Closing the Women’s Health Gap Requires More than Connecting the Dots—it Demands a Culture Shift

Last month, at the World Economic Forum (WEF), in Davos, McKinsey Health Institute launched Closing the Women’s Health Gap: A $1 Trillion Opportunity to Improve Lives and Economies. According to the report, addressing shortcomings in women’s healthcare will reduce the time women spend in poor health by almost two-thirds. More than 3.9 billion women will experience richer, more productive lives—yielding upwards of $1 trillion in benefits to the global economy each year.

The report takes a wide view of women’s health, considering both sex-specific conditions, as well as conditions that affect women disproportionately or differently (acknowledging the need for future research that is inclusive of transgender, non-binary, and gender-fluid communities). Too few do. Debate and discourse on women’s health is frequently narrowed to sexual and reproductive functions, rendering invisible the myriad, interconnected ways women are made to unjustly suffer.

810 people die every day due to preventable complications in pregnancy and childbirth, with many more facing severe morbidity and disability. The global burden of women’s cancers continues to rise. There is a consistent disparity in mental illness between women and men. COVID’s disruption of essential services has only exacerbated the situation, with women often forced to the margins—poorer, younger, and from minority backgrounds—most impacted.

“Addressing shortcomings in women’s healthcare will reduce the time women spend in poor health by almost two-thirds… yielding upwards of $1 trillion in benefits to the global economy each year.”

Women are at greater risk of misdiagnosis, improper treatment, and complications in common medical situations. For example, one in ten women experience endometriosis, often waiting up to ten years before being correctly diagnosed. In 2017, England’s National Institute for Health and Care Excellence released its first ever guidance for health professionals on endometriosis. The main recommendation? Listen to women.

Compounding this, sexual and reproductive rights are increasingly under attack with emboldened opposition in every corner of the world. Policies, programs, and narratives undermining bodily autonomy and reproductive freedom—be it fertility, contraception, surrogacy, childfree-ness, gender self-determination, and abortion—are spreading at an alarming rate.

Closing the Gap highlights four root causes, that if addressed, will close the gap.

• The study of human biology defaults to the male body, limiting understanding and resulting in fewer and less effective treatments for women.
• Health burdens for women are systematically underestimated, with datasets that exclude or undervalue conditions.
• Women are more likely to face barriers to care.
• There is low investment in women’s health conditions relative to their prevalence.

The report recommends prioritizing women-centric research; strengthening systematic collection, analysis, and reporting of sex- and gender-specific data; expanding women sensitive/specific care, prevention, and treatment services; and creating incentives and new financing models to stimulate investment.

As I took in the root causes and recommendations, I also took in the audience. Of the 50 or so people in attendance, I recognized nearly everyone, if not by individual face, by organizational name. They were the usual suspects, people already predisposed to the topic. And I realized an especially important root cause was missing, which explained the missing people. Underpinning all the others is a disregard for the perspectives and voices of women; an entitled belief that we know what is best for you, it is what is best for us.

This of course runs counter to the report’s case that investing in women’s health makes dollars and sense for everyone. Unfortunately, while the societal benefits of better health and well-being for women have been long documented and disseminated, evidence almost never speaks for itself. If it did the world would look radically different. Decisions that arise from data—or do not—are always founded in community and/or personal values and beliefs.

Even a trillion-dollar headline, backed with data, failed to draw new businesses, investors, governments, and philanthropists into the room. Why? Likely because they do not believe it or believe in it. And by it, I mean women. Sans Sikrit—Founder and Chairwomen of Tower Capital—aptly captured the challenge when I heard her say previously there exists “a psychological gap” relative to investing in women’s health.

As I moved from event to event during Davos, each one more opulent than the last, it became clear we who champion women’s health have our own psychological gap. Because we easily invest in technologies, systems, and conferences—so many conferences—in support of women’s health, but we tend to underinvest in women themselves.

I sipped champagne beneath chandeliers in the “equality lounge” and could not help but guess aloud at the cost and expected return on investment (such information rarely makes it into annual reports). I wondered exactly how much and what kind of evidence is required, and most importantly from whom, before corporate and philanthropic proponents of “data-informed decision-making” cut sponsorship checks. I pondered what it implied about what we choose to value and whose word we choose to believe.

“Closing the women’s health gap requires a shift in our collective culture. It demands we elevate and invest in strategies that provoke change in worldviews, norms, and prejudices.”

Closing the women’s health gap requires a shift in our collective culture. It demands we elevate and invest in strategies that provoke change in worldviews, norms, and prejudices. Undeniably, the technologies and systems women’s health businesses and donors invest in help to shape culture because they make certain behaviors easier or harder to adopt and execute. But change of mind—change in mindset—is rarely accomplished via top-down mechanisms, outside pressures, or global conferences alone.

Women’s health corporations and philanthropists do not/cannot compel culture change themselves (they throw great parties but are often late to the party). However, they can better support the women, grassroots organizers, and local groups that can and do. They can fund those who are known and trusted by their communities and best positioned to effectively challenge and change ideas about people’s worth, importance, and capacities and make alternative futures believable and appealing.

Robust people powered movements have proven highly effective at achieving massive social, political, and economic change over time, while also helping people to survive the right now.  Yet the impatient optimism that drove much of global women’s health and development over the last two decades has caused many of us to abandon the long view. We overestimated the enduring impact of quick wins and underestimated the potential for sea change. We overlooked and undervalued what history has shown to be a guaranteed strategy for success. Unfortunately, our opponents did not.

Many of us find it difficult to remain optimistic these days. After returning home from Davos, I went to the Martin Luther King Jr. Memorial in downtown Washington DC, as I often do, to read the stone and remember “the arc of the moral universe is long, but it bends towards justice.” Of course, we must help it along. True change is made across—and measured in—generations, and it begins within.

Embracing a fuller of definition of women’s health, one that reflects the realities and priorities of women, is a good place to restart. Continuing forward with the five recommendations in Closing the Women’s Health Gap report is smart too. But I want to add a recommendation of my own—or perhaps, it is a challenge—to those of us routinely in attendance at these global conferences and forums and who back women’s health and believe in women’s rights.

Publish what we spend on these forums annually—from airfare to per diems and the meetings and events that comprise them—as well as associated measures of impact. At the same time, make equivalent contributions to feminist funds—African Women and Development Fund, Equality Fund, Global Fund for Women, Mama Cash, Prospera—to name a few. They support practitioners that build community power and transform culture for the good of women, girls, gender-diverse people, and the world.

Closing the Gap ends with an unexpected brush of purple prose. 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 economy. I, too, cannot resist the urge to end with a flowery display and opt to extend the metaphor. If health equity sits within a tree of principles, it only exists because the seeds of gender equality have been planted and continue to stem from the grassroots.

This article was originally published by Kristy Kade on 8th February 2024.

Kristy Kade

WID Network Leader Kristy Kade, the CEO of White Ribbon Alliance, is a distinguished advocacy strategist with over a decade of experience in leading transformative initiatives in public health and development. Her journey began at White Ribbon Alliance in September 2017, where her leadership has been pivotal in advocating for women’s rights, health, and well-being. Kristy’s approach, focusing on grassroots involvement and policy change, has had a profound impact across diverse regions, including the US, Europe, Sub-Saharan Africa, Latin America, and Asia.

Prior to her current role, Kristy honed her expertise at PATH as the Director of Policy and Advocacy, managing an extensive portfolio of projects in over ten countries, and at Pathfinder International as Associate Director of Advocacy and Public Policy. Her work spans several critical areas, such as maternal, newborn, and child health, HIV, TB, malaria, family planning, and more. Kristy is known for her skill in building coalitions, integrating strategies across sectors, and empowering communities at all levels – from local to global.

She has championed the “What Women Want” initiative, emphasizing the importance of directly involving women and girls in health policymaking. Her commitment to this cause has led to significant advocacy victories and global recognition of the need to centre women’s voices in health discussions. Kristy’s leadership continues to inspire and mobilize resources and support for women’s health worldwide.