Closing the women’s health gap: A $1 trillion opportunity to improve lives and economies (2024)

Over the 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 2018.1Max Roser, “Twice as long—life expectancy around the world,” Our World in Data, October 8, 2018. But this is not the full picture. Women spend more of their lives in poor health and with degrees of disability (the “health span” rather than the “life span”). A woman will spend an average of nine years in poor health, which affects her ability to be present and/or productive at home, in the workforce, and in the community and reduces her earning potential (see sidebar “Terminology used in this report”).

Building on previous work from the McKinsey Health Institute and the McKinsey Global Institute,2“Prioritizing health: A prescription for prosperity,” McKinsey Global Institute, July 8, 2020. analysts quantified this health gap in terms of disability-adjusted life years (DALYs)3Global Burden of Disease Collaborative Network, “Global Burden of Disease Study 2019 (GBD 2019),” Institute for Health Metrics and Evaluation (IHME), 2020. and the extent to which this difference results from the structural and systematic barriers women face (see sidebar “Research methodology” ). Addressing the 25 percent more time that women spend in “poor health” relative to men not only would improve the health and lives of millions of women but also could boost the global economy by at least $1 trillion annually by 2040. This estimate is probably conservative, given the historical underreporting and data gaps on women’s health conditions, which undercounts the prevalence and undervalues the health burden of many conditions for women.

Critically, better health is correlated with economic prosperity. The women’s health gap equates to 75 million years of life lost due to poor health or early death per year (Exhibit 1), the equivalent of seven days per woman per year. Addressing the gap could generate the equivalent impact of 137 million women accessing full-time positions by 2040. 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 substantial investment but also reflect new market opportunities.

While improving women’s health has positive economic outcomes, it is foremost an issue of health equity and inclusivity. Addressing the women’s health gap could improve the quality of life for women, as well as creating positive ripples in society, such as improving future generations’ health and boosting healthy aging.

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The challenges women face when seeking healthcare play out in multiple different ways and in different diseases and sectors of society. In terms of the potential economic impact of addressing these challenges, all age groups and geographies could benefit, with most of the potential coming from women of working age (Exhibit 2).

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Embracing the full definition of women’s health

Women’s health is often simplified to include only sexual and reproductive health (SRH), which meaningfully underrepresents women’s health burden. This report defines women’s health as 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).4Consistent with the National Institutes of Health (NIH); see NIH, “Women’s Health.”

Research shows that SRH and maternal, newborn, and child health (MNCH) account for approximately 5 percent of women’s health burden,5“Global Burden of Disease Study 2019 (GBD 2019), IHME.” Used with permission. All rights reserved. although this is probably an underestimate (Exhibit 3). An estimated 56 percent of the burden comes from health conditions that are more prevalent and/or manifest differently in women. The remaining 43 percent stems from conditions that do not affect women disproportionately or differently based on current evidence.

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Women are most likely to be affected by a sex-specific condition between the ages of 15 and 50. Other conditions occur throughout women’s 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 themselves and their families (Exhibit 4).

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Pregnancy complications can increase risk for chronic illnesses; for example, gestational hypertension can portend chronic hypertension,6“Blood pressure and pregnancy,” Centers for Disease Control and Prevention. and women who have had gestational diabetes have a 50 percent risk of developing type 2 diabetes seven to ten years after the birth of the child.7“What is gestational diabetes?,” Joslin Diabetes Center, n.d. Good maternal health helps the mother and baby, with benefits extending beyond pregnancy and birth.

Health equity encompasses access to the interventions 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 interventions that lead to the best outcomes.

How to read this report

The analysis presented in this report includes an assessment of the health burden associated with the women’s health gap as measured in potential years of healthy life. This health improvement potential was then translated to economic potential, measured as contribution to gross domestic product (GDP). Sections 2 through 4 of this report focus 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, where economic impact is measured in terms of additional GDP.

While this report focuses on the potential economic benefits of closing the women’s health gap, there is also a moral imperative to close the women’s health gap and to improve the lives of millions of women worldwide.

Biomedical 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.8“Medical knowledge, including diagnostic criteria, is principally based on a male standard. Women patients’ symptoms are often labelled ‘atypical’, suggesting biases in diagnostic criteria.” L. Galea and R. S. Parekh, “Ending the neglect of women’s health in research,” British Medical Journal, 2023, Volume 381, Number 1303. The majority of animal models have been based on male specimens.9I. Zucker and A. K. Beery, “Males still dominate animal studies,” Nature, June 2010. 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 female biology better, fundamentally new research tools should be developed—for example, animal models, computational models, patient avatars and humanized models—that better classify women’s symptoms and manifestations of disease, as opposed to calling those “atypical.”10K. J. Schulte and H. N. Mavrovitz, “Myocardial infarction signs and symptoms: Females vs. males,” Cureus, April 2023, Volume 15, Number 4. This represents a tremendous opportunity for 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 use in both sexes. This is true, for example, for some therapies used in asthma and cardiovascular disease. Analysts looked at 183 of the most widely used interventions across 64 health conditions representing roughly 90 percent of the health burden for women, reviewing more than 650 academic papers, to assess the extent of this phenomenon. Of the interventions studied 50 percent reported sex-disaggregated data. In cases where sex-disaggregated data was available, 64 percent of the interventions studied were found to put women at a disadvantage due to lower efficacy, more limited access, or both, while for men this was the case only for 10 percent of interventions (Exhibit 5).

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Examples include:

• Asthma is a common respiratory condition affecting men and women at similar prevalence rates. Acute asthma exacerbations present as symptoms such as shortness of breath, wheezing, cough, or chest tightness.11University of Washington’s Institute for Health Metrics and Evaluation (IHME) Global Burden of Disease estimates the prevalence rate globally at 3.3 percent for males and 3.5 percent for females in 2019. “Global Burden of Disease Study 2019 (GBD 2019),” IHME, (used with permission); “Acute asthma exacerbation in adults,” BMJ Best Practice, updated November 2, 2023. A mainstay of treatment is inhaler therapy with bronchodilators and corticosteroids, but studies indicate that this treatment is around 20 percentage points less effective in reducing exacerbations in women than in men.12Rik J. B. Loymans et al., “Comparative effectiveness of long-term drug treatment strategies to prevent asthma exacerbations: Network meta-analysis,” British Medical Journal, May 2014, Volume 348; K. E. Wells et al., “The relationship between combination inhaled corticosteroid and long-acting β-agonist use and severe asthma exacerbations in a diverse population,” Journal of Allergy and Clinical Immunology, May 2012, Volume 129, Number 5.
• Cardiovascular and cerebrovascular disease—particularly ischemic heart disease and stroke—is the biggest single contributor to disease burden globally for both men and women, accounting for 16 percent of DALYs globally for men and 14 percent for women.13Data for 2019. “Global Burden of Disease Study 2019 (GBD 2019)” , IHME, (used with permission). One German study found that, despite identical technical success of a percutaneous cardiac intervention for men and women, the age-adjusted risk of death or of cardiac events was 20 percent higher in women than in men.14T. Heer 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, March 2017, Volume 6, Number 3.

Research in women’s health primarily focuses on diseases with high mortality, overlooking diseases leading to disability

One way to assess research priorities is through pipeline assets. There is up to a tenfold higher volume of new therapies in development for some of the most common women’s cancers compared with debilitating gynecological conditions (Exhibit 6). One possible reason 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 women’s health conditions—in particular, menopause, premenstrual syndrome, endometriosis, and polycystic ovary syndrome.

Additionally, maternal conditions should receive more attention. Compared with women-specific cancers, they contribute a similar share to overall suffering among women, but there is a large discrepancy in the pipeline of therapies in development. For example, even though postpartum hemorrhage (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 over the past 30 years.15A roadmap to combat postpartum haemorrhage between 2023 and 2030, World Health Organization, 2023.

In all, when tackling women’s health, the solution is not to divide more slices of one pie: it’s to make more pie.

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See Also

Women And Investing In 2024: Everything You Need To Know | BankrateWhy Investing in Women Benefits us AllGender Lens Investing InitiativeWhy is a Man Invest in a Woman? – Olavarría

How the lack of sex- and gender-specific data and research affects safety

Since 2000, women in the United States have reported total adverse events from approved medicines 52 percent more frequently than men, and serious or fatal events 36 percent more frequently.16For adverse events, this was 12.9 million for women versus 8.5 million for men through 2022, according to the Food and Drug Administration Adverse Events Reporting System (FAERS). For serious or fatal events, this was 8.3 million for women versus 6.1 million reports for men. Healthcare professionals in the United States reported 4.4 million serious or fatal events for women, versus 3.8 million for men through 2022.17Food and Drug Administration Adverse Events Reporting System. An analysis 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 with men (Exhibit 7).

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The research conducted indicates that systematic lack of disease understanding created a women’s health gap of 40 million to 45 million DALYs per year, or four days per woman per year. This is equivalent to around 60 percent of the total gap due to sex-related biology differences (see Exhibit 1 above). This estimate includes the known gap for conditions 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 no sex-disaggregated evidence is available for specific conditions that could, if evidence existed, potentially demonstrate levels of effectiveness difference comparable to conditions where sex-based analysis is available. The longevity of women cannot explain the disparity, and the effectiveness gap has a disproportionate impact on women and girls between ten and 40 years old and in certain regions (Latin America 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 can quantify problems and measure the impact of potential solutions. It is the critical ingredient of robust, evidence-based analysis and decision making. Yet many of the epidemiological and clinical data sets widely used today fail to provide a complete picture of women’s health because they undercount and undervalue the health burden. When women’s health is invisible, there are missed opportunities to improve lives, especially for women and girls in vulnerable populations.18J. H. Flaskerud and A. M. Nyamathi, “Attaining gender and ethnic diversity in health intervention research: Cultural responsiveness versus resource provision,” Advances in Nursing Science, June 2000, Volume 22, Number 4; M. Agénor 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, August 2016, Volume 16.

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 investment in women’s health. For example, an emerging body of evidence indicates potential gender bias in the measurement of pain, where women’s pain is routinely under-investigated and undertreated, with implications for clinical and psychological outcomes.19“Analysis: Women’s pain is routinely underestimated, and gender stereotypes are to blame,” University College London, April 9, 2021; L. L. Zhang et al., “Gender biases in estimation of others’ pain,” Journal of Pain, September 2021, Volume 22, Number 9; D. Glowacki, “Effective pain management and improvements in patients’ outcomes and satisfaction,” Critical Care Nurse, June 2015, Volume 35, Number 3. Collectively, these incomplete data sets can influence decision making and have the potential to exacerbate the women’s health gap.

Gaps exist across the data value chain

Stage 1: Pre-data generation

The data gap starts at the very definition of women’s health. There is a lack of consistent and aligned definitions and measurement scales for conditions and symptoms affecting women. For example, definitions of health-related burden associated with menopause or menstrual syndromes differ, and pain instruments and scales lack consistency.

Stage 2: Data generation

This encompasses both epidemiological and clinical data, including the documentation of women’s 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 percent of healthcare-related R&D efforts are targeted specifically at women’s health issues.20“Unlocking opportunities in women’s healthcare,” McKinsey, February 14, 2022.

Stage 3: Data aggregation

Sex-disaggregated results are available in the public domain for only 50 percent of the interventions analyzed. One study found that a quarter of clinical trials in the United States had sex-disaggregated data. Further, clinical trial designs and end-point selection can fail to consider potential differences between sexes. Evidence for intervention effectiveness may be drawn from unrepresentative populations because researchers did not recruit adequate numbers of women (and minorities). In another study, in 2021, half of countries reported COVID-19 cases and deaths by sex, 14 percent reported COVID-19 hospitalizations by sex, and 10 percent reported COVID-19 intensive-care-unit admissions by sex.21The COVID-19 Sex Disaggregated Data Tracker: May update report, Global Health 50:50, May 2021.

Stage 4: Data analysis

The metrics selected for analysis and publication may hide or dilute the experience of specific groups relative to others. Data sets gathered during the digital age have led to growth in machine-learning (ML) algorithms, but neither the 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 that using counterfactual fairness and similar methods can mitigate bias in areas such as race and gender.22J. Manyika, J. Silberg, and B. Presten, “What do we do about the biases in AI?,” Harvard Business Review, October 2019; Matt J. Kusner et al., “Counterfactual fairness,” in Advances in Neural Information Processing Systems 30, ed. I. Guyon et al., NeurIPS Proceedings, 2017.

Women can face barriers to timely and accurate diagnosis

There is evidence of significant and systematic differences in diagnostic assessments between men and women that can affect the accuracy of calculations of the prevalence and burden for several diseases affecting women. A study conducted in Denmark23“Across diseases, women are diagnosed later than men,” Faculty of Health and Medical Sciences, University of Copenhagen, news release, March 11, 2019. 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 was 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.24S. Westwood et al., “Disparities in women with endometriosis regarding access to care, diagnosis, treatment, and management in the United States: A scoping review,” Cureus, May 2023, Volume 15, Number 5; Andrew W. Horne and Philippa T. K. Saunders, “SnapShot: Endometriosis,” Cell, December 2019, Volume 179, Number 7.

Comparisons of endometriosis estimates also indicate unexplained variations. The WHO estimates that around 10 percent of women of reproductive age are living with endometriosis.25“Endometriosis,” fact sheet, World Health Organization, March 24, 2023. In contrast, the Global Burden of Disease estimates this figure to be 1 to 2 percent.26“Global Burden of Disease Study 2019 (GBD 2019)” IHME, (used with permission). This discrepancy—an eightfold difference—means there could be anywhere from 24 million to 190 million women affected worldwide.

For women, not only does the difficulty in getting a recorded diagnosis create a barrier to care, but the resulting lack of recorded diagnoses filters into how investors or researchers prioritize needs and assess market potential. In endometriosis, the data gap primarily reflects delays in diagnosis, which run to approximately ten years on average.27“Endometriosis: Guideline of European Society of Human Reproduction and Embryology,” European Society of Human Reproduction and Embryology, 2022; UK National Institute for Health and Care Excellence (NICE), Endometriosis: Diagnosis and management, NICE Guideline NG73, 2017. This leads to lower research 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 affects hundreds of millions of women across the world. In menopause, the challenge is more fundamental. While it is understood that most individuals who are biologically female experience symptoms at some point during the menopause transition,28J. A. Clayton, “Sex influences in neurological disorders: Case studies and perspectives,” Dialogues in Clinical Neuroscience, December 2016, Volume 18, Number 4; J. Whiteley et al., “The impact of menopausal symptoms on quality of life, productivity, and economic outcomes,” Journal of Women’s Health, November 2013, Volume 22, Number 11. this is rarely counted or considered within classifications of health and disease. For example, the IHME Global Burden of Disease data set currently captures the health burden associated with menopause within a catch-all category of “other gynecological diseases.”29Other gynecological disorders include menstrual disorders and non-menstrual disorders, including absent, scanty, and rare menstruation, pain and other conditions, and inflammatory and non-inflammatory diseases of the breast, ovaries, and cervix. “Other gynecological diseases—level 4 cause,” Global Burden of Disease Summaries, Institute for Health Metrics and Evaluation (IHME), University of Washington, 2019. As a result, it is not possible to identify clearly the underlying prevalence or the symptom severity (or disability weight) associated with menopause in that data set. Furthermore, some of the symptoms experienced during menopause, such as mood swings or depression, are often associated with other conditions, leading to misdiagnosis.30Bruce Dorr, “In the misdiagnosis of menopause, what needs to change?,” American Journal of Managed Care, September 14, 2022.

Additionally, there is a lack of data on maternal health overall, especially in LMICs, which can lead 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 around which interventions or policies to prioritize. The WHO reports that every day in 2020, approximately 800 women died from preventable causes related to pregnancy and childbirth. translating to a death every two minutes. Most of these deaths occur in LMICs.31The state of the world’s children 2015, UNICEF and Partnership for Maternal, Newborn, and Child Health, November 20, 2014; Trends in maternal mortality 2000 to 2020: Estimates by WHO, UNICEF, UNFPA, World Bank Group and UNDESA/Population Division, World Health Organization, February 23, 2023.

Gaps in understanding the effectiveness of health interventions

One example of the gap in clinical evaluations can be seen in US clinical trials. The Food and Drug Administration (FDA) has issued guidance on gender differences in clinical evaluation of medicines since 1993.32US Food and Drug Administration, “Guideline for the study and evaluation of gender differences in the clinical evaluation of drugs,” Federal Register (58 F.R. 39406), July 1993. In clinical trials from 2000 to 2022, women’s participation in oncology trials improved.33K. Jenei et al., “The inclusion of women in global oncology drug trials over the past 20 years,” JAMA Oncology, 2021, Volume 7, Number 10. However, a comparison of women’s participation with their share of the disease burden finds that women remain underrepresented in surgical trials for cancers of the bladder, head and neck, stomach, and esophagus.34Nirosha D. Perera et al., “Analysis of female participant representation in registered oncology clinical trials in the United States from 2008 to 2020,” Oncologist, June 2023, Volume 28, Number 6. While women experience a greater share of the health burden for some diseases, such as in neurology, the ratio is not reflected in clinical trial participation. Additionally, equitable representation of women (and men) of different races and ethnicities has long lagged (see sidebar “Case study: COVID-19 vaccine development”).

Ensuring sex-differentiated results

Representative clinical studies capable of producing stratified results 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 patients) and regulators insist on evidence for cohort-specific impact.

Today, some conditions, such as leukemia and meningitis, are believed to affect men and women equally. But the research to identify potential differences is lacking. Stakeholders may explore how a systematic and proactive approach 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—those combining study results to draw conclusions about therapeutic effectiveness. These can be used to analyze sex-specific efficacy without increasing sample size.35K. A. L’Abbé, A. S. Detsky, and K. O’Rourke, “Meta-analysis in clinical research,” Annals of Internal Medicine, August 1987, Volume 107, Number 2. Other analysis has found that investing in women as investigators could lead to more women enrolled in trials.36Waldhorn et al., “Trends in women’s leadership of oncology clinical trials,” June 2022.

Addressing data gaps in women’s health would require concerted effort across multiple fronts,37More detailed discussion available in Burns et al., “Closing the data gaps in women’s health,” April 3, 2023. potentially including requiring sex- and gender-disaggregated data to further understanding.

Several studies have indicated that women are more frequent users of health services than men.38K. D. Bertakis et al., “Gender differences in the utilization of health care services,” Journal of Family Practice, February 2000, Volume 49, Number 2; Gretchen Berlin, Lucia Darino, Megan Greenfield, and Irina Starikova, “Women in the healthcare industry,” McKinsey, June 7, 2019; “Gender mainstreaming in health,” European Institute for Gender Equality (EIGE), January 2017. These differences, however, may be reduced substantially when adjusted for different levels of need, such as reproduction or differences in disease prevalence.39Yingying Wang et al., “Do men consult less than women? An analysis of routinely collected UK general practice data,” BMJ Open, 2013, Volume 3. The McKinsey analysis finds that some of this unbalanced usage may result from inadequate service. Compared with men, women who present the same condition may not receive the same evidence-based care.40Emily Paulsen, “Recognizing, addressing unintended gender bias in patient care,” Duke Health Practice Management, January 14, 2020. These delays can add unnecessary costs to health systems, not to mention costs and stress to the patient and their family.

Inequalities exist throughout the full pathway of care

Intersectionality and health outcomes

This paper explores ways in which sex and gender influence an individual’s health chances and experience of health services. These differences are all too often 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 (exhibit). Within the United States, Native American and Black women are up to four times more likely to die from a pregnancy-related cause than White women. For Black families, this holds true even after adjustment for differences in income levels.1Kate Kennedy-Moulton et al., Maternal and infant health inequality: New evidence from linked administrative data, NBER Working Paper 30093, 2022. In India, a woman of upper caste is three times more likely to use prenatal care and five times more likely to have a trained birth attendant than a woman of lower caste.2E. Saroha, M. Altarac, and L. M. Sibley, “Caste and maternal health care service use among rural Hindu women in Maitha, Uttar Pradesh, India,” Journal of Midwifery & Women's Health, 2008, Volume 53. A study in the United Kingdom indicated that women from ethnic minority backgrounds have an increased risk of postpartum hemorrhage.3Jennifer Jardine et al., “Risk of postpartum haemorrhage is associated with ethnicity: A cohort study of 981,801 births in England,” BJOG: An International Journal of Obstetrics and Gynaecology, December 2021, Volume 129, Number 8. On a global scale, 94 percent of pregnancy-related deaths occurred in low‐resource settings, with 86 percent occurring in sub‐Saharan Africa and Southern Asia.4“Maternal health,” Pan American Health Organization, n.d.; Trends in maternal mortality, 2000 to 2017: Estimates by WHO, UNICEF, UNFPA, World Bank Group, and the United Nations Population Division, United Nations Population Fund (UNFPA), September 2019.

The 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. At each segment of this pathway, inequalities exist, especially for women who are disadvantaged in ways beyond their gender (see sidebar “Intersectionality and health outcomes”).

Awareness and prevention

Health education, including menstrual education, is one of the most effective ways to help women learn about their bodies.41M. M. Khan, “Menstrual health and hygiene: What role can schools play?,” World Bank, May 27, 2022. Countries vary in the types and amount of health education, but around the world, women who experience conditions such as painful periods, endometriosis, polycystic ovary syndrome, or uterine fibroids may have limited awareness of what is normal and when to seek medical advice.42F. Ní Chéileachair, B. E. McGuire, and H. Durand, “Coping with dysmenorrhea: A qualitative analysis of period pain management among students who menstruate,” BMC Women’s Health, October 2022, Volume 22, Number 1; A. Jabeen et al., “Polycystic ovarian syndrome: Prevalence, predisposing factors, and awareness among adolescent and young girls of South India,” Cureus, August 2022, Volume 14, Number 8; Chandler Dykstra et al., “‘I think people should be more aware’: Uterine fibroid experiences among women living in Indiana, USA,” Patient Education and Counseling, February 2023, Volume 107. 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 health insurance policies.43Y. T. Yang and D. R. Chen, “Effectiveness of a menstrual health education program on psychological well-being and behavioral change among adolescent girls in rural Uganda,” Journal of Public Health in Africa, April 2023, Volume 14, Number 3; Catherine Kansiime et al., “Menstrual health intervention and school attendance in Uganda (MENISCUS-2): A pilot intervention study,” BMJ Open, 2020, Volume 10, Number 2; Parisa Khalilzadeh et al., “Evaluating the effect of educational intervention based on the health belief model on the lifestyle related to premenstrual syndrome and reduction of its symptoms among the first-grade high school girls,” BMC Public Health, May 2023, Volume 23.

Prevention 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 percent, particularly if women are vaccinated when they are younger.44Jiayao Lei et al., “HPV vaccination and the risk of invasive cervical cancer,” New England Journal of Medicine, October 2020, Volume 383. In 2020, the WHO launched the 90-70-90 targets, which aim to have 90 percent of girls vaccinated against HPV, 70 percent of women screened for HPV by age 35 and again at 45, and 90 percent of women with precancer treated or with invasive cancer managed. According to the WHO, great disparities exist among countries: less than 25 percent of LICs and less than 30 percent of LMICs have introduced the vaccine, compared with 85 percent of high-income countries (HICs).45Global strategy to accelerate the elimination of cervical cancer as a public health problem, World Health Organization, 2020. Some 36 percent of women worldwide have been screened for cervical cancer in their lifetime—84 percent in high-income countries and less than 20 percent in LMICs or LICs.46L. Bruni et al., “Cervical cancer screening programmes and age-specific coverage estimates for 202 countries and territories worldwide: A review and synthetic analysis,” Lancet Global Health, August 2022, Volume 10, Number 8 (erratum in Lancet Global Health, July 2023, Volume 11, Number 7. In this report, the analysis began with the projected baseline disease burden by sex, age group, year, and country for 195 countries. For more on methodology, see the technical appendix.

The importance of increasing awareness goes beyond patients. Many doctors are unaware of how diseases can affect or manifest differently in women, so they are unable to provide proper care to many patients.

Accessibility and affordability of care

Women may encounter barriers related to access and affordability. Healthcare spending and insurance premiums have 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 percent extra for supplementary hospital insurance, with greater disparities in specific age groups. A 31-year-old woman pays, on average, 37 percent more than a man of the same age.47Daniel Dreier, “Financial inequalities between women and men in Switzerland,” Moneyland, January 23, 2023. Similarly, Indian private insurers employ gender-based premiums, leading to higher expenses for women.48“How health insurance premium varies by gender?” Future Generali, February 11, 2022. Further McKinsey analysis of US copay rates finds American women have an average of $135 more out-of-pocket expenses per year than men. Of that, $55 goes to higher copay 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 to menstrual products and hygiene facilities.49“Menstrual health and hygiene,” World Bank, May 12, 2022. In Bangladesh, a study conducted by the HERproject showed that 73 percent of women employed by a textile factory in Bangladesh missed work for an average six days a month.50K. Tull, “Period poverty impact on the economic empowerment of women,” University of Leeds Nuffield Centre for International Health and Development, January 23, 2019. This absenteeism negatively affects not only business but also the lives and the livelihoods of women who are not paid for days they do not work. However, when the HERproject provided menstrual pads and other work-based interventions (sharing information regarding menstruation, reducing stigma, etcetera), absenteeism dropped to 3 percent.51K. Tull, “Period poverty impact on the economic empowerment of women,” University of Leeds Nuffield Centre for International Health and Development, January 23, 2019.

Family planning also is highly relevant. Women of childbearing age who are sexually active must 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, for reasons that include a lack of access and support, according to the 2023 Global Contraception Policy Atlas.52“Launch of the Global Contraception Policy Atlas at Women Deliver 2023,” European Parliamentary Forum for Sexual and Reproductive Rights, July 18, 2023. 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 one’s family, and higher levels of “family dysfunction.”53Joseph M. Boden, David M. Fergusson, and l. John Horwood, “Outcomes for children and families following unplanned pregnancy: Findings from a longitudinal birth cohort,” Child Indicators Research, March 2014, Volume 8.

These disparities can be tackled. Alternative models and systems are helping to increase accessibility and affordability of care for women while also reducing costs for healthcare systems and individuals. Examples include the US Affordable Care Act and women’s health hubs in the United Kingdom.54“Women’s health hubs cost-benefit analysis,” UK Department of Health & Social Care, July 22, 2023.

Timely diagnosis

The 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. One study found women were up to seven times more likely than men to have a heart condition misdiagnosed and be discharged during a heart attack.55J. Hector Pope et al., “Missed diagnoses of acute cardiac ischemia in the emergency pepartment,” New England Journal of Medicine, April 2000, Volume 342, Number 16; Elizabeth G. Nabel, “Coronary heart disease in women—an ounce of prevention,” New England Journal of Medicine, August 2000, Volume 343, Number 8; Harvard Health Blog, “Women and pain: Disparities in experience and treatment,” October 9, 2017. More sensitive biomarkers to detect heart attacks in women have been identified,56O. Ola et al., “Clinical impact of high-sensitivity cardiac troponin T implementation in the community,” Journal of the American College of Cardiology, 2021, Volume 77, Number 25; Arash Mokhtari, Ulf Ekelund, and Ulf Ekström, Riktlinjer för användning av Siemens högkänsliga troponin I vid handläggning av patienter med bröstsmärta (Guidelines for the use of Troponin I (Siemens) in the management of patients with chest pain), Region Skåne (Skåne County, Sweden), November 6, 2023. and studies are ongoing to validate the impact on health outcomes, but medical school curricula and residency and fellowship trainings need to be updated to reflect these differences.

For maternal care, untreated tuberculosis may have a mortality rate of up to 40 percent in high-risk areas,57A. Zumla, M. Bates, and P. Mwaba, “The neglected global burden of tuberculosis in pregnancy,” Lancet Global Health, 2014, Volume 2, Number 12. where women often have lower uptake of treatment, probably as a result of societal norms. One possible solution is the integration of tuberculosis screening in antenatal care for pregnant women. This strategy was tested in Pakistan and proved to be feasible and effective.58Rozina Feroz Ali et al., “Integrating tuberculosis screening into antenatal visits to improve tuberculosis diagnosis and care: Results from a pilot project in Pakistan,” International Journal of Infectious Diseases, July 2021, Volume 108.

Choice of treatment

Accurate diagnosis should prompt delivery of evidence-based treatment. But sex and gender can affect care, even for common conditions. For example, upon discharge, women cardiac 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.59“Women more likely to die after heart attack than men,” press release, European Society of Cardiology, May 22, 2023.

Outcomes after an acute cardiac event could potentially improve via sex- and gender-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 systemwide protocol that includes emergency department catheterization lab activation, a STEMI (ST elevation myocardial infarction) safe-handoff checklist; transfer to an immediately available catheterization lab, and a radial-first approach to percutaneous coronary intervention.60C. P. Huded et al., “4-step protocol for disparities in STEMI care and outcomes in women,” Journal of the American College of Cardiology, 2018, Volume 71, Number 19. A discharge checklist for guideline-directed medical therapy has been shown to reduce mortality in heart failure patients by 65 percent for both sexes.61H. Rismiati et al., “The role of discharge checklist in guideline-directed medical therapy for heart failure patients,” Korean Journal of Internal Medicine, 2023, Volume 38, Number 2.

While some efforts to achieve gender parity require heavy investment, there are budget-conscious solutions with potentially huge impact. UNICEF’s Côte d’Ivoire Country Office, for example, produced a low-cost version of a uterine balloon tamponade device to treat maternal hemorrhage. The product, which uses a catheter and a condom, has a 95 percent success rate and has been scaled nationally.62“Uterine balloon tamponade,” UNICEF Office of Innovation, n.d.

Creating solutions to tackle care disparities

Overall, the gap in care delivery contributes 34 percent to the women’s health gap (see Exhibit 1 above). Consider how sex- and gender-appropriate care delivery could reduce the women’s health burden by 25 million DALYs per year globally, corresponding to 2.5 days per woman per year.

Global public health programs 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 health 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 program and associated investment package.63Gender and TB: A Stop TB Partnership paper, Stop TB Partnership, 2021; Gender and TB investment package: Community, rights and gender, Stop TB Partnership, 2020. One pillar of this approach is the 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 bridge 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 treatments.

When it comes to affordability and access, counteracting the rise in healthcare costs while benefiting 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 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.64“‘What is CMMI?’ and 11 other FAQs about the CMS Innovation Center,” KFF, 2018.

VBC models in the United States include accountable care organizations (ACOs), voluntary networks 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 2020.65“Medicare Shared Savings Program saves Medicare more than $1.8 billion in 2022, continues to deliver high-quality care,” news release, US Department of Health and Human Services, August 24, 2023; Corinne Lewis et al., “The impact of the payment and delivery system reforms of the Affordable Care Act,” Commonwealth Fund, April 28, 2022. Outside of the United States, the European Hospital Alliance’s nine hospitals have offered a blueprint that includes measuring costs and outcomes for every patient and bundled payments for care cycles.66Y. Cossio-Gil et al., “The roadmap for implementing value-based healthcare in European university hospitals—consensus report and recommendations,” Value in Health, 2022, Volume 25, Number 7. Value-based models are designed to reduce costs while improving quality outcomes for patients. For example, given the amount of time, number of tests, and number of providers a woman may see before an endometriosis diagnosis, a revised 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 data sets, and interoperable electronic records are potential options for enhancing care delivery. Ultimately, a combination of innovation, investment, and ability to scale could unlock better care delivery solutions for women.

There has been a historical underinvestment in women’s health research from the public, social, and private sectors. Funding sources typically overlook the fact that many conditions manifest differently in each sex, creating variances in outcome.

Closing the health gap will require increased investment not only for understanding sex-based differences but also for addressing unmet needs in women’s health. Further, additional funding and new business models could support sex- and gender-appropriate care.

Research funding neglects women’s health

One approach to redirecting investments is to examine policies based on actual population needs. This approach is pertinent for public funding, which continues to be one of the primary investment sources for scientific research. In the United States, up to 45 percent of basic and applied life-sciences research is funded through federal and nonfederal government sources.67U.S. research and development funding and performance: Fact sheet, Congressional Research Service, September 13, 2022; Mark Boroush and Ledia Guci, “Research and development: US trends and international comparisons,” Science and Engineering Indicators, National Science Board, April 28, 2022. The importance of public funding 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.68E. Cleary, M. J. Jackson, and F. Ledley, “Government as the first investor in biopharmaceutical innovation: Evidence from new drug approvals 2010–2019.” Institute for New Economic Thinking Working Paper Series No. 133, November 18, 2020; E. G. Cleary et al., “Contribution of NIH funding to new drug approvals 2010–2016,” Proceedings of the National Academy of Sciences of the United States of America, 2018, Volume 115, Number 10.

Women’s health funding data by country can be scarce. In the United States, the National Institutes of Health (NIH) allocates 11 percent of its budget to women’s-health-specific research. Thus, despite women having a 50 percent higher mortality rate in the year following a heart attack, only 4.5 percent of the NIH’s budget for coronary artery disease supports women-focused research.69Perspectives on advancing NIH research to inform and improve the health of women, National Institutes of Health, Office of Research on Women’s Health, 2021. In Canada and the United Kingdom, 5.9 percent of grants between 2009 and 2020 went to research that looked at female-specific outcomes or women’s health.70K. Smith, “Women’s health research lacks funding—these charts show how,” Nature, May 3, 2023.

In another example as of 2015, there were five times more scientific studies on erectile dysfunction than premenstrual syndrome.71ResearchGate Blog, “Why do we still not know what causes PMS?,” August 12, 2016. In a trial where the medication sildenafil citrate was shown to relieve menstrual pain, research stopped due to a lack of funding.72R. Dmitrovic, A. R. Kunselman, and R. S. Legro, “Sildenafil citrate in the treatment of pain in primary dysmenorrhea: A randomized controlled trial,” Human Reproduction, November 2013, Volume 28, Number 11; “There’s a gender gap in medical data, and it’s costing women their lives, says this author,” CBC, August 17, 2019.

These examples reflect how underfunding certain research leads to and augments the women’s 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 nonprofits evaluate resources and policies across populations, they create an opportunity to advance health equity and benefit 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 Women’s Health Access Matters, which aims to increase women’s health research and accelerate investment in sex-based research over the next three years.73“WHAM launches #3not30 Campaign to call for doubling the funding for women’s health research in the next three years,” news release, Women’s Health Access Matters (WHAM), January 19, 2023.

Many attractive opportunities in women’s health remain untapped. Currently, global life sciences R&D efforts primarily focus on conditions with a high contribution of years of life lost (YLLs) to the overall disability-adjusted life years (DALY). This has often disadvantaged women since they have a higher probability of being affected by conditions that affect quality of life—measured as years lived with a disability (YLDs)—rather than length of life. Among these conditions are rheumatoid arthritis, endometriosis, uterine fibroids, and diabetes. The disability weight for someone with moderate abdominal pain and primary infertility due to endometriosis is 0.121; for moderate rheumatoid arthritis, 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 to trade a year of life to avoid 3.2 years with rheumatoid arthritis. Additionally, gynecological conditions, such as endometriosis and uterine fibroids, which affect up to 68 percent of women,74Zheng Lou et al., “Global, regional, and national time trends in incidence, prevalence, years lived with disability for uterine fibroids, 1990–2019: An age-period-cohort analysis for the Global Burden of Disease 2019 study,” BMC Public Health, May 2023, Volume 23, Number 916. have 33 assets in the pipeline , while other conditions that affect a lower percentage have more assets (Exhibit 8).

Women often face conditions that are not fatal but can cause disability and impede their quality of life.

Some conditions, such as colon or liver cancer, affect men and women differently, and on average, women are more likely to develop a more serious or severe form of these conditions.

Certain conditions, such as Alzheimer’s and other dementias, affect women disproportionately. A 2019 report found that, globally, women with dementia outnumbered men with dementia 100 to 69.1GBD 2019 Dementia Forecasting Collaborators, “Estimation of the global prevalence of dementia in 2019 and forecasted prevalence in 2050: An analysis for the Global Burden of Disease Study 2019,” Lancet Public Health, February 2022, Volume 7, Issue 2.

Certain women-specific conditions, such as ovarian cancer, cause less disability because the fatality rates are higher. Ovarian cancer is the most lethal gynecological cancer, with a five-year relative survival rate of 17 percent for a patient diagnosed at an advanced stage.1Lauren A. Baldwin et al., “Ten-year relative survival for epithelial ovarian cancer,” Obstetrics & Gynecology, September 2012, Volume 120, Number 3.

Certain conditions affecting men, such as testicular cancer, have a low number of assets and share of suffering caused by disability.

Certain conditions affect men and women equally in terms of suffering caused by disability, such as diabetes and liver disease.

Market potential of treatments for endometriosis and menopause

Globally, 190 million women are suffering from endometriosis.1“Endometriosis,” World Health Organization, March 24, 2023. Currently, no cure exists, and treatments focus on symptom management. Based on prevalence and unmet need, the market potential for endometriosis treatments is estimated at $180 billion to $250 billion globally (exhibit), given today’s 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 another area of high unmet need globally. Based on the age distribution of the population and share of symptomatic cases, it is estimated that more than 450 million women worldwide have menopausal or perimenopausal symptoms.2Estimate based on global population of women between ages 45 and 55 and more than 90 percent of women experiencing at least one symptom during the menopausal transition. Based on the prevalence of menopause, its impact on women’s life, the high unmet need, and the share of women seeking treatment today, estimated global market potential to treat symptoms ranges from $120 billion to $350 billion globally.3Aja Mangum, “The $600 billion market for women in menopause is fit for disruption,” Bloomberg, March 28, 2021.

Addressing sex-specific conditions can pay off. For example, the debut of Viagra for erectile dysfunction, which affected an estimated 152 million men in 1995, generated $400 million in sales revenue within its first three months in the US market in 1998.75I. A. Ayta, J. B. McKinlay, and R. J. Krane, “The likely worldwide increase in erectile dysfunction between 1995 and 2025 and some possible policy consequences,” BJU International, July 1999, Volume 84, Number 1; Berkeley Lovelace Jr., “Pfizer still holds the lead in the erectile dysfunction market even as Viagra sales falter,” CNBC, February 14, 2019. By 2012, worldwide sales hit a record $2.1 billion.76“Viagra outdoes competition with Q3 sales,” Pharmaceutical Technology, December 18, 2020. Globally, given the similar prevalence and high unmet need for conditions such as endometriosis and menopause, there is enormous potential for innovative treatments (see sidebar “Market potential of treatments for endometriosis and menopause”).

Enormous potential also exists for treatment of breast cancer. 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).77Evaluate Pharma database, accessed 2023. An opportunity remains to improve outcomes of breast cancer in LMICs, where the fatality rate of 72 percent has been higher than the incidence rate (62 percent).78S. Al-Sukhun et al., “Breast cancer priorities in limited-resource environments: The price-efficacy dilemma in cancer care,” American Society of Clinical Oncology Educational Book, Volume 42, June 22, 2022. Globally, endometriosis, uterine fibroids and menopause are among the conditions with high unmet need and economic potential.

Private equity/venture capital investors are increasing investments in women’s health, with excitement about digital health solutions

Private equity and venture capital investments in women’s health are starting to grow quickly as opportunities in women’s health become clearer and more female technology (FemTech) start-ups set out to disrupt the healthcare market.79E. Kemble et al., “The dawn of the FemTech revolution,” McKinsey, February 14, 2022. Within the FemTech space is concentrated activity concerning maternal health patient support, consumer menstrual products, gynecological devices, and fertility solutions.80E. Kemble et al., “The dawn of the FemTech revolution,” McKinsey, February 14, 2022.

The start-ups making the top deals in the past four years mainly focus on men’s sexual and overall health. A McKinsey analysis found that 11 start-ups addressing erectile dysfunction, among other men’s health concerns, secured $1.24 billion in 2019–23, while eight start-ups addressing endometriosis received $44 million. Funding for companies focusing on erectile dysfunction was six times greater than for companies focused on endometriosis. However, investors may be starting to see the potential. In the past four years, women’s health newcomers received $2.2 billion in funding. Some 60 percent of the top deals exclusively addressed women’s health, specifically endometriosis, fertility, and maternal and neonatal health.81E. Kemble et al., “The dawn of the FemTech revolution,” McKinsey, February 14, 2022.

Another potential avenue for innovation is digital health, which has the potential to make health more equitable.82D. Argyres et al., “Digital health: An opportunity to advance health equity,” McKinsey, July 26, 2022. In the digital healthcare space, FemTech companies received 3 percent of the total digital-health funding.83“FemTech Revolution: Which start-ups are transforming women’s health?,” EIT Health Ireland-UK, March 8, 2023.

Given the large unmet need and resulting opportunity, those who continue to forgo investing in women’s health may find themselves left behind by the players that tap into this high-potential market.

The disparities in women’s health affect not only women’s quality of life but also their economic participation and ability to earn a living 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 women’s increased labor force participation. Therefore, it is not surprising that the gap in women’s health results in lost economic potential.

Addressing the health gap women face could boost the global economy by adding at least $1 trillion to the global economy by 2040. This means a 1.7 percent increase in the average per capita GDP generated by women.

Women’s economic participation has been and will be a major driver of economic growth

Extended participation by women boosts economies and GDP growth.84E. Ortiz-Ospina, S. Tzvetkova, and M. Roser, “Women’s employment,” Our World in Data, 2018. 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.85A. Weinstein, “When more women join the workforce, wages rise—including for men,” Harvard Business Review, January 31, 2018. Ability to participate in the economy also benefits women individually. In a 2023 poll, when women around the world were asked if they preferred to work in paid jobs, care for their families, or do both, 70 percent said they preferred to work in paid jobs or do both.86That is, the 70 percent combines responses from women saying they would prefer to work at paid jobs with responses from those saying they prefer to both work at paid jobs and care for their homes and families. Towards a better future for women and work: Voices of women and men, International Labour Organization/Gallup, 2017.

Endometriosis and menopause have a substantial impact on women’s ability to work and earning potential

Menopause and endometriosis 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 percent of affected women state that menopause interferes with their lives, and one-third of these women also experience depression.1Burns et al., “Closing the data gaps in women’s health,” April 3, 2023. Further, menopause is linked to premature departure from the workforce.2Lizzy Burden, “Women are leaving the workforce for a little-talked-about reason,” Bloomberg, June 18, 2021; S. D’Angelo et al., “Impact of menopausal symptoms on work: Findings from women in the Health and Employment after Fifty (HEAF) study,” International Journal of Environmental Research and Public Health, December 2022, Volume 20, Number 1. Similarly, endometriosis is linked to loss in productivity and absenteeism.3Kelechi E. Nnoaham et al., “Impact of endometriosis on quality of life and work productivity: A multicenter study across ten countries,” Fertility and Sterility, August 2011, Volume 96, Number 2. This analysis factors in the actual economic impact for both conditions. Studies have found that up to 90 percent of women reported menopausal symptoms during the transition.4Ginger D. Constantine et al., “Behaviours and attitudes influencing treatment decisions for menopausal symptoms in five European countries,” Post Reproductive Health, September 2016, Volume 22, Number 3. 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 of cases at 24 million, whereas the WHO puts the prevalence at 190 million.5WHO, “Endometriosis,” March 24, 2023.

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 (exhibit).

Conversely, the women’s health gap limits individual women and directly affects the global economy by impairing women’s economic participation and productivity. Chronic diseases are often linked to extended absences from work,87Paul Hemp, “Presenteeism: At work—but out of it,” Harvard Business Review, October 2004. and poor health is a cause of “presenteeism,” where individuals go to work but cannot perform at their full capacity, reducing productivity. Finally, disabilities and informal caregiving obligations hold back affected individuals, often women, from full workforce participation (see sidebar “Endometriosis and menopause have a substantial impact on women’s ability to work and earning potential”).

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 to support themselves and their families and has the potential to lift more women out of poverty.

Better health often enables individuals to work more effectively

The health disparities outlined in this report affect individuals of all age groups, with about 50 percent of the burden affecting women of working age. Closing the women’s health gap could allow women to add 1.7 percent to GDP . Comparatively, the World Bank estimates that if the status quo remained, GDP growth could reach 2.7 percent, 2.9 percent, and 3.4 percent in 2023, 2024, and 2025, respectively.88Global economic prospects, World Bank, June 2023.

Looking at the different channels affecting GDP, the largest impact, amounting to around $400 billion or avoiding 24 million years with disability, would be created through fewer health conditions (Exhibit 9). Expanded participation and increased productivity could each contribute more than 20 percent of total impact.

9

Treating ten health conditions would contribute more than half of the economic impact

On a global level, effective treatment of ten conditions—for example, premenstrual syndrome (PMS), depressive symptoms, and migraines—could make up more than 50 percent of the economic impact (Exhibit 10). This impact suggests which conditions to consider prioritizing 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. 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.89Arman Arab et al., “Beneficial role of calcium in premenstrual syndrome: A systematic review of current literature,” International Journal of Preventive Medicine, September 2020, Volume 11. A study in Iran found that the severity and frequency of PMS symptoms was significantly lower in an intervention group that offered education and coping strategies.90Farzaneh Babapour et al., “The effect of peer education compared to education provided by healthcare providers on premenstrual syndrome in high school students: A social network‐based quasi‐experimental controlled trial,” Neuropsychopharmacology Reports, March 2023, Volume 43, Number 1. Addressing PMS with effective interventions could allow women to experience less pain, experience better quality of life, and feel more able to work.

The conditions having the greatest economic impact in different countries will differ from one geographic region to another based on each region’s disease burden and healthcare status. The examination of economic impact, rather than DALY impact, gives more weight to conditions that affect people during years of working age, as that is when economic contribution is highest. Conditions such as ischemic heart disease may affect more people, but if the burden of morbidity and premature mortality 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 ten conditions. For example, infertility can lead to significant anxiety, depression symptoms, and other psychological distress.91Cedars-Sinai Blog, “How infertility impacts mental health,” September 8, 2020.

10

Generally, a reduction in health conditions is tied to a woman’s economic potential, with allowances for regional socioeconomic and healthcare factors (Exhibit 11). The top two conditions by contribution to GDP impact of the women’s health gap are always a combination of two of the top four global conditions: PMS, depression, migraine, or other gynecological conditions. Larger differences among regions are observed when looking at the top ten or more conditions.

11

Across the four channels, the highest GDP impact relative to women’s GDP is observed in HICs and LICs (Exhibit 12). 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) regions exhibit an overall lower projected GDP impact.

12

Investing in women’s health shows positive return on investment (ROI): for every $1 invested, approximately $3 is projected in economic growth

Investing in improving women’s health not only improves women’s quality of life but also enables them to participate more actively in the workforce and make a living. The potential value created through women’s 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 uptake of interventions required to address the women’s health gap, including all relevant interventions considered cost-effective in each setting.92To identify the incremental or net steady-state cost of each intervention, we identified the cost per DALY averted from the scientific literature (primarily WHO, DCP-3, and the Tufts Cost-Effectiveness Analysis Registry) for each intervention and income archetype and converted to standardized US dollars. To calculate the total cost for each country, we multiplied the unit cost (cost per DALY averted) by the volume of DALYs averted by that particular intervention in 2040. For further discussion of the strengths and limitations of this approach, see the technical appendix. The analysis compared this to the additional economic potential that could be unlocked by the health improvements associated with these interventions.

The expected economic return varies by region. The ROI is greatest in higher-income settings, where it is around $3.50 returned for every $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 create 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 on $1 invested.

The analysis examines only the direct costs of addressing the gaps in care delivery identified. In the longer term, a range of greater positive returns is possible, given that improvement in the lives of women influences the health and resilience of their families and communities.

Where to start tackling the women’s health gap to reap the greatest benefit for all

Globally, the top ten conditions by economic impact account for more than 50 percent of the total GDP impact. This highlights areas with high unmet needs and potential, aiding decision makers in 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 toward health equity.

The content and sequence of each action will need to be tailored to regional conditions. Building on the knowledge developed throughout this report, a fact-based strategic assessment can lead to better health equity for each country.

As noted in this report, women’s health has been under-researched, and women face 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 to close the women’s 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 women’s health innovation, and (5) examining business policies to support women.

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 disproportionately

The women’s health gap could be narrowed by increasing funding to achieve equality with investments in funding for men’s health and using 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 understanding 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 biology.

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 guidelines 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. Life science companies, academic institutions, and educational bodies should ensure that women and people of color not only find representation but be actively involved in research, leadership, and decision-making roles. For example, women form almost 70 percent of the global health and social workforce, but it is estimated they hold only 25 percent of senior roles.93“10 key issues in ensuring gender equity in the global health workforce,” WHO, March 20, 2019. The benefits of increasing women’s representation are manifold: for example, teams boasting diverse gender representation have been associated with higher levels of accountability and effectiveness.94Jennifer Asuako, “Women’s participation in decision making: Why it matters,” UN Development Programme, December 4, 2020. In one study that analyzed more than 440,000 medical patents filed from 1976 through to 2010, patented biomedical inventions created by women were up to 35 percent more likely to benefit women’s 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 preeclampsia, as well as conditions that disproportionately affect women, such as lupus.95Rembrand Koning, Sampsa Samila, and John-Paul Ferguson, “Who do we invent for? Patents by women focus more on women’s health, but few women get to invent,” Science, June 2021, Volume 372, Number 6548.

Systematically collect and analyze sex-, ethnicity-, and gender-specific data to have more accurate representation of women’s health burden and the impact of different interventions

The prevalence of conditions such as 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 direct additional funding to the research and treatment of these underserved conditions.

• Beyond epidemiological data, today’s 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 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 formulations and dosages. This could yield better health outcomes and a higher probability of success. To further encourage the shift toward disaggregated data, the Women’s Health Innovation Opportunity Map 2023 proposes establishing sex as a biological variable.96Women's Health Innovation Opportunity Map: 50 high-return opportunities to advance global women’s health R&D, Bill & Melinda Gates Foundation and National Institutes of Health, October 2023. This would enable national health departments and 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 exacerbate existing biases or violate patient privacy rules. Developing robust, secure, and holistic data sets could enable companies to differentiate in an overcrowded marketplace.

Enhance access to gender-specific care, from prevention to diagnosis and treatment

• Women deserve the same high-quality level of care from their healthcare providers as men, which doesn’t 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 addition to medical schools, continuing medical education organizations and credentialing entities could assess whether healthcare providers are receiving the latest information and training on the women’s health gap and sex- and gender-based differences. Current and future healthcare professionals of 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 clinical 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 cutoffs for biomarkers, discharge checklists) to guide decision making and minimize biases. Similarly, life science companies could include sex-specific evidence and outcomes on product package inserts and labels to inform healthcare professionals on the best regimens for different subpopulations.97Women's Health Innovation Opportunity Map: 50 high-return opportunities to advance global women’s health R&D, Bill & Melinda Gates Foundation and National Institutes of Health, October 2023.
• To reduce maternal mortality globally, investing in 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 percent of newborn deaths, and 65 percent of stillbirths while contributing to the economic development and empowerment of women.98Christina Östberg Lloyd and Christian Sand Horup, “Leaders in women's health call for more investment in midwives to prevent 4.3 million deaths each year,” World Economic Forum, May 5, 2023.
• Governments, educational bodies, philanthropic 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. Healthcare 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 elevate the quality of healthcare women receive.

In addition, two things to enable closing the gap include:

Create incentives for new financing models to close the women’s health gap

• Historically, given lower levers of investments overall for women’s health under the traditional financing model schemes, new financing models have a critical role to play. These models can accelerate innovation. One example is the advance market commitment (AMC) geared to COVID-19 vaccine development and deployment.
• Research and reliable data on the women’s health landscape can help spur investment. For investors, the gender-based healthcare landscape presents a mosaic of unexplored opportunities. By pivoting toward this opportunity, investors 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 research and services—for example, by earmarking funds, providing tax incentives, lowering application fees, and expediting the drug approval process. Philanthropic organizations, donors, and international bodies could offer grants and prizes at a national or local level to spur innovation while supporting capacity building in regions where gender-based health disparities are highest. Examples might be launching a grant or award program geared toward reducing rates of respiratory illnesses in areas where there is a high percentage of women smokers, or toward a technology-based solution for women 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 to projects that directly address the women’s health gap. Governments could further promote private-sector investments by creating tax incentive programs for angel investors and venture capitalists that invest in women’s health.99Women's Health Innovation Opportunity Map: 50 high-return opportunities to advance global women’s health R&D, Bill & Melinda Gates Foundation and National Institutes of Health, October 2023.
• With collaboration, stakeholders have the potential to encourage investments and inspire the development of innovative financing models in women’s health.

Establish business policies that support women’s health

As 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 women’s health, examine ways to better involve women in decision-making processes, provide health and wellness benefits that support women’s health, and create safe working environments in which women can speak openly about their health needs. By 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, high impact could come from flexible work policies that recognize menopause. Given the fact that women are more than twice as likely as men to have depressive symptoms in their lifetime,100“Depression in women,” Mental Health America, n.d. employers may explore how mental-health programs 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 vision. If the decision makers are predominantly men, the workplace tends to benefit men. Previous McKinsey research has found a “broken rung” in women’s advancement throughout industries: for every 100 men promoted from entry-level to manager roles, 87 women are promoted and only 73 women of color are promoted.101“Women in the workplace 2023,” McKinsey, October 5, 2023. Overall, due to gender disparities in early promotions, men end up with 60 percent of manager-level positions in a typical company. More women in senior leadership positions may be able to advocate for policies that support women’s health, and companies may ultimately benefit from a healthier and more productive workforce.

Data-driven, scalable actions to improve women’s health may vary widely, but the critical component is to determine how each stakeholder can contribute to narrowing the gap.

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.

Achieving health equity is a collaborative and ongoing endeavor that relies on the active participation of governments, healthcare institutions, nongovernmental organizations, individuals, and all stakeholders vested in this cause. Tackling the women’s health gap depends on addressing the interconnected factors outlined in this report: the deficit of women-specific knowledge in science, the glaring data gaps, the disparities in healthcare delivery, and the insufficient investment in women’s health.

Recognizing the vast potential to improve the lives and livelihoods of half the global population while boosting the economy serves as the catalyst for closing the women’s 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, philanthropists, activists, and more.

In this endeavor lies an opportunity of $1 trillion in economic potential driven by improved women’s 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.

Women’s health is not a stand-alone 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 narrow the health gap but also contribute to the betterment of a shared global future.