18 Questions about sex-based differences were rarely investigated or recorded,with the assumption now known to be false that there are few important differences in the functioning of organs and systems in men and women beyond reproduction.To understand basic femal

76、e biology better,fundamentally new research tools should be developed(for example,animal models,computational models,patient avatars and humanized models)that better classify womens symptoms and manifestations of disease(as opposed to calling those“atypical”).19There is a tremendous opportunity for

77、the healthcare and life sciences community to improve the lives of women around the world.Effectiveness of and access to medical therapies may vary There are well-known cases where women and men experience important differences in the uptake or effectiveness of a medicine designed and approved for u

78、se for both.This is true,for example,for some therapies to treat asthma and cardiovascular disease.Analysts looked at 183 of the most widely used interventions across 64 health conditions,representing roughly 90%of the health burden for women,reviewing more than 650 academic papers to assess the ext

79、ent of this phenomenon.Of the interventions studied,only 50%reported sex-disaggregated data.In cases where sex-disaggregated data was available,64%of the interventions studied were found to put women at a disadvantage,either due to lower efficacy or access,or both,while for men this was the case for

80、 only 10%of interventions.(Figure 5).Effectiveness of and access to interventions vary between men and womenFIGURE 5:Examples include:Asthma is a common respiratory condition affecting men and women at similar prevalence rates,where acute asthma exacerbations present as symptoms such as shortness of

81、 breath,wheezing,cough or chest tightness.20 Inhaler therapy with bronchodilators and corticosteroids is a mainstay of treatment.But studies indicate that this treatment is around 20 percentage points less effective in reducing exacerbations in women compared to men.21 Cardiovascular and cerebrovasc

82、ular disease particularly ischaemic heart disease and stroke is the biggest single contributor to disease burden globally for both men and women,accounting for 16%of DALYs globally for men and 14%for women.22 One German study found that despite identical technical success of a percutaneous cardiac i

83、ntervention for men and women,there was a 20%higher age-adjusted risk of death or of cardiac events in women compared to men.23 Assets in current pharma pipelines,number of assets vs.contribution to women suffering by disability(years lived in disability,or YLD)in%Assets currently in pipeline(prereg

84、istration to phase III)Note:Includes pipeline of assets(including the assets that have previously been approved for other conditions)across 67 conditions,mapped to their respective years of life lost rate and years of life lived with disability rate from the Global Burden of Disease dataset.Source:P

85、harma Projects,University of Washingtons Institute for Health Metrics and Evaluation,“Global Burden of Disease Study 2019”,used with permission39011000%100%of women suffering caused by disability90%80%70%60%50%40%30%20%10%0708090100Ovarian cancerCervical cancerUterine cancerMaternal haemo

86、rrhageEndometriosisMenopausePolycystic ovarian syndromeUterine fibroidsPMSMaternalhypertensivedisordersMaternal sepsis and other maternal infectionsWomen-specific cancersMaternal conditionsGynaecological conditionsR2=18%p=0.19Closing the Womens Health Gap:A$1 Trillion Opportunity to Improve Lives an

87、d Economies11Research in womens health primarily focuses on diseases with high mortality,overlooking diseases leading to disabilityOne way to assess research priorities is through pipeline assets.There is up to a 10-fold higher volume of new therapies in development for some of the most common women

88、s cancers compared to debilitating gynaecological conditions(Figure 6).One possible reason for this is the higher mortality rate of oncologic conditions.The solution is not to trim cancer funding,but to recognize the possibilities for advances in research related to other womens health conditions,in

89、 particular menopause,premenstrual syndrome,endometriosis and polycystic ovary syndrome.Additionally,maternal conditions should receive more attention:while they contribute a similar share to overall suffering among women compared to women-specific cancers,there is a large discrepancy in the pipelin

90、e of therapies in development.For example,even though postpartum haemorrhage(PPH)is the leading direct preventable cause of maternal mortality in low-income countries(LICs)and low-or middle-income countries(LMICs),only two new medicines shown to be effective in PPH management have been developed ove

91、r the past 30 years.24In all,when tackling womens health,the solution is not to divide more slices of one pie:its to make more pie.Pipeline assets for women-specific conditions by disease groupFIGURE 6:How the lack of sex-and gender-specific data and research affects safetySince 2000,women in the Un

92、ited States have reported total adverse events from approved medicines 52%more frequently than men,and serious or fatal events 36%more frequently.25 Healthcare professionals in the United States reported 4.4 million serious or fatal events for women versus 3.8 million for men in 2022.26 An analysis

93、of all medicines withdrawn for safety reasons a process that requires objective scientific review shows that,since 1980,products are 3.5 times more likely to be removed because of safety risks in women patients as compared to men(Figure 7).Note:Withdrawals for safety and adverse events were categori

94、zed by the risk to women,men or non sex-specific.Health risk was judged by the number of sex-reported adverse events,the number of men vs.women adversely affected by the drug based on%in trial,or higher rates of drug prescribed to men vs.women.Source:Pharmaprojects(global drug withdrawals from 19802

95、023);press searchp=0.19Withdrawals from market between 1980 and 2023,number of withdrawalsReason for withdrawalWomens health risksMens health riskNon sex-specific risksInsufficient data29%of withdrawals due to womenshealth risks216x3.521258%of withdrawals were due to mens health risks29%of withdrawa

96、ls were due to non sex-specifichealth risks34%of withdrawals did not have sufficient information on sex-specific adverse event reportingClosing the Womens Health Gap:A$1 Trillion Opportunity to Improve Lives and Economies12Global drug withdrawals by type of risk,19802023FIGURE 7:The research conduct

97、ed indicates that systematic lack of disease understanding created a womens health gap of 4045 million DALYs per year,or four days per woman per year.This is equivalent to around 60%of the total gap due to sex-related biology differences(Figure 1).This estimate includes the known gap for conditions

98、that affect both sexes and an estimate of the gap represented by the average lower effectiveness for women-specific conditions relative to men.It also includes the“unknown”gap:this is where there is no sex-disaggregated evidence available for specific conditions that could,if it existed,potentially

99、demonstrate levels of effectiveness difference comparable to conditions where sex-based analysis is available.The longevity of women cannot explain the disparity:the effectiveness gap has a disproportionate impact on women and girls between 10 and 40 years old and in certain regions such as Latin Am

100、erica and Central Asia.Shining a light on the interventions for which this information was not reported would benefit both men and women,by enabling innovators to develop interventions that are better suited for specific subpopulations.Data gaps under-estimate womens health burden,limiting innovatio

101、nand investment2Health data gaps diminish and skew the picture of womens health.Closing the Womens Health Gap:A$1 Trillion Opportunity to Improve Lives and Economies13Closing the Womens Health Gap:A$1 Trillion Opportunity to Improve Lives and Economies14Data can quantify problems and measure the imp

102、act of potential solutions.It is the critical ingredient of robust,evidence-based analysis and decision-making.Yet many of the datasets(epidemiological and clinical)widely used today fail to provide a complete picture of womens health,both undercounting and undervaluing the health burden.When womens

103、 health is invisible,there are missed opportunities to improve lives,especially among women and girls in vulnerable populations.27 A lack of data also leads to potential underestimation of disease severity and health burden,influencing both the care that women receive and the level of innovation and

104、 investment in womens health.For example,there is an emerging body of evidence indicating potential gender bias in the measurement of pain,where womens pain is routinely underinvestigated and undertreated,with implications for clinical and psychological outcomes.28 Collectively,these incomplete data

105、sets can influence decision-making and have the potential to exacerbate the womens health gap.Gaps exist across the data value chainStage 1:Pre-data generation29The data gap starts at the very definition of womens health:there is a lack of consistent and aligned definitions and measurement scales fo

106、r conditions and symptoms affecting women.For example,there are different definitions of health-related burden associated with menopause or menstrual syndromes,and a lack of consistency in pain instruments and scales.Stage 2:Data generationThis encompasses both epidemiological and clinical data,incl

107、uding the documentation of womens specific symptoms and markers for diagnosis.There is little understanding of how some diseases manifest differently in women and a lack of data on the health-related burden associated with some women-specific conditions.For example,in the United States,4%of healthca

108、re-related R&D efforts are targeted specifically at womens health issues.30Stage 3:Data aggregationSex-disaggregated results are available in the public domain for only 50%of the interventions analysed.One study found that a quarter of clinical trials in the US had sex-disaggregated data.Further,cli

109、nical trial designs and end-point selection can fail to consider potential differences between sexes.Evidence for intervention effectiveness may be drawn from unrepresentative populations due to failure to recruit adequate numbers of women(and minorities).In another,in 2021,half of countries reporte

110、d COVID-19 cases and deaths by sex,14%reported COVID-19 hospitalizations by sex and 10%reported COVID-19 intensive care unit admission by sex.31Stage 4:Data analysisThe metrics selected for analysis and publication may hide or dilute the experience of specific groups compared to others,and datasets

111、gathered during the digital age have led to growth in machine-learning(ML)algorithms.Neither this data nor the programs applied to it are de facto neutral.Without guardrails to protect equity,this technology could perpetuate structural disparities.Artificial intelligence(AI)experts have suggested th

112、at using counterfactual fairness and similar methods can mitigate bias in areas such as race and gender.32 Women can face barriers to timely and accurate diagnosis There is evidence of significant and systematic differences in diagnostic assessments between men and women,which has an impact on the c

113、alculation of the accurate prevalence and burden for several diseases affecting women.A study conducted in Denmark33 across 21 years showed that women were diagnosed later than men for more than 700 diseases.For cancer,it took women two and a half more years to be diagnosed.For diabetes,the delay wa

114、s four and a half years.Analyses of US health records and studies indicate that fewer than half of women living with endometriosis have a documented diagnosis.34 Comparisons of endometriosis estimates also indicate unexplained variations.The WHO estimates that around 10%of women of reproductive age

115、are living with endometriosis.35 In contrast,the Global Burden of Disease estimates this figure to be 12%.36 This discrepancy an eightfold difference means there could be anywhere from 24 million to 190 million women affected worldwide.For women,the difficulty in getting a recorded diagnosis not onl

116、y creates a barrier to care,but the resultant lack of recorded diagnoses filters into how investors or researchers prioritize needs and assess market potential.In endometriosis,the data gap is primarily due to delays in diagnosis,which is approximately 10 years on average.37 This leads to lower rese

117、arch investments:for instance,adenomyosis,the sister and highly co-morbid condition to endometriosis,has received two grants from the National Institutes of Health(NIH),yet it affects hundreds of millions of women across the world.In menopause,the challenge is more fundamental.While it is understood

118、 that most individuals who are biologically female experience symptoms38 at some point during the menopause transition,39 this is rarely counted or considered within classifications of health and disease.For example,the IHME Global Burden of Disease dataset currently captures the health burden assoc

119、iated with menopause within a catch-all category of“other gynecological diseases”.40 As a result,it is not possible to identify clearly the underlying prevalence,or the symptom severity(or Closing the Womens Health Gap:A$1 Trillion Opportunity to Improve Lives and Economies15disability weight)associ

120、ated with menopause in that dataset.Furthermore,some of the symptoms experienced during menopause,such as mood swings or depression,are often associated with other conditions,leading to misdiagnosis.41 Additionally,there is a lack of data on maternal health overall,especially in LMICs,which can lead

121、 to inadequate healthcare services for pregnant women and new mothers.The lack of data obscures the full picture of maternal health needs,making pregnancy and birth more dangerous for women and creating challenges regarding which interventions or policies to prioritize.The WHO reports that every day

122、 in 020 approximately 800 women died from preventable causes related to pregnancy and childbirth translating to a death every two minutes and most of these deaths occur in LMICs.42 Gaps in understanding the effectiveness of health interventionsOne example of the gap in clinical evaluations can be se

123、en in US clinical trials.The Food and Drug Administration(FDA)has had policies requiring investigation of gender differences in clinical evaluation of medicines since 1993,43 and in clinical trials from 2000 to 2022 womens participation in oncology trials improved.44 However,in comparing womens part

124、icipation to their share of the disease burden,women remain under-represented in surgical trials for cancers of the bladder,head and neck,stomach and oesophagus.45 While women experience a greater share of the health burden for some diseases,such as in neurology,the ratio is not reflected in clinica

125、l trial participation.Additionally,equitable representation of women(and men)of different races and ethnicities has long lagged.Case study:COVID-19 vaccine developmentBOX 3:In the race to develop a COVID-19 vaccine,a massive number of both experimental and observational clinical trials were needed.W

126、hile representation of women was equal or better across trials,this was not reflected in consistent reporting of sex-specific results.One analysis found that when examining 41 articles on COVID-19 research,while 35 studies showed safety data,only 12 of these presented data by sex or gender.46 Less t

127、han 5%of investigators out of 2,500 COVID-19 studies had pre-planned for sex-disaggregated data analysis in their studies.47 Where adverse effects and sex differences were published,adverse events were more common in women patients.48 Ensuring sex-differentiated resultsToday,only about 5%of trials r

128、eport the number of participants by sex.49 The typical perception is that average results across large and undifferentiated groups may dilute the scale of impact for some but create a more unified picture of the value proposition.Representative clinical studies capable of producing stratified result

129、s may involve larger and longer clinical trials,increasing costs and extending time to market.However,the results would likely lead to more effective interventions with higher uptake among patients.The risk/reward equation for investors becomes more balanced if payers(governments,insurers and patien

130、ts)and regulators insist on evidence for cohort-specific impact.There are conditions today that are believed to affect men and women equally,such as leukaemia or meningitis,but the research to identify potential differences is lacking.Stakeholders may explore how a systematic and proactive approach

131、to designing and reporting clinical outcomes could take sex and gender into account.One route to start working with sex-and gender-specific data analysis in general is through meta-analytical techniques(bining study results to draw conclusions about therapeutic effectiveness)that can be used to anal

132、yse sex-specific efficacy without increasing sample size.50 Other analysis has found that investing in women as investigators could lead to more women being enrolled in trials.51Addressing data gaps in womens health would require concerted effort across multiple fronts,52 potentially including requi

133、ring sex-and gender-disaggregated data to further understanding.Creating sex-and gender-responsive care delivery systems3Closing the Womens Health Gap:A$1 Trillion Opportunity to Improve Lives and Economies16Patients benefit from care delivery that reflects sex-and gender-specific needs.Closing the

134、Womens Health Gap:A$1 Trillion Opportunity to Improve Lives and Economies17Several studies have indicated that women are more frequent users of health services than men.53 These differences,however,may be reduced substantially when adjusted for different levels of need,such as reproduction or differ

135、ences in disease prevalence.54 The McKinsey analysis finds that some of this unbalanced usage may be due to inadequate service.Compared to men,women who present the same condition may not receive the same evidence-based care.55 These delays can add unnecessary costs to health systems,not to mention

136、costs and stress to the patient and their family.Inequalities exist throughout the full pathway of careThe care pathway runs from awareness of a health issue to access to services and preventive care,timely and accurate diagnosis and effective treatment and follow-up.Awareness and preventionHealth e

137、ducation,including menstrual education,is one of the most effective ways to help women learn about their bodies.56 While every country may vary in the types and amount of health education,women around the world who experience conditions such as painful periods,endometriosis,polycystic ovarian syndro

138、me or uterine fibroids may have limited awareness of what is normal and when to seek medical advice.57 Education can also improve school attendance,teach effective management strategies that reduce symptom severity and reduce potential fertility problems in the future,which are often excluded from h

139、ealth insurance policies.58Prevention and promotion are also needed for better health.The human papillomavirus(HPV)vaccine,for example,is proven to reduce the incidence of cervical cancer by nearly 90%,particularly if women are vaccinated when they are younger.59 In 2020,the WHO launched the 90-70-9

140、0 targets,aiming to have 90%of girls vaccinated against HPV,70%of women screened for HPV by age 35 and again at 45 and 90%of women with pre-cancer treated or with invasive cancer managed.However,according to the WHO,there are great disparities among countries:today,less than 25%of LICs and less than

141、 30%of LMICs have introduced the vaccine,compared with 85%of high-income countries(HICs).60 Some 36%of women worldwide have been screened for cervical cancer in their lifetime,84%in high-income countries and less than 20%in LMICs or LICs.61 The importance of increasing awareness goes beyond patients

142、 many doctors are not aware of how diseases can affect or manifest differently in women,preventing them from providing proper care to many patients.Accessibility and affordability of careWomen may encounter barriers related to access and affordability.Healthcare spending and insurance premiums have

143、historically been higher for women.For instance,in Switzerland,healthcare insurance premiums are more expensive for women because they are considered to have higher healthcare costs.On average,Swiss women pay more than 12%extra for supplementary hospital insurance,with greater disparities in specifi

144、c age groups.A 31-year-old woman pays,on average,37%more than a man of the same age.62 Similarly,Indian private insurers employ gender-based premiums,leading to higher expenses for women.63 Further McKinsey analysis of US co-pay rates finds American women have an average of$135 more out-of-pocket ex

145、penses per year compared to men.Of that,$55 is due to higher co-pay rates for conditions predominantly affecting women.Affordability means more than paying for direct healthcare services it also means being able to afford hygiene products.For instance,around 500 million people worldwide lack access

146、to menstrual products and hygiene facilities.64 In Bangladesh,a study conducted by the HERproject showed that 73%of women missed work for an average six days a month in a textile factory.65 This absenteeism negatively affects not only business but also the lives and livelihoods of women who are not

147、paid for days they do not work.However,when the HERproject provided pads and other work-based interventions(sharing information regarding menstruation,reducing stigma,etc.),absenteeism dropped to 3%.66Family planning is also highly relevant.Women of childbearing age who are sexually active must also

148、 evaluate the cost of contraceptives,many of which are not covered by insurance.An estimated 257 million women in developing regions who want to avoid pregnancy are not using safe and effective family planning methods,due to factors such as a lack of access and support,according to the 2023 Global C

149、ontraception Policy Atlas.67 For any woman,a lack of contraception which can lead to sexually transmitted diseases(STDs)or unintended pregnancy can,in the long run,result in job loss,career setbacks,diminished ability to support oneself or ones family and higher levels of“family dysfunction”.68These

150、 disparities can be tackled.There are alternative models and systems helping to increase accessibility and affordability of care for women while also reducing costs for healthcare systems and individuals this includes the US Affordable Care Act and womens health hubs in the United Kingdom.69 Closing

151、 the Womens Health Gap:A$1 Trillion Opportunity to Improve Lives and Economies18Timely diagnosisThe male-centric models of disease described earlier can contribute to delays in care and lower-quality treatment decisions once a woman is within the care system.Women are seven times more likely than me

152、n to have a heart condition misdiagnosed or be discharged during a heart attack.70 More sensitive biomarkers to detect heart attacks in women have been identified,71 and studies are ongoing to validate the impact on health outcomes,but medical school curricula and residency and fellowship trainings

153、need to be updated to reflect these differences.For maternal care,untreated tuberculosis may have a mortality rate of up to 40%in high-risk72 areas,where women often have lower uptake of treatment probably due to societal norms.One possible solution is the integration of tuberculosis screening in an

154、tenatal care for pregnant women.This strategy was tested in Pakistan and proved to be feasible and effective.73Choice of treatmentAccurate diagnosis should prompt delivery of evidence-based treatment.But sex and gender can affect care,even for common conditions.For example,upon discharge,women cardi

155、ac patients are less likely to be prescribed secondary prevention to reduce the risk of further events.This(along with other risk factors)contributes to women being twice as likely to die from a serious heart attack.74Outcomes after an acute cardiac event could potentially improve via sex-and gender

156、-adapted protocols for guideline-directed management.This begins at admission and continues through the procedure and until discharge.One health system reduced outcome disparities with a standardized system-wide protocol including emergency department catheterization lab activation,a STEMI(ST elevat

157、ion myocardial infarction)safe hand-off checklist;transfer to an immediately available catheterization lab;and a radial first approach to percutaneous coronary intervention.75 A discharge checklist for guideline-directed medical therapy has been shown to reduce mortality in heart failure patients by

158、 65%for both sexes.76While some efforts to achieve gender parity require heavy investment,there are budget-conscious solutions with potentially huge impact.UNICEF Cte dIvoire Country Office,for example,produced a low-cost version of a uterine balloon tamponade device to treat maternal haemorrhage.Th

159、e product,which uses a catheter and a condom,has a 95%success rate and has been scaled nationally.77Intersectionality and health outcomesBOX 4:This paper explores ways in which sex and gender influence an individuals health chances and experience of health services.These differences are all too ofte

160、n further exacerbated by overlapping levels of discrimination and disadvantage,such as race,ethnicity,socioeconomic status,disability,age and sexual orientation.The effects are strikingly clear in maternal health(Figure 8).Within the US,Native American and Black women are 23x more likely to die from

161、 a pregnancy-related cause than white women.For Black families,this holds true even after adjustment for differences in income levels.78 In India,a woman of upper caste is 3x more likely to use prenatal care and 5x more likely to have a trained birth attendant compared to a woman of lower caste.79 A

162、 study in the UK indicated that women from ethnic minority backgrounds have an increased risk of post-partum haemorrhage.80 On a global scale,94%of pregnancy-related deaths occurred in low-resource settings,with 86%occurring in sub-Saharan Africa and Southern Asia.81 7xmore likely than men to have a

163、 heart condition misdiagnosed or be discharged during a heart attack.Women areMaternal deaths across ethnicities in the US,number of maternal deaths per 100,000 birthsSources:James,A.H.,Federspiel,J.J.and Ahmadzia,H.K.,“Disparities in Obstetrics Hemorrhage Outcomes”;US Centers for Disease Control an

164、d Prevention,Racial/Ethnic Disparities in PregnancyRelated Deaths United States,20072016Black4130141312Native AmericanAsianWhiteHispanicIn the US,Native American and Black women are 23x more likely to die from a pregnancy-related cause than white womenClosing the Womens Health Gap:A$1 Trillion Oppor

165、tunity to Improve Lives and Economies19Disparities across ethnicities in maternal deaths in the USFIGURE 8:Creating solutions to tackle care disparitiesOverall,the gap in care delivery contributes 34%to the womens health gap(Figure 1).Consider how sex-and gender-appropriate care delivery could reduc

166、e the womens health burden by 25 million DALYs per year globally,corresponding to 2.5 days per woman per year.Global public health programmes are increasingly being designed and improved from a sex-and gender-informed perspective.This involves an investigation of the role sex and gender play in heal

167、th outcomes,including health-related stigma,barriers to accessing health services and vulnerabilities to different health risks.For example,the Stop TB Partnership developed a gender-responsive tuberculosis delivery programme82 and associated investment package.83 One pillar of this approach is the

168、routine collection,analysis and use of sex-disaggregated data and inclusion of sex and gender in monitoring and evaluation.Improvements in the diagnostic tools available would represent a major step forward for patients.Yet even without innovative tools,it would be possible to improve care and bridg

169、e the gaps in diagnosis with more consistent and standardized screening and data collection.Earlier diagnosis and a more holistic,patient-centric treatment approach could help improve disease and symptom management,prevent uncontrolled progression and resulting complications and reduce unnecessary t

170、reatments.When it comes to affordability and access,counteracting the rise in healthcare costs while benefitting patients and insurance providers could be achieved through approaches such as value-based care(VBC).VBC aims to link healthcare payments to the quality of outcomes,shifting incentives for

171、 healthcare providers from performing more treatments to delivering better treatments.These models seek to enhance care quality and reduce healthcare expenses by emphasizing prevention and high-quality results.84VBC models in the United States include accountable care organizations(ACOs),voluntary n

172、etworks of healthcare providers operating under Medicare.This includes the Medicare Shared Savings Program(MSSP),which returned$1.9 billion in net savings to Medicare in 2020.85 Outside of the United States,the European Hospital Alliances nine hospitals have also offered a blueprint that includes me

173、asuring costs and outcomes for every patient and bundled payments for care cycles.86 Value-based models are designed to reduce costs while improving quality outcomes for patients.For example,given the amount of time,multiple tests and providers a woman may see before an endometriosis diagnosis,a rev

174、ised model of care could offer a holistic and patient-centric approach that provides a faster diagnosis,reduces costs for a healthcare system or payer and ultimately improves outcomes.At a global level,AI,unbiased datasets and interoperable electronic records are potential options for enhancing care

175、 delivery.Ultimately,a combination of innovation,investment and ability to scale could unlock better care delivery solutions for women.Directing investments towards womens health4Closing the Womens Health Gap:A$1 Trillion Opportunity to Improve Lives and Economies20More investments are needed to und

176、erstand biology and improve care delivery for women.Comparison of current innovations in pipeline and share of suffering caused by disability1%of suffering caused by disabilityAssets currently in pipeline(preregistration to phase III)Women affected differently1,00000%100%90%80%70%60%50%40%30%20%10%2

177、00400600800Cirrhosis and other chronic liver diseasesTrachael,bronchus and lung cancerLeukaemiaBreast cancerDiabetes mellitusAsthmaIdiopathic epilepsyRheumatoid arthritisColon and rectum cancerAlzheimers disease and other dementiasOvarian cancerProstate cancerLiver cancerWomen affected disproportion

178、atelyWomen-specific conditionsMale-specific conditionsNo sex difference1.R2=14%,p 0.005 for%of suffering caused by disability.Note:Includes pipeline of assets(including the assets that have previously been approved for other conditions)across 67 conditions,mapped to their respective YLL rate and YLD

179、 rate from the Global Burden of Disease dataset.Source:Pharmaprojects(May 2023);University of Washingtons Institute for Health Metrics and Evaluation,“Global Burden of Disease Study 2019”,used with permissionStomach cancerCervical cancerUterine cancerTesticular cancerClosing the Womens Health Gap:A$

180、1 Trillion Opportunity to Improve Lives and Economies21There has been a historical underinvestment in womens health research,from the public,social and private sectors.When there is funding,it overlooks the fact that many conditions manifest differently in each sex,creating variances in outcome.Clos

181、ing the health gap will require increased investment not only for understanding sex-based differences but also for addressing unmet needs in womens health.Further,additional funding and new business models could support sex-and gender-appropriate care.Research funding neglects womens healthRe-examin

182、ing policies that are based on actual population needs is one approach.Public funding continues to be one of the primary sources for scientific research.In the US,up to 45%of basic and applied research in life sciences is funded through federal and non-federal sources.87 The importance of public fun

183、ding is even higher if we consider that for life sciences companies to reach later-stage development they rely on results from basic and applied research.88 While womens health funding data by country can be scarce,the NIH allocates 11%of its budget to womens health-specific research in the US;despi

184、te women having a 50%higher mortality rate the year following a heart attack,only 4.5%of the NIHs budget for coronary artery disease supports women-focused research.89 In Canada and the UK,5.9%of grants between 2009 and 2020 looked at female-specific outcomes or womens health.90In another example,as

185、 of 2015 there were five times more scientific studies on erectile dysfunction than premenstrual syndrome.91 In a trial where the medication sildenafil citrate was shown to relieve menstrual pain,research stopped due to a lack of funding.92 These examples reflect how underfunding certain research le

186、ads to and augments the womens health gap.One goal could be for existing budgets to be more fairly distributed to reflect the disease burden and unmet need.When governments and non-profits evaluate resources and policies across populations,they create an opportunity to advance health equity and bene

187、fit society.They could consider which investments reap the highest socioeconomic return,including in medical research.One example of targeted investment is the 3not30 campaign by the Womens Health Access Matters to increase womens health research and accelerate investment in sex-based research over

188、the next three years.93There remain many attractive,untapped opportunities in womens health.Currently,global life sciences R&D efforts primarily focus on conditions with a high contribution of years of life lost(YLL)to the overall DALY.This has often disadvantaged women because they have a higher FI

189、GURE 9:Comparison of current innovations in the pipelineEndometriosis and menopause market potential compared to top four therapeutic areas by global annual spend,$billions1.Market potential estimate for endometriosis treatments based on prevalence of 190 million women,existing unmet need and share

190、of women on contraceptives and other medication to treat endometriosis was considered to determine targetable patient group.Share of endometriosis patients undergoing surgery and IVF was further considered to triangulate revenue.2.Global spend from projected spending 2027,IQVIA.3.Market potential es

191、timate for menopause treatments based on prevalence of more than 450 million women,existing unmet need and share of women on HRT and other medication to treat menopause symptoms was considered to determine targetable patient group.Source:Prevalence from WHO;Mecha,E.O.,“Endometriosis among African Wo

192、man”;amount for women on treatment from Reproductive Fertility;Ellis,K.,Munro,D.and Clarke,J.,“Endometriosis is Undervalued:A Call to Action”;unmet need from The World Bank;prices of treatments from International Journal of Environmental Research and Public Health(doi:10.3390/ijerph17134683)and addi

193、tional press search;global spend from IQVIA180120250Endometriosis1Menopause3$90bn Respiratory2$130bn Cardiovascular2$180bn Immunology2$380bn Oncology2 350Lower boundHigher boundClosing the Womens Health Gap:A$1 Trillion Opportunity to Improve Lives and Economies22probability of being affected by con

194、ditions that affect quality of life(years lived with a disability,YLDs)rather than length of life(YLL),such as rheumatoid arthritis,endometriosis,uterine fibroids or diabetes.For example,the disability weight for someone with moderate abdominal pain and primary infertility due to endometriosis is 0.

195、121;for moderate rheumatoid arthritis(RA),it is 0.3017.This translates to a person being willing to trade a year of their life to avoid 8.3 years of living with endometriosis,or trade a year of life to avoid 3.2 years with RA.Additionally,gynaecological conditions,such as endometriosis and uterine f

196、ibroids,which affect up to 68%94 of women,have 26 assets in the pipeline.Comparatively,other conditions may affect a lower percentage but have more assets(Figure 9).Addressing sex-specific conditions can pay off:for example,the debut of Viagra for erectile dysfunction,which affected an estimated 152

197、 million men in 1995,generated$400 million in sales revenue within its first three months in the US market in 1998.95 By 2012,worldwide sales hit a record$2.1 billion.96 Given the similar prevalence and high unmet need for conditions such as endometriosis and menopause,there is enormous potential fo

198、r innovative treatments(Box 5).BOX 5:Globally,190 million women97 are suffering from endometriosis.Currently no cure exists and treatments focus on symptom management.Based on prevalence and high unmet need,the market potential for endometriosis treatments is estimated at$180220 billion globally(Fig

199、ure 10)based on todays share of endometriosis patients seeking treatment.Innovation in this space,including faster diagnosis rates and earlier access to treatment,could increase the market potential.Menopause is also an area of high unmet need globally.Based on the age distribution of the population

200、 and share of symptomatic cases,it is estimated that more than 450 million women worldwide have menopause or peri-menopause symptoms(Figure 10).98 Based on the prevalence,the impact menopause has on womens life,the high unmet need and the share of women seeking treatment today,the estimated market p

201、otential for medication is$120$230 billion globally.99Estimated global market potential for menopause and endometriosisFIGURE 10:Endometriosis and menopause market potentialClosing the Womens Health Gap:A$1 Trillion Opportunity to Improve Lives and Economies23There is enormous potential around treat

202、ments for sex-or gender-specific conditions.For example,there is high interest in breast cancer R&D(646 assets in the pipeline),and sales revenues from breast cancer treatments were at$18 billion in 2022(comparatively,sales for prostate cancer treatments were$11 billion in 2022).100 There remains an

203、 opportunity to improve outcomes of breast cancer in LMICs,where the fatality rate 72%was higher than the incidence rate(62%).101 Globally,endometriosis,uterine fibroids and menopause are among the conditions with high unmet need and economic potential.Private equity/venture capital investors are in

204、creasing investments in womens health,with excitement about digital health solutionsPrivate equity and venture capital investments in womens health are starting to grow quickly as opportunities in womens health become clearer and more female technology(FemTech)start-ups set out to disrupt the health

205、care market.102 Within the FemTech space,there is a concentration of activity concerning maternal health patient support,consumer menstrual products,gynaecological devices and fertility solutions.103 The start-ups making the top deals in the past four years mainly focus on mens sexual and overall he

206、alth.A McKinsey analysis found that 11 start-ups addressing erectile dysfunction,among other mens health concerns,secured$1.24 billion in 20192023,while eight start-ups addressing endometriosis received$44 million.Funding for companies focusing on erectile dysfunction was six times higher compared t

207、o endometriosis.However,investors may be starting to see the potential.In the past four years,womens health newcomers received$2.2 billion in funding.Some 60%of the top deals exclusively addressed womens health,specifically endometriosis,fertility among women and maternal and neonatal health.104Digi

208、tal health is another potential avenue for innovation,with the potential to make health more equitable.105 In the digital healthcare space,FemTech companies received 3%of the total digital health funding.106 Given the large unmet need and resulting opportunity,those who continue to forgo investing i

209、n womens health may find themselves left behind by the players that tap into this high-potential market.Closing the womens health gap could boost the global economy 5Closing the Womens Health Gap:A$1 Trillion Opportunity to Improve Lives and Economies24Data indicates a potential$1 trillion increase

210、annually by 2040.GDP,2040,$trillionAnnual growthrate,2020401.Note that$1 trillion is likely the lower end of the range given data availability issues.2.Includes impact on older adults(high-and upper-middle-income countries only),informal caregivers(in OECD only)and people with disabilities(global).S

211、ource:University of Washingtons Institute for Health Metrics and Evaluation,used with permission;Oxford Economics;ILOSTAT;OECD;Eurostat;National Transfer Accounts project;McKinsey Global Institute analysis+1 trillion1(+1.7%)Base caseGDP,20402.60%2.64%142.0143.00.40.20.20.2Fewer healthconditionsExpan

212、dedparticipationIncrease inproductivity2Fewer earlydeathsPotentialGDP,2040Closing the Womens Health Gap:A$1 Trillion Opportunity to Improve Lives and Economies25The disparities in womens health affect not only womens quality of life but also their economic participation and ability to earn a living

213、for themselves and their families.Health is intricately linked to economic productivity,prospects for prosperity and contribution to economic output.Economic growth over the past 70 years has been closely tied to womens increased labour force participation.Therefore,it is not surprising that the gap

214、 in womens health results in lost economic potential.Addressing the additional health burden women face could boost the global economy by adding at least$1 trillion to the global economy by 2040.This means a 1.7%increase in the average per capita GDP generated by women.Womens economic participation

215、has been and will be a major driver of economic growthExtended participation by women boosts economies and GDP growth.107 The rise in the number of women in formal economic activities since the 1950s has been a major driver of economic growth and wage increases.108 In a 2023 poll,when women around t

216、he world were asked if they preferred to work in paid jobs,care for their families or do both,70%said they preferred to work in paid jobs.109 Addressing the gap could generate the equivalent impact of 137 million women accessing full-time positions by 2040.This would enable women to secure an income

217、 to support themselves and their families and has the potential to lift more women out of poverty.Beyond limiting individual women,the womens health gap directly affects the global economy by impairing womens economic participation and productivity.Chronic diseases are often linked to extended absen

218、ces from work,110 and poor health also causes“presenteeism”,where individuals cannot perform at their full capacity,reducing productivity.Finally,informal caregiving obligations and disabilities can limit affected individuals from full workforce participation.Better health often means being able to

219、work more effectivelyThe health disparities outlined in this report affect individuals of all age groups,with about 50%of the burden impacting women of working age.Women with fewer health conditions could add 1.7%in GDP.Comparatively,if the status quo remained,the World Bank estimates an annual GDP

220、growth of 2.7%,2.9%and 3.4%for 2023,2024 and 2025,respectively.111 Looking at the different channels affecting GDP,the largest impact would also be created through fewer health conditions,amounting to around$400 billion,or avoiding 24 million years lived with disability.Expanded participation and in

221、creased productivity contribute more than 20%of total impact.Economic output in GDP of closing the womens health gap on a global scaleFIGURE 11:GDP impact of closing the womens health gap for the top 10 conditions,$billionsChannel with the highest contribution to GDP impact:Adjusting for the actual

222、disease burden would place menopause among the top two conditions,with a GDP impact of$120 billionPremenstrual syndrome 115Depressive disorders 100Migraine 80Other gynaecological diseases 69Anxiety disorders 47Ischaemic heart disease 43Osteoarthritis 35Asthma 24Drug-use disorders 20Ovarian cancer 17

223、Note:Based on estimate,number of women aged 4555(excluding peri-and postmenopausal women),multiplied by the share of symptomatic cases(92%).Source:Endometriosis prevalence from WHO;prevalence base for GDP impact calculation from IHME GBD(2019)Fewer early deathsFewer health conditionsIncrease in prod

224、uctivityClosing the Womens Health Gap:A$1 Trillion Opportunity to Improve Lives and Economies26The top 10 conditions alone contribute more than 50%of the economic impact On a global level,there are 10 conditions,such as premenstrual syndrome(PMS),depressive symptoms and migraines,that,if addressed,c

225、ould make up more than 50%of the economic impact(Figure 12).This indicates which conditions could be prioritized globally.For example,addressing PMS has the potential to contribute$115 billion to the global economy.Rather than defaulting to PMS being a“part of life”,there are ways to manage symptoms

226、.A 2020 analysis found that women who took calcium supplements experienced fewer PMS symptoms,such as anxiety or water retention,than women who took a placebo.112 A study in Iran found that the severity and frequency of PMS symptoms was significantly lower in an intervention group that offered educa

227、tion and coping strategies.113 By addressing PMS with effective interventions,women could experience less pain,experience better quality of life and feel more able to work.Regional disease burden and healthcare status will lead to conditions having the greatest economic impact in different countries

228、.When examining economic impact,rather than DALY impact,more weight is given to conditions that affect people during years of working age,as that is when economic contribution is highest.Conditions such as ischaemic heart disease may affect more people,but if the burden of morbidity and premature mo

229、rtality happens after the usual age of retirement,the economic impact is more limited.Additionally,other conditions not listed could be the underlying cause for the top 10 conditions.For example,infertility can lead to significant anxiety,depression symptoms and other psychological distress.114Top t

230、en conditions by GDP impactFIGURE 12:Generally,a reduction in health conditions is tied to a womans economic potential,with allowances for regional socioeconomic and healthcare factors(Figure 13).The top two conditions by contribution to GDP impact of the womens health gap are always a combination o

231、f two of the top four global conditions(PMS,depression,migraine or other gynaecological conditions).Larger differences among regions are observed when looking at the top 10 or more conditions.Relative share of gender gap GDP impact of womens GDP per capita across different levers and geographiesRela

232、tive share of gender gap GDP impact to total womens GDP per capita,%1.Pre-menstrual syndrome.2.Other gynaecological conditionsSource:McKinsey analysisMiddle East and North AfricaLatin AmericaEastern Europe and Central AsiaEast AsiaAustralasia2.3%1.1%1.3%1.5%1.7%1.1%1.8%2.2%2.4%DepressionPMS1PMSMigra

233、inePMSOther Gyn2PMSDepressionOther GynDepressionPMSOther GynOther GynPMSDepressionPMSOther GynPMSFewer health conditionsExpanded participationIncrease in productivityFewer early deathsTop two conditions contributing mostto GDP impactContribution of gender gap to womens GDPper capitaSouth AsiaSub-Sah

234、aran AfricaUS and CanadaUS and CanadaChannelsHighMediumLowShare of different channels on total womens GDP impact due to closing the gender health gap Share of GDP impact in%,total GDP impact in$billionsSource:McKinsey analysis00708090100HIC29265020UMICLMICLIC724Fewer

235、 early deaths2167015Fewer health conditionsIncrease in productivityExpanded participationClosing the Womens Health Gap:A$1 Trillion Opportunity to Improve Lives and Economies27GDP impact relative to womens GDP per capita across geographic regions,as well as the top two conditions contributing most t

236、o GDP impact by regionFIGURE 13:FIGURE 14:Across the four channels,the highest GDP impact relative to womens GDP is observed in HICs and LICs(Figure 14).For LICs,most of the impact comes from fewer early deaths and fewer health conditions.Both upper-middle income(UMIC)and lower-middle income(LMIC)re

237、gions exhibit an overall lower projected GDP impact.Contribution of different channels GDP impact in different income regionsMenopause and endometriosis-related GDP impact of closing womens health gap,$billionsSource:McKinsey analysisEndometriosisEconomic impact basedon IHME prevalenceAdditional eco

238、nomic impactaccounting for undercountingTotal 2040 GDP impact byaddressing endometriosisand menopauseMenopause2602Closing the Womens Health Gap:A$1 Trillion Opportunity to Improve Lives and Economies28Endometriosis and menopause have a substantial impact on womens ability to work and earn

239、ing potentialBOX 6:Endometriosis and menopause not only cause women pain and reduce their quality of life but also substantially affect their ability to work and their earning potential.Roughly 80%of affected women state that menopause interferes with their lives,and one-third of these women also ex

240、perience depression.115 Further,menopause is linked to premature departure from the workforce.116 Similarly,endometriosis is linked to loss in productivity and absenteeism.117 For both conditions,prevalence and disease burden are heavily underestimated.This analysis factors in the actual economic im

241、pact for both conditions.Studies have found up to 90%of women reported menopausal symptoms during the transition.118 This leads to a global prevalence of more than 450 million women and highlights the vast underestimate(versus 35 million in the IHME database).For endometriosis,IHME places the number

242、 of cases at 24 million,whereas the WHO puts the prevalence at 190 million.119 Based on these adjusted numbers,improving effectiveness,uptake,access and delivery of care for these conditions alone could give a$130 billion uplift to the global economy by 2040.Addressing endometriosis and menopause al

243、one could contribute about$130 billion to global GDP impact by 2040.FIGURE 15:Investing in womens health shows positive return on investment(ROI):for every$1 invested,$3 is projected in economic growthInvesting in improving womens health not only improves womens quality of life but also enables them

244、 to participate more actively in the workforce and make a living.The potential value created through womens higher economic participation and productivity exceeds the costs of implementation by a ratio of$3 to$1 globally.This estimate is based on the net annual costs associated with the additional u

245、ptake of interventions required to address the womens health gap,including all relevant interventions considered cost-effective in each setting.120 The analysis compared this to the additional economic potential that could be unlocked by the health improvements associated with these interventions.Th

246、e expected economic return is greatest in higher-income settings,where the ratio is around$3.5 returned to$1 invested.More investment is probably needed in some LICs to establish the basic health infrastructure required to support low-cost delivery of high-quality health services,as well as to creat

247、e better and more rewarding economic opportunities for women.Still,the analysis indicates that the overall benefit would exceed the costs even in these settings,at a rate of around$2 returned to$1 invested.The analysis examines only the direct costs of addressing the gaps in care delivery identified

248、.In the longer term,a range of greater positive returns is possible,given that improvement in the lives of women influences the heath and resilience of their families and communities.Closing the Womens Health Gap:A$1 Trillion Opportunity to Improve Lives and Economies29The analyses and findings abov

249、e provide indications on where to start tackling the womens health gap,reaping the highest benefit for allGlobally,the top 10 conditions by economic impact account for more than 50%of the total GDP impact(Figure 12).This highlights areas with high unmet needs and potential,aiding decision-makers in

250、prioritizing efforts to address health disparities.Specific conditions and their socioeconomic contexts vary among regions,influencing their contribution to the economy.This information could guide tailored strategies towards health equity.The content and sequence of each action will need to be tail

251、ored to the regional conditions.Building on the knowledge developed throughout this report,a fact-based strategic assessment can lead to better health equity for each country.Call to action:How to close the womens health gap6Closing the Womens Health Gap:A$1 Trillion Opportunity to Improve Lives and

252、 Economies30To improve health equity and encourage economic growth,stakeholders need to develop a cooperative and comprehensive strategy.Closing the Womens Health Gap:A$1 Trillion Opportunity to Improve Lives and Economies31As noted in this report,womens health has been under-researched and women fa

253、ce different challenges from men in affordability and access to treatment.This health gap creates unnecessary suffering and preventable economic losses.It does not have to be this way.Through collaborative efforts on five fronts,a more equitable and healthy future is possible.There is an opportunity

254、 to close the womens health gap by(1)investing in women-centric R&D,(2)strengthening the collection and analysis of sex-and gender-disaggregated data,(3)enhancing access to gender-specific care,(4)encouraging investments in womens health innovation and(5)examining business policies to support women.

255、Invest in women-centric research to fill the knowledge and data gaps in women-specific conditions,as well as in diseases affecting women differently and/or disproportionatelyThe womens health gap could be narrowed by increasing funding to achieve equality with investments in funding for mens health

256、and from protocols that set standards of equity and diversity.Scientists,life science companies(pharma,biotech,MedTech),healthcare providers and others in the healthcare ecosystem may consider how the traditional understanding of disease is focused primarily on the male body.A more in-depth understa

257、nding of these differences would enable more effective care interventions and improved health outcomes.One example of venture capital-backed funding addressing this disparity is Repro Grants,which allots up to$100,000 for research projects aimed at deepening understanding of female reproductive biol

258、ogy.For conditions that affect women differently or disproportionately,more effective interventions start with clinical trials designed with inclusivity at their core,informed by preclinical research using female animal models.Specifically,there should be stronger diversity,equity and inclusion guid

259、elines for clinical trial design.Guidance could incorporate male versus female disease prevalence mix and use sex-specific thresholds for biomarkers,to yield an adequate patient representation in clinical trials.Equitable representation by prevalence also implies more diverse research organizations.

260、Life science companies,academic institutions and educational bodies should ensure that women and people of colour not only find representation but are actively involved in research,leadership and decision-making roles.For example,women form almost 70%of the global health and social workforce but it

261、is estimated they hold only 25%of senior roles.121 The benefits of increasing womens representation are manifold:for example,teams boasting diverse gender representation have been associated with higher levels of accountability and effectiveness.122 In one study that analysed more than 440,000 medic

262、al patents filed from 1976 through to 2010,patented biomedical inventions created by women were up to 35%more likely to benefit womens health than biomedical inventions created by men.The patents from women were more likely to address women-specific conditions such as breast cancer and postpartum pr

263、eeclampsia,as well as conditions that disproportionately affect women,such as lupus.123 Systematically collect and analyse sex-,ethnicity-and gender-specific data to have more accurate representation of womens health burden and the impact of different interventionsThe prevalence of conditions such a

264、s endometriosis and menopause is underestimated,leading investors and life science companies to underestimate the market potential of these conditions and underinvest.By accurately assessing and reporting on the prevalence of such conditions,national health institutes and other authorities may direc

265、t additional funding to the research and treatment of these underserved conditions.Beyond epidemiological data,todays technology makes the systematic collection and analysis of sex-,race-and gender-disaggregated data simpler at all stages of the R&D process.Life science companies could harness this

266、capability to strengthen the collection,analysis and reporting of disaggregated data at each stage of the process.This approach to data has the potential to enable life sciences companies to evaluate the safety and efficacy of their pipeline products more accurately,including by adjusting formulatio

267、ns and dosages.This could yield better health outcomes and a higher probability of success.To further encourage the shift towards disaggregated data,the Womens Health Innovation Opportunity Map 2023124 proposes establishing sex as a biological variable.This would enable national health departments a

268、nd international health organizations to develop and enforce guidelines regarding disaggregation of data by sex and gender in research studies and health surveys.Biotech,MedTech and FemTech enterprises also have exciting opportunities related to AI and ML,which ensures that these models do not exace

269、rbate existing biases or violate patient privacy rules.Developing robust,secure and holistic datasets could enable companies to differentiate in an overcrowded marketplace.Closing the Womens Health Gap:A$1 Trillion Opportunity to Improve Lives and Economies32Enhance access to gender-specific care,fr

270、om prevention to diagnosis and treatmentWomen deserve the same high-quality level of care from their healthcare providers as men,which doesnt mean the same care per se.There is a pressing need to redesign medical curricula as well as residency and fellowships to reflect sex and gender differences.In

271、 addition to medical schools,continuing medical education organizations and credentialling entities could assess whether healthcare providers are receiving the latest information and training on the womens health gap and sex-and gender-based differences.Current and future healthcare professionals of

272、 all specialties must be equipped with accurate and updated knowledge of biological differences,including sex-specific manifestations of symptoms.Future certification or tests could include questions meant to address whether providers have internalized this knowledge.Next,the path to excellence in c

273、linical care lies in acknowledging and rectifying inherent equity disparities.Gender-and sex-responsive services benefit patients,healthcare providers and society at large.Health systems could implement new guidelines and protocols(for example,sex-specific cut-offs for biomarkers,discharge checklist

274、s)to guide decision-making and minimize biases.Similarly,life science companies could include sex-specific evidence and outcomes on product package inserts/labels to inform healthcare professionals on the best regimen for different subpopulations.125To reduce maternal mortality globally,investing in

275、 the training and upskilling of midwives could save an estimated 4.3 million lives per year and prevent roughly two-thirds of maternal deaths,64%of newborn deaths and 65%of stillbirths while contributing to the economic development and empowerment of women.126 Governments,educational bodies,philanth

276、ropic institutions and many other stakeholders can use this moment to raise awareness of the sex-specific manifestations of disease for example,ensuring that newly diagnosed endometriosis patients have access to up-to-date resources,including which trials they could potentially participate in.Health

277、care entities,philanthropic organizations or community health workers could start or reinvigorate in-person support groups for conditions such as endometriosis or menopause,or for mental health support.Collectively,better education and resources,plus new diagnostics,are among the ways to potentially

278、 elevate the quality of healthcare women receive.In addition,two actions to help close the gap are:Create incentives for new financing models to close the womens health gapHistorically,given lower levers of investments overall for womens health under the traditional financing model schemes,new finan

279、cing models have a critical role to play.These models can accelerate innovation:one example is the Advance Market Commitment(AMC)geared at COVID-19 vaccine development and deployment.Research and reliable data on the womens health landscape can help spur investment.For investors,the gender-based hea

280、lthcare landscape presents a mosaic of unexplored opportunities.By pivoting towards these opportunities,they can channel funds into high-impact areas,bridge the data gap and enable more investment and innovation.Governments could explore policies that encourage sex-and gender-responsive health resea

281、rch and services;for example,by earmarking funding,providing tax incentives,lowering application fees,expediting the drug approval process and more.Philanthropic organizations,donors and international bodies could offer grants and prizes at a national or local level to spur innovation,while supporti

282、ng capacity-building in regions where gender-based health disparities are highest.Examples might be launching a grant or award programme geared towards reducing rates of respiratory illnesses in areas where there is a high percentage of women smokers,or towards a technology-based solution for women

283、in vulnerable populations to access transportation to healthcare services.Private-sector stakeholders could help develop new financial products and investment vehicles,such as gender-lens investing,to attract capital towards projects that directly address the womens health gap.Governments could furt

284、her promote private-sector investments by creating tax incentive programmes for angel investors and venture capitalists that invest in womens health.127With collaboration,stakeholders have the potential to encourage investments and inspire the development of innovative financing models in womens hea

285、lth.Establish business policies that support womens healthAs previously outlined,healthcare disparities also lead to economic losses due to absenteeism,presenteeism and reduced productivity overall.Employers could consider how their workplace policies and benefits support womens health,examine ways

286、to better involve women in decision-making processes,provide health and wellness benefits that support womens health and create safe working environments in which women can Closing the Womens Health Gap:A$1 Trillion Opportunity to Improve Lives and Economies33speak openly about their health needs.By

287、 better understanding employee demographics,employers could invest in the areas with higher impact and potential(for example,if a workforce includes women between 45 and 55 years old,flexible work policies that recognize menopause could help many employees).Given the fact that women are more than tw

288、ice as likely as men to have depressive symptoms in their lifetime,128 employers may explore how mental-health programmes can help employees find evidence-based mental health resources that meet their needs.Often,leaders create change in the workplace based on their own experiences,knowledge or visi

289、on.If the decision-makers are predominantly men,the workplace tends to benefit men.Previous McKinsey research has found a“broken rung”in womens advancement throughout industries:for every 100 men promoted from entry-level to manager roles,87 women are promoted and only 73 women of colour are promote

290、d.129 Overall,due to gender disparities in early promotions,men end up with 60%of manager-level positions in a typical company.More women in senior leadership positions may be able to advocate for policies that support womens health,and companies may ultimately benefit from a healthier and more prod

291、uctive workforce.Data-driven,scalable actions to improve womens health may vary widely,but the critical component is to determine how each stakeholder can contribute to narrowing the gap.Closing the Womens Health Gap:A$1 Trillion Opportunity to Improve Lives and Economies34ConclusionThere is a moral

292、 imperative to address the womens health gap and improve the lives and livelihoods of billions of women worldwide.If health equity efforts sit within a tree of principles,they can be watered by research,flourish in the sun of business investments and grow far-reaching branches that stretch into the

293、economy.Achieving health equity is a collaborative and ongoing endeavour that relies on the active participation of governments,healthcare institutions,non-governmental organizations,individuals and all stakeholders vested in this cause.Tackling the womens health gap depends on addressing the interc

294、onnected factors outlined in this report:the deficit in women-specific knowledge in science,the glaring data gaps,the disparities in healthcare delivery and the insufficient investment in womens health.Recognizing the vast potential to improve the lives and livelihoods of half the global population

295、while boosting the economy serves as the catalyst for closing the womens health gap.Every facet of this gap,from limited education to suboptimal treatments,offers an opportunity for transformation with the active involvement of governments,life science innovators,educational institutions,philanthrop

296、ists,activists and more.In this endeavour,there lies an opportunity of$1 trillion in economic potential driven by improved womens health and economic participation.The question is not whether this wealth of opportunities exists but rather who will take the initiative to seize it and drive change.Wom

297、ens health is not a standalone issue it is a cornerstone of societal well-being and progress.Better health and well-being for women creates a ripple effect that extends to families,communities and nations.This holistic approach,supported by collective action and sustained investment,will not only na

298、rrow the health gap but also contribute to the betterment of a shared global future.Closing the Womens Health Gap:A$1 Trillion Opportunity to Improve Lives and Economies35ContributorsLead Authors Kweilin Ellingrud Senior Partner,McKinsey&Company;Director,McKinsey Global InstituteLucy Prez Senior Par

299、tner,McKinsey&Company;Affiliated Leader,McKinsey Health InstituteAnouk Petersen Partner,McKinsey&CompanyValentina Sartori Partner,McKinsey&CompanyWorld Economic ForumShyam Bishen Head,Centre for Health and Healthcare;Member of the Executive CommitteeAmira Ghouaibi Head,Womens HealthJudith Moore Head

300、,Healthcare InitiativesChristian Sand Horup Project Fellow,Womens Health InitiativeWe would like to thank Ferring Pharmaceuticals for championing the Coalition for Investing in Womens Health Anshu Banerjee,WHO;Sarah Barnes,The Woodrow Wilson International Center for Scholars;Jeff Bernson,Mathematica

301、;Sanjana Bhardwaj,Bill&Melinda Gates Foundation;Bineta Diop,Femmes African Solidarit;Samukeliso Dube,Family Planning 2030;Charlotte Ersbll,Ferring Pharmaceuticals;Anna Frellsen,Maternity Foundation;Katy Geguchadze,Maven Clinic;Patricia Geli,C10 Labs;Mark Hanson,PMNCH;Katja Iversen,Museum for the Uni

302、ted Nations;Kristy Kade,White Ribbon Alliance;Keren Leshem,OCON Healthcare;Sofiat Makanjuola-Akinola,Roche Diagnostics Solutions;Divya Mathew,Women Deliver;Alexandra Plowright,Anglo American;Vivian Riefberg,University of Virginia;Elizabeth Rowley,PATH;Noha Salem,Organon;Stephanie Sassman,Genentech;N

303、andini Selvam,IQVIA;Dilly Severin,United Nations Foundation;Kathleen Sherwin,Plan International;David Wafford,United Nations Foundation;Michelle Williams,Harvard T.H.Chan School of Public Health;Alice Zheng,RH CapitalClosing the Womens Health Gap:A$1 Trillion Opportunity to Improve Lives and Economi

304、es36Endnotes1 The Womens Health Innovation Opportunity Map is a report from the Innovative Equity Forum,sponsored by the Bill and Melinda Gates Foundation and the National Institutes of Health(NIH):https:/orwh.od.nih.gov/sites/orwh/files/docs/womens-health-rnd-opportunity-map_2023_508.pdf.2 The term

305、s“woman”and“man”in this report generally reflect,but are not used exclusively for,sex assigned at birth.The authors acknowledge the importance and need for more research into the challenges facing the transgender,gender-fluid and non-binary communities.The term“woman”in this report includes those un

306、der age 18.3 Remme,M.et al.,“Investing in the Health of Girls and Women:A Best Buy for Sustainable Development”,British Medical Journal,2 June 2020:https:/ Roser,M.,“Twice as Long Life Expectancy around the World”,OurWorldInData,8 October 2018:https:/ourworldindata.org/life-expectancy-globally.5 McK

307、insey Global Institute,“Prioritizing Health:A Prescription for Prosperity”,8 July 2020:https:/ DALYs for a disease or health condition are the sum of the years of life lost to due to premature mortality(YLLs)and the years lived with a disability(YLDs)due to prevalent cases of the disease or health c

308、ondition in a population.University of Washingtons Institute for Health Metrics and Evaluation,“Global Burden of Disease Study 2019”,2020:https:/www.healthdata.org/research-analysis/gbd.Used with permission.7 For further details on the method and assumptions used to translate health benefits into ec

309、onomic impact,see the technical appendix.8 Consistent with the National Institutes of Health(NIH);see NIH,“Womens Health”:https:/www.nichd.nih.gov/health/topics/womenshealth.9 University of Washingtons Institute for Health Metrics and Evaluation,“Global Burden of Disease Study 2019”,2020:https:/www.

310、healthdata.org/research-analysis/gbd.Used with permission.10 Centers for Disease Control and Prevention,“Blood Pressure and Pregnancy”:https:/www.cdc.gov/bloodpressure/pregnancy.htm.11 Joslin Diabetes Center,“What is Gestational Diabetes?”:https:/www.joslin.org/patient-care/diabetes-education/diabet

311、es-learning-center/what-gestational-diabetes.12 Measured in disability-adjusted life years(DALYs),comprising years lived with disability(YLD)and years of life lost(YLL).13 Reduction per country,age group,disease,risk factor,year analysed;measured in deaths,years lived with disability(YLD)and years o

312、f life lost(YLL).14 University of Washingtons Institute for Health Metrics and Evaluation(IHME),Global Burden of Disease dataset,2019.Used with permission.15 International Labour Organization(ILOSTAT),“ILO Modelled Estimates Database”(accessed 14 February 2022):https:/ilostat.ilo.org/data/.16 Such a

313、s probability to return to workforce,wage penalties,time from unemployment to employment,time lag of interventions,time to reach intervention theoretical maximum.17“Medical knowledge,including diagnostic criteria,is principally based on a male standard.Women patients symptoms are often labelled atyp

314、ical,suggesting biases in diagnostic criteria.”Galea,L.and Parekh,R.S.,“Ending the Neglect of Womens Health in Research”,British Medical Journal,381,2023,1303:https:/pubmed.ncbi.nlm.nih.gov/37308180/.18 Zucker,I.and Beery,A.K.,“Males Still Dominate Animal Studies”,Nature,June 2010:https:/ Schulte,K.

315、J.and Mavrovitz,H.N.,“Myocardial Infarction Signs and Symptoms:Females vs.Males”,Cureus,2023:https:/www.ncbi.nlm.nih.gov/pmc/articles/PMC10182740/.20 University of Washingtons Institute for Health Metrics and Evaluation,“Global Burden of Disease Study 2019”,2020:https:/www.healthdata.org/research-an

316、alysis/gbd.Used with permission.BMJ Best Practice,“Acute Asthma Exacerbation in Adults”,BMJ Publishing Group 2023:https:/ Loymans,R.J.B.et al.,“Comparative Effectiveness of Long Term Drug Treatment Strategies to Prevent Asthma Exacerbations:Network Meta-analysis”,British Medical Journal,348,2014:htt

317、ps:/pubmed.ncbi.nlm.nih.gov/24919052/;Wells,K.E.et al.,“The Relationship Between Combination Inhaled Corticosteroid and Long-Acting-agonist Use and Severe Asthma Exacerbations in a Diverse Population”,Journal of Allergy and Clinical Immunology,129(5),May 2012,12741279:https:/www.ncbi.nlm.nih.gov/pmc

318、/articles/PMC3340459/.22 Data for 2019.University of Washingtons Institute for Health Metrics and Evaluation,“Global Burden of Disease Study 2019”,2020:https:/www.healthdata.org/research-analysis/gbd.Used with permission.Closing the Womens Health Gap:A$1 Trillion Opportunity to Improve Lives and Eco

319、nomies3723 Heer,T.et al.,“Sex Differences in Percutaneous Coronary Intervention Insights from the Coronary Angiography and PCI Registry of the German Society of Cardiology”,Journal of the American Heart Association,6(3),20 March 2017:https:/pubmed.ncbi.nlm.nih.gov/28320749/.24 World Health Organizat

320、ion,“A Roadmap to Combat Postpartum Haemorrhage between 2023 and 2030”,2023:https:/cdn.who.int/media/docs/default-source/reproductive-health/maternal-health/pph-roadmap.pdf?sfvrsn=db36b511_3.25 For adverse events,this was 12.9 million for women vs.8.5 million for men through to 2022,according to the

321、 Food and Drug Administration Adverse Events Reporting System(FAERS).For serious or fatal events,this was 8.3 million for women vs.6.1 million reports for men.26 Ibid.27 Flaskerud,J.H.and Nyamathi,A.M.,“Attaining Gender and Ethnic Diversity in Health Intervention Research:Cultural Responsiveness Ver

322、sus Resource Provision”,Advances in Nursing Science,22(4),June 2000:https:/pubmed.ncbi.nlm.nih.gov/10852665/;Agnor,M.et al.,“Sexual Orientation Identity Disparities in Health Behaviors,Outcomes,and Services Use Among Men and Women in the United States:A Cross-Sectional Study”,BMC Public Health,16,Au

323、gust 2016:https:/ University College London,“Analysis:Womens Pain Is Routinely Underestimated,and Gender Stereotypes Are to Blame”,9 April 2021:https:/www.ucl.ac.uk/news/2021/apr/analysis-womens-pain-routinely-underestimated-and-gender-stereotypes-are-blame#:text=An%20additional%20experiment%20showe

324、d%20that,to%20report%20pain%20than%20men;Zhang,L.et al.,“Gender Biases in Estimation of Others Pain”,The Journal of Pain,22(9),September 2021,10481059:https:/pubmed.ncbi.nlm.nih.gov/33684539/;Glowacki,D.,“Effective Pain Management and Improvements in Patients Outcomes and Satisfaction”,Critical Care

325、 Nurse,35(3),June 2015,3341:https:/pubmed.ncbi.nlm.nih.gov/26033099/.29 Developed from:Burns,D.et al.,“Closing the Data Gaps in Womens Health”,McKinsey,April 2023:https:/ McKinsey&Company,“Unlocking Opportunities in Womens Healthcare”:https:/ Global Health 50:50,“The COVID-19 Sex Disaggregated Data

326、Tracker”,May update report,2021:https:/globalhealth5050.org/wp-content/uploads/May-2021-Data-Tracker-Update.pdf.32 Manyika,J.,Silberg,J.and Presten,B.,“What Do We Do About the Biases in AI?”,Harvard Business Review,October 2019:https:/hbr.org/2019/10/what-do-we-do-about-the-biases-in-ai;Kusner,M.J.e

327、t al.,“Counterfactual Fairness”,NeurIPS Proceedings,2017:https:/papers.nips.cc/paper_files/paper/2017.33 The Faculty of Health and Medical Sciences,University of Copenhagen,“Across Diseases,Women Are Diagnosed Later Than Men”,March 2019:https:/ Westwood,S.et al.,“Disparities in Women with Endometrio

328、sis Regarding Access to Care,Diagnosis,Treatment,and Management in the United States:A Scoping Review”,Cureus,15(5),May 2023,e38765:https:/www.ncbi.nlm.nih.gov/pmc/articles/PMC10250135/;Horne,A.W.and Saunders,P.T.,“SnapShot:Endometriosis”,Cell,179(7),12 December2019,1677:https:/pubmed.ncbi.nlm.nih.g

329、ov/31951524/.35 World Health Organization,“Endometriosis Factsheet”,2023:https:/www.who.int/news-room/fact-sheets/detail/endometriosis.36 University of Washingtons Institute for Health Metrics and Evaluation,“Global Burden of Disease Study 2019”,2020:https:/www.healthdata.org/research-analysis/gbd.U

330、sed with permission.37 European Society of Human Reproduction and Embryology,“Endometriosis:Guideline of European Society of Human Reproduction and Embryology”,2022:https:/www.eshre.eu/Guidelines-and-Legal/Guidelines/Endometriosis-guideline.aspx;United Kingdom National Institute for Health and Care

331、Excellence(NICE),“Endometriosis:Diagnosis and Management”,NICE Guideline NG73,2017:https:/www.nice.org.uk/guidance/ng73.38 Clayton,J.A.,“Sex Influences in Neurological Disorders:Case Studies and Perspectives”,Dialogues in Clinical Neuroscience,18(4),December 2016:https:/www.ncbi.nlm.nih.gov/pmc/arti

332、cles/PMC5286721/.39 Whiteley,J.et al.,“The Impact of Menopausal Symptoms on Quality of Life,Productivity,and Economic Outcomes”,Journal of Womens Health,22(11),November 2013,983990:https:/pubmed.ncbi.nlm.nih.gov/24083674/.40 Other gynaecological disorders include menstrual disorders and non-menstrua

333、l disorders,including absent,scanty and rare menstruation,pain and other conditions;and inflammatory and non-inflammatory diseases of the breast,ovaries and cervix.University of Washingtons Institute for Health Metrics and Evaluation,“Global Burden of Disease Study 2019”,2020:https:/www.healthdata.org/research-analysis/gbd.Used with permission.41 Dorr,B.,“In the Misdiagnosis of Menopause,What Need