Women are more likely to die after a heart attack than men. Women are more likely to develop dementia than men. Women are more likely to suffer from depression and anxiety than men.
Though these common medical conditions affect women and men, the threats to women’s health are often larger, leading to greater rates of chronic illness and decreasing quality of life.
Illnesses disproportionately impacting women’s health are numerous and diverse, but one thread binds many of these conditions: research investigating the causes and developing treatments often ignores and excludes women.
Women have historically been excluded from research and clinical trials out of concern for their reproductive health and risk of birth defects. However, women who used contraception; whose male partners were vasectomized; and those who were not sexually active with males were also excluded, bringing into question the validity of this policy.
Currently, trial protocols frequently require women of reproductive age to use contraception, without regard to sexual orientation, sexual activity or partner status, posing a barrier to study participation and thus further limiting generalizability of results.
It has also been argued that hormonal variability presented by women who menstruate complicates studies, a claim not supported by evidence. In fact, males also experience hormonal variations.
Myths around women’s biology and the ignorance that sustained these beliefs are far from benign neglect.
Advances in cardiovascular research in the 1980s and ’90s that improved outcomes for men were significantly smaller in women. Of particular concern is the increase in hospitalization for heart attacks seen in women under 55, a trend not observed in men.
More recently the REBOOT trial found “beta-blockers” – a group of drugs commonly used to treat heart failure – were less effective in women; for some conditions they increased deaths. Other work suggests a sex-specific medication effect in heart failure: higher doses of cardiovascular agents (e.g., angiotensin-converting enzyme inhibitors) were associated with hospitalization and mortality in women but not in men.
The exclusion of women from drug trials has led to women experiencing adverse drug reactions nearly twice as often as men and a greater rate of hospitalization from these reactions. Actively or effectively excluding women from biomedical research has come at a significant cost to their health.
The foundation of bias against women’s health is significant, and it will take concerted efforts to build a more equitable environment.
But it can be done.
In fact, in some ways Canada has been a global leader in women’s health research. Guidelines for the inclusion of sex and gender in research developed by the Canadian Institutes of Health Research has served as an international model for other research funding bodies. But there remain significant issues with respect to women’s health research in Canada.
We call on Canada, its citizens, educational institutions, businesses and governments to build on this work and improve women’s health by pursuing the following objectives:
- Equitable research funding
Globally, less than 5 per cent of research and development funding is directed toward women’s health. In Canada, only 6.8 per cent of federal funding supports women’s health research. Globally, Canada’s women’s health gap ranks among the costliest relative to Gross Domestic Product (GDP), signalling an opportunity we have yet to seize.
Increasing investments in women’s health research is necessary to close the knowledge gap in women’s health. This funding should support the scope of research, from basic science investigations to clinical trials and public health initiatives.
Expanding the funding is not simply an increase in an outlay of research dollars: it is an investment. Studies consistently show that dollars invested in research produce an economic return that is several-fold higher and closing the gap in women’s health would add $37 billion to Canada’s GDP.
Increased research funding is an investment in the physical, mental and economic health of Canadians.
- Integrate women’s health into education
Women’s health should be a standard component of health education, from K-12 schools through university programs and training for health-care professionals. These initiatives do not necessarily need to stand alone. Integrating women’s health into existing curricula not only provides important content but also normalizes women’s health and allows it to be seen for what it is: health.
Education should be provided for everyone, not just girls and women. This inclusive approach could be lifesaving. For example, most people do not know that women experience unique symptoms when having a heart attack, causing early signs to be missed in nearly 80 per cent of women. Friends, family members and colleagues educated in women’s health may recognize these symptoms and help seek timely medical care.
- Expand the definition of women’s health
Nanette Wegner, a clinical cardiologist and professor emerita of medicine at Emory University School of Medicine, first coined the term “bikini medicine” to describe the confinement of women’s health to conditions that affected the breasts and reproductive organs.
A recent review of “women’s health” studies found that nearly half focused on reproductive health, while common health concerns including cardiovascular disease, musculoskeletal disorders and infectious diseases were under-represented. This narrow definition of women’s health has led to the neglect of the unique circumstances women face for non-reproductive medical issues, which represent many of the major causes of morbidity and mortality over the life course.
Research across all systems of the body and for diseases outside of the reproductive system should be included in women’s health funding opportunities, and education in women’s health should extend beyond reproduction to include issues that impact women differently or disproportionately.
- National strategy for women’s health
Canada is the only G7 country without a women’s health strategy. Long-term planning for scientific inquiry is critical to ensure stability and to recruit and retain researchers and health-care practitioners. A coordinated and evidence-based plan to reduce the gap in women’s health and research is critical to create a solid foundation of innovation and care.
A national strategy would also create accountability by setting out measurable standards, generating publicly available progress reports and tying funding to the achievement of milestones.
While the initiatives we propose are ambitious and require new investments in infrastructure, people and programs, they are feasible.
Canada has a wealth of skilled researchers, clinicians and educators to support the work. Financial investments in research and improved health-care systems have a history of generating positive economic returns as well as savings in the form of improved health.
However, the obstacles are similarly real.
Political opposition to equity initiatives is significant and growing. These positions are often fixed in a misunderstanding of objectives and an entrenched culture of misogyny that permeates politics. Concerted efforts to explain the goals of expanding women’s health support and the positive impact this has for all Canadians must come from business leaders, academic institutions, researchers, health-care workers and educators to explain how all Canadians will benefit.
Increasing government spending, particularly in a time of economic uncertainty, is similarly difficult. But the economic benefits counter these concerns. The research community, with support from their institutions and industry, must engage with the public and elected officials alike to make this case.
In short, the path forward to prioritizing women’s health and well-being must be laid by Canadians whose voices propel political, social and economic change around the world.
Women’s lives depend on this.
