3 Questions with Dr. Choo: Women’s Health
Even though women represent more than half of the world's population, their health and well-being has not been prioritized. It wasn’t too long ago – 1977 – when the U.S. Food and Drug Administration recommended that women of childbearing age be excluded from clinical research studies as they were considered a “vulnerable” population. The gender bias we see in health care can, and does, have significant implications on how women experience medical care, and we know it has a negative impact on health outcomes. And for women of color, there’s a compounded impact. According to research from the Kaiser Family Foundation, American Indian/Alaskan Native and Black women have pregnancy-related mortality rates that are over two and three times higher, respectively, compared to the rate for White women. Although we have seen increased innovation in women’s health in recent years and more organizations dedicated to women’s health and well-being, we still have a way to go. Real Chemistry spoke with Esther Choo, M.D. M.P.H., an emergency physician and health policy researcher, about some of the barriers and challenges that remain in women’s health care today.
1. What are some of the barriers to investment in women's health?
Until the 1990s, women in the U.S. were systematically excluded from clinical trials on the grounds that they were a vulnerable population – as they could be pregnant – and that their hormonal milieu, in general, created too much complexity for research. So clinical practice was informed by studies performed mostly on males, from laboratory rats to humans. Not only did that prevent women from getting appropriate diagnoses and treatments (medicines, procedures, devices) that had demonstrated sex- and gender-specific safety and efficacy, but it cloaked a fuller understanding of diseases and potential therapies. For example, it was only by the inclusion of female rat lines that researchers observed that progesterone could be protective against traumatic brain injury.
Now, there are steps at the federal level to ensure that women are systematically included in clinical trials. For example, the influence of biological sex must be discussed in every grant proposal submitted to the National Institutes of Health. However, there is still a legacy of
thinking of men as "normative" and the “standard” and women as a deviation from the norm. For example, women are often described as having "atypical" symptoms of myocardial infarction when they don't present in the "classic" way, with “typical” and “classic” defined by a population of men. We adjust for women, instead of thinking of women as a core recipient of health. And when the health issue is only relevant to women (childbirth, lactation, breast or ovarian cancer, gynecologic health), it often gets less attention and funding.
Even though women represent more than half of the world's population, they are often thought of and treated as a niche population – even more so for women who are racial or ethnic minorities, disabled, non-English speaking or transgender. This mindset of deprioritization shows whenever we look at national performance on basic indices of health, such as maternal morbidity and mortality. So we need to boost efforts to improve the science and delivery of health care to all women.
At the same time, investment in women's health care and health research needs to go hand in hand with investment in women's overall well-being. We can't separate out financial security, access to safe neighborhoods, housing, education and opportunity. Investing in women’s health means caring about their whole lives and the many inequities they experience. Too many societal elements are specifically eroding the health of women in this moment to think that we can move the needle just by having great health care solutions.
2. What are some things the health care community should be doing (or doing differently) to engage women to make sure they get equitable treatment?
1 – We should be much more critical about science that does not engage women participants or does not include women scientists. We should expect to see women well represented at every level and in every domain – in the conduct and leadership of science, in policy-making, in industry, in health systems, and in public health – and be vocal about when they are not.
2 – Women will be more engaged when we make health care more engaging to them, by meeting them where they are and considering how health care fits into their actual, complex and overburdened lives. We should look for solutions that are actually working for women (e.g., digital health platforms providing women's health) and highlight them.
3 – I love how much great, accessible education is happening online by well-established health professionals. We can all do better by using these platforms to highlight the tenacious inequities that women face and discuss how to ensure equitable care for all.
4 – By and large, we are sticking to old habits of putting men in charge of designing solutions for women, a missed opportunity to trust women to be the strategic leaders of women's health care. And it's not just women's health that's at stake when we aim to connect well with women, as women are frequently the decision-makers around health care for their families and the gatekeepers for their entire community.
3. Almost two years into the pandemic, what are the new (or lingering) challenges women, in particular, are facing?
During the pandemic, women have continued to shoulder most of the domestic responsibilities in their homes. They have experienced disproportionately high job losses, which is especially true for women of color. Despite occupying more frontline roles throughout the pandemic, women have had less of a voice in conversations and decisions around health care, as they remain underrepresented in health care leadership, policy and media. And this has been a devastating year for access to reproductive rights: women now must travel further, pay more, fight harder and fear more for their reproductive health. The gender gaps in prosperity (income, cash reserves, benefits, career advancement) we saw before the pandemic will only deepen, requiring a large investment in women and in the kind of workplace that supports women and all those with families. With all these additional gender-based burdens, it is not a surprise that women have been disproportionately affected by mental health conditions, including anxiety and depression, during the pandemic.
Whenever we talk about equity, there is an unspoken question from some: “What’s in it for me? Why should I care about and invest in improvements for others?” There is often a lack of recognition that lives are intertwined, that society and health are strengthened when we acknowledge and address inequities such as those affecting women. Improving women’s health doesn’t just help individual women. It affects their partners and all those they care for. It affects the creativity and productivity and impact they have in their immediate and extended communities. Boosting women’s health can have a powerful ripple effect.
Dr. Choo is an emergency physician and health policy researcher. She speaks and advises organizations on improving equity in the workplace in the provision of health care and has published on these topics in the New England Journal of Medicine, Harvard Business Review, Washington Post, NBC Think and USA Today. She is a founding member of Equity Quotient, an equity consulting group, and a columnist for The Lancet, writing on topics related to health disparities. Find her on LinkedIn.
As a president at Real Chemistry, Michele Schimmel has a passion for developing brand-building marketing communications that drive action and deliver on business objectives. One of her areas of expertise is marketing-to-women – engaging them both as patients themselves and as the “chief medical officer” for their family. Michele has spent the past decade creating business-driving communications programs for reproductive health brands including Phexxi, Plan B One Step, Paragard, NuvaRing, Nexplanon and Merck for Mothers to name a few. She also has expertise in the areas of aesthetics, psoriasis, overactive bladder, severe food allergies and menopause. Find her on LinkedIn.
