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1、Photo by Marc Tan Kearney,SingaporeCardiovascular health inequity for women in the Asia Pacific regionThe Asia Pacific region is home to more than 60 percent of the worlds 8 billion inhabitants,yet there is a scarcity of data pertaining to womens health and the burden of gender inequality in the reg

2、ion.Despite contributing to half of the population,womens health is seen as niche.Important gaps exist in our understanding of factors that distinguish womens health and outcomes across Asia Pacific countries.Globally,women and girls experience worse outcomes at all points of the healthcare value ch

3、ain.In the Asia Pacific countries,social determinants of health adversely affect women,leading to substantial economic costs.We believe it will take business,finance,government,and non-governmental organizations collaborating and leveraging their capabilities and resources to address the womens heal

4、th gap in the Asia Pacific region.Simply scaling up existing healthcare systems will not be enough to attain gender health parity and reach those most in need;it will require new innovative and sustainable approaches.Creating equity in health will improve healthcare and health outcomes for everyone,

5、not just for women.Improvements in global health have been widespread but not equal.In the Asia Pacific region,accessing healthcare has become easier in 27 countries over the past decade,but women in rural,low-income households still have difficulty obtaining care because of distance and financial i

6、mpediments.1 The global economic impact of health inequities is significant.Closing the womens health gap could add at least$1 trillion annually to the world economy by 2040.2 In Europe,socioeconomic inequality is estimated to cost approximately 1.4 percent of GDP every year,which is higher than the

7、 EUs current annual defense expenditures of 1.3 percent of GDP.3 Based on an analysis of several high-cost diseases,healthcare disparities in the US related to race,socioeconomic status,and sex or gender accounted for$320 billion in annual spending.4 No estimates are available that quantify the econ

8、omic impact of the gender health gap in the Asia Pacific region,however data show that the COVID-19 pandemic exacerbated pre-existing inequalities.5 Addressing gender-based health disparities is crucial for achieving United Nations Sustainable Development Goals(SDGs).Improving womens and girls healt

9、h outcomes contributes to the SDGs by enhancing their ability to participate in education,the workforce,and decision-making processes.6 Womens and girls health and livelihoods are more vulnerable to the adverse effects of climate change and disasters,which impinge upon their access to healthcare ser

10、vices,as well as increasing maternal and child health-related risks.7 Case for change1 Health at a Glance:Asia/Pacific OECD/WHO 2018(https:/doi.org/10.1787/health_glance_ap-2018-en)2 World Economic Forums Closing the womens health gap:A$1 trillion opportunity to improve lives and economies,2024(http

11、s:/www.weforum.org/publications/closing-the-women-s-health-gap-a-1-trillion-opportunity-to-improve-lives-and-economies/)3 Mackenbach et al,Economic Costs of Health Inequalities in the European Union(2011)(https:/pubmed.ncbi.nlm.nih.gov/21172799/)4 Yerramilli P,Chopra M,Rasanathan K.The cost of inact

12、ion on health equity and its social determinants.BMJ Global Health 2024;9:e012690(https:/doi.org/10.1136/bmjgh-2023-012690)5 Report:The COVID-19 crisis continues to exacerbate gender inequalities|UN Women Asia-Pacific(https:/asiapacific.unwomen.org/en/stories/press-release/2022/06/the-covid-19-crisi

13、s-continues-to-exacerbate-gender-inequalities)6 Why Gender Equality Matters Across All SDGs https:/www.unwomen.org/sites/default/files/Headquarters/Attachments/Sections/Library/Publications/2018/SDG-report-Chapter-3-Why-gender-equality-matters-across-all-SDGs-2018-en.pdf7 Explainer:How gender inequa

14、lity and climate change are interconnected|UN Women Headquarters(https:/www.unwomen.org/en/news-stories/explainer/2022/02/explainer-how-gender-inequality-and-climate-change-are-interconnected)1Cardiovascular health inequity for women in the Asia Pacific region1.Research and developmentHistorically,c

15、linical trials have not adequately enrolled women or analyzed sex-specific differences in the data,and researchers continue to study men and apply their findings to women.Males,frequently of the Caucasian race,have been the“norm”population.This has resulted in women receiving less evidence-based cli

16、nical care than men.While the number of women participating in randomized clinical trials has increased,ethnic and racial minorities continue to be under-represented in research published in peer reviewed medical journals.Under-representation of women in research is especially notable in cardiology

17、trials of patients with coronary artery disease and heart failure with reduced ejection fraction,and in arrhythmia studies,especially those involving devices and procedures.9 The European Society of Cardiology called for“investment in research focusing on womens cardiovascular health,including mater

18、nal health,leading to better prevention and care.”10 It is essential to ensure the participation of women in clinical research,and equally important to include women from ethnic and racial minorities in cardiovascular disease studies.Globally,the gender health gap results in women having poorer acce

19、ss to healthcare,receiving incorrect or delayed diagnoses,and getting fewer effective treatments than men.Historically,womens health has been systematically under-researched,underfunded,and undervalued.While the Asia Pacific regions economic and socioeconomic factors complicate the analysis of healt

20、h outcomes,our research has uncovered sufficient evidence to lead us to conclude that women experience notably worse outcomes than men in five key areas:research and development,education,access,treatment outcomes,and investment.This paper will focus on the womens health gap in cardiovascular diseas

21、e(CVD),given its status as the leading cause of death among women,not only in the Asia Pacific region but also globally.Deaths in Asia accounted for 60 percent of the 18.6 million CVD deaths recorded globally in 2019.The CVD burden in the region is forecast to continue its upward trend in the years

22、ahead,with cardiovascular mortality in Asia expected to double by 2050.8 A staggering 80 percent of CVD cases could be averted through the adoption of appropriate lifestyle modifications,underscoring the immense potential for prevention.Evidence of inequity8 The Lancet Regional Health-Western Pacifi

23、c 2024;49:101138(https:/doi.org/10.1016/j.lanwpc.2024.101138)9 Cho,L,Vest,A,ODonoghue,M.et al.Increasing Participation of Women in Cardiovascular Trials:JACC Council Perspectives.J Am Coll Cardiol.2021 Aug,78(7)737751(https:/www.jacc.org/doi/abs/10.1016/j.jacc.2021.06.022)10 Vogel B,Acevedo M,Appelm

24、an Y,Bairey Merz CN,Chieffo A,Figtree GA,Guerrero M,Kunadian V,Lam CSP,Maas AHEM,Mihailidou AS,Olszanecka A,Poole JE,Saldarriaga C,Saw J,Zhlke L,Mehran R.The Lancet women and cardiovascular disease Commission:reducing the global burden by 2030.Lancet.2021 Jun 19;397(10292):2385-2438(https:/pubmed.nc

25、bi.nlm.nih.gov/34010613/)2Cardiovascular health inequity for women in the Asia Pacific region3.AccessAn estimated 1.6 billion people in Asia and the Pacific lack effective access to social health protections.13 Gaps in coverage disproportionately affect women,informal workers,agricultural workers,an

26、d their families.Only 45.9 percent of women in Asia and the Pacific are legally covered for income protection during maternity leave.For women aged 15 to 49,distance from healthcare providers is another major obstacle in obtaining care,especially for those with lower education levels.An Asia Pacific

27、-wide survey by Roche Diagnostics of 3,320 women across eight countries found that 21 percent of them strongly felt that they had delayed or avoided medical treatment one or several times due to a family obligation.14 Overcoming the invisible barriers that hinder womens access to healthcare is cruci

28、al for improving outcomes.Delay in presentation of a heart attack to a hospital has been widely reported as a gender disparity leading to poorer outcomes among women.15 A global systematic review found that the average delay from the onset of symptoms of a heart attack and in-hospital diagnosis was

29、270 minutes in women and 240 minutes in men.16 A study in Australia showed that women have a 30-minute longer delay in getting to the hospital after the onset of symptoms of a heart attack.A meta-analysis of 56 published studies concluded that delays in care for women suffering a heart attack contri

30、bute to a two-fold higher than men in-hospital mortality,repeat heart attack,stroke,and major bleeding.17 2.EducationOutside of reproductive health,womens health topics are given short shrift in medical schools.A desktop review of the Australian Medical Council standards for assessment and accredita

31、tion of primary medical programs found there to be no fixed or explicit requirement to include womens health subjects in Australian medical school curricula.The study found course outlines do not adequately address womens health and clinical medicine textbooks do not account for sex and gender diffe

32、rences.11 A review of the curricula of 19 Australian medical schools showed that while 84 percent had a womens health course,these were typically clinical rotations in obstetrics/gynecology.12 In a country that consistently ranks highly in health outcomes compared to other OECD nations,there is a cl

33、ear lack of emphasis on womens health.Despite efforts to implement gender medicine into medical school curricula across Europe and the United States,the overall appetite for doing so has been poor.When it comes to a heart attack,women do not typically present with the classical symptoms of shortness

34、 of breath and chest pain;they are more likely to display other symptoms such as gastro-intestinal problems,prolonged fatigue,or sleep disturbances.This means womens cardiovascular symptoms are often dismissed or ignored.If healthcare professionals are not routinely educated in gender differences in

35、 clinical presentation,women are likely to continue to be underdiagnosed or misdiagnosed.11 Merone L,Tsey K,Russell D,Nagle C.Representation of Women and Womens Health in Australian Medical School Course Outlines,Curriculum Requirements,and Selected Core Clinical Textbooks.Womens Health Rep(New Roch

36、elle).2024 Apr 5;5(1):276-285(https:/www.ncbi.nlm.nih.gov/pmc/articles/PMC11002328/)12 Vogel B,Acevedo M,Appelman Y,Bairey Merz CN,Chieffo A,Figtree GA,Guerrero M,Kunadian V,Lam CSP,Maas AHEM,Mihailidou AS,Olszanecka A,Poole JE,Saldarriaga C,Saw J,Zhlke L,Mehran R.The Lancet women and cardiovascular

37、 disease Commission:reducing the global burden by 2030.Lancet.2021 Jun 19;397(10292):2385-2438(https:/pubmed.ncbi.nlm.nih.gov/34010613/)13 https:/www.ilo.org/resource/news/16-billion-across-asia-and-pacific-lack-access-social-health-protection 14 https:/www.weforum.org/agenda/2023/03/why-improving-w

38、omen-s-health-must-become-a-social-and-national-priority/15 2023 Bosomworth et al.Cureus 15(8):e43482.DOI 10.7759/cureus.43482(https:/ Bugiardini R,Ricci B,Cenko E,Vasiljevic Z,Kedev S,Davidovic G,Zdravkovic M,Milii D,Dilic M,Manfrini O,Koller A,Badimon L.Delayed Care and Mortality Among Women and M

39、en With Myocardial Infarction.J Am Heart Assoc.2017 Aug 21;6(8):e005968.doi:10.1161/JAHA.117.005968.PMID:28862963;PMCID:PMC5586439.(https:/www.ncbi.nlm.nih.gov/pmc/articles/PMC5586439/)17 Shah T,Haimi I,Yang Y,et al.:Meta-analysis of gender disparities in in-hospital care and outcomes in patients wi

40、th ST-segment elevation myocardial infarction.Am J Cardiol.2021,147:23-32.10.1016/j.amjcard.2021.02.015(https:/ health inequity for women in the Asia Pacific region5.InvestmentDigital technologies have immense potential to address health inequities in Asia,especially when it comes to access to healt

41、hcare.Virtual care has become an integral part of healthcare delivery,making it easier for people who are immobile,isolated,or do not have adequate local resources to consult with a health professional.One example of this is the My Anna Health platform.Focused on womens health,it is powered by AI pr

42、esented as a humanoid character named Anna.She profiles patients,provides health assessments,delivers lists of providers,and offers to set up appointments.Cardio Explorer is another example of a digital health technology that is specifically focused on helping prevent heart attacks in women.It is an

43、 AI-based,non-invasive test that calculates the probability of coronary heart disease on a gender-specific basis.As healthcare digitizes globally,however,the gap for women risks being exacerbated in the Asia Pacific region because of limits in access to technology.Across low-and middle-income countr

44、ies in Asia,197 million fewer women than men own a mobile phone,according to the Mobile Gender Gap Report 2023.20 In the Asia Pacific region as a whole,65 percent of women have a mobile phone,compared to 88 percent of men.This discrepancy could become yet another contributing factor toward gender-re

45、lated health inequities in an increasingly digitized world.The womens health technology sector presents significant untapped potential for increased investment.Currently,digital start-ups focusing on womens health receive only a fraction3 percentof global digital health funding.21 Furthermore,CVD-re

46、lated health start-ups receive less funding compared to those addressing other major health conditions.There is a clear opportunity in increased financing of innovative companies that address womens specific healthcare needs and challenges.See figure on page 5 for examples of healthcare inequities e

47、xperienced by women with CVD across the healthcare value chain.4.Treatment outcomesThe socioeconomic burden of disease is greater for women than for men in the Asia Pacific region.The leading causes of disease in women,including cardiovascular disease,cancer,and mental health disorders,are also the

48、diseases that men suffer from;however,the underlying risk factors,both biological and socioeconomic,are sex specific.These risk factors are poorly understood and not routinely considered in the standardized medical algorithms that are used to assess a persons risk of heart attack.Tools such as QRISK

49、3 that calculate the estimated risk of CVD can account for the differences in risk factors between men and women and are being used in the UK by the NHS.18 CVD is the leading cause of death for women in the Asia Pacific region,who are twice as likely to die from a heart attack as men.As the region w

50、ith the largest population and a great diversity of ethnicities,cultures,socioeconomic status,and healthcare systems,Asia faces many challenges in CVD prevention and treatment.Research and innovation over the past decade have led to an increase in the chances of surviving a heart attack.However,wome

51、n do not appear to be benefitting from this improvement in quality of care and outcomes.Clinical recognition of cardiac signs and symptoms needs to improve to reduce the excess rates of mortality in women due to underdiagnosis and undertreatment.19 The evidence suggests that a lot of small but cumul

52、ative differences between the management of CVD in men and women are impacting the treatment outcomes of women with CVD.These discrepancies are likely to be more pronounced in the Asia Pacific region and include delays in going to a hospital,higher chances of misdiagnosis,barriers in accessing effec

53、tive treatment such as stents and heart surgery,and a lower likelihood of being prescribed medication to control cholesterol levels or to being referred to rehabilitation or after-care services.18 Hippisley-Cox J,Coupland C,Brindle P.Development and validation of QRISK3 risk prediction algorithms to

54、 estimate future risk of cardiovascular disease:prospective cohort study BMJ 2017;357:j2099 doi:10.1136/bmj.j2099(https:/ Bosomworth J,Khan Z.Analysis of Gender-Based Inequality in Cardiovascular Health:An Umbrella Review.Cureus.2023 Aug 14;15(8):e43482.doi:10.7759/cureus.43482.PMID:37711935;PMCID:P

55、MC10499465.(https:/ The-Mobile-Gender-Gap-in-Asia.pdf(https:/ https:/eithealth.eu/news-article/femtech-revolution-which-start-ups-are-transforming-womens-health/4Cardiovascular health inequity for women in the Asia Pacific regionSource:Kearney analysisFigureThe healthcare value chain is multifaceted

56、;each segment plays a crucial role in delivering equitable and quality healthcare servicesThe healthcare value chainExamples of healthcare inequities experienced by women with CVDRegulationPayerGovernmentInsurance companiesGovernmentPharmaceutical companiesProviderDistributorManufacturerResearch and

57、 developmentUnderinvestment in research,medical training,cardiovascular health start-ups,and public awareness about womens heart healthWomen are more likely to be underdiagnosed,under-treated,have delayed treatment,and less aggressive treatment resulting in poorer outcomes and higher mortality compa

58、red to menWomen have an increased incidence of adverse reactions to cardiovascular drugs which tend to be more severe than in men,resulting in a greater percentage of hospital admissionsMany medical devices,including some cardiovascular implants,have been primarily designed based on male physiology

59、and anatomy,leading to suboptimal fit and function in womenInadequate representation of women from ethnic and racial minorities in clinical trials,to better understand the pathophysiology and treatment outcomes of CVD in womenRegulationPayerProviderDistributorManufacturerResearch and developmentHosp

60、italsMail order,direct to consumerPharmaceutical companiesClinics and specialty roomsDistributorsMedical devices and productsBiotechnologyRetail pharmacyCommunity care5Cardiovascular health inequity for women in the Asia Pacific regionKey steps for creating positive change for womens cardiovascular

61、health outcomes Shape the public health agenda Promote a coordinated approach by governments,patient advisory groups,industry bodies,and financial entities to raise awareness about the risks of cardiovascular disease and the difference in CVD symptoms in women and to promote preventative measures ta

62、ilored to women.Overhaul medical education Embed gender-specific information in all medical curricula,training,and clinical practice,including mandatory instruction on the differences in cardiovascular disease presentation and management in women.Improve women and girls access to education and incre

63、ase their autonomy in the management of their own CVD health.Double down on research and development Address the gap in research about women and the representation of women and women of color in clinical trials for cardiovascular disease.More must be done to enhance research,analysis,evidence,and da

64、ta on womens health.The health inequities women face cannot be effectively addressed by individual efforts alone but call for collaboration through publicprivate partnerships and engagement with multi-stakeholder communities.To close the gender health gap,organizations must work together and leverag

65、e their distinct strengths and assets.Such a cooperative approach is essential for tackling the multifaceted factors that contribute to health disparities across the large and diverse populations in the Asia Pacific region,including social determinants of health,access to care,and cultural considera

66、tions.Progress can be made when specific diseases and conditions are dealt with at the national or regional level,as demonstrated by the Lancet women and cardiovascular disease commission.22 This initiative brought together a team of international experts from 11 countries to summarize existing evid

67、ence and identify knowledge gaps in research,prevention,treatment,and access to care for women with CVD.Their recommendations provide a pathway to reducing the global burden of CVD in women by 2030.The Asia Pacific region,home to some of the most populous nations and facing a rising prevalence of CV

68、D,stands to benefit considerably from a coordinated,multinational strategy to transform womens health outcomes.Gender inequities in health,particularly in CVD,are tied to systemic under-representation and insufficient consideration of women across all stages of healthcare delivery,from prevention an

69、d diagnosis to treatment and long-term management.We have identified six decisive means of reducing gender bias,particularly in cardiovascular health systems:heightening awareness,implementing medical education,expanding the evidence base,increasing access,improving data collection,and investing in

70、womens health.Creating positive change22 Nathani M,Vogel B,Mehran R.Closing the gap:cardiovascular disease in women.Climacteric.2024 Feb;27(1):16-21.doi:10.1080/13697137.2023.2281935.Epub 2024 Jan 15.PMID:38174697.(https:/pubmed.ncbi.nlm.nih.gov/38174697/)6Cardiovascular health inequity for women in

71、 the Asia Pacific regionAccelerate investment Address the lack of financing for womens health by increasing investment in womens cardiovascular disease start-ups,which are currently woefully underfunded.The traditional format for doctor visits has remained largely unchanged for decades while the inc

72、idence of chronic conditions,such as cardiovascular disease,has increased dramatically.We must embrace technology and completely rethink how to efficiently deliver healthcare for women in the decades to come.We need to ensure that gender bias does not make its way into algorithms that inform the tec

73、hnology that healthcare professionals are increasingly relying on in their decision-making.It is essential that we raise awareness of issues relating to gender inequity in the Asia Pacific region and encourage the public and private sectors to work together to intensify research,investment,and colla

74、boration.Build women-focused integrated care pathways Harness successful use cases from within Asia Pacific communities where collaboration between healthcare professionals,privatepublic partnerships,and local populations has effectively tackled cardiovascular health challenges,thus establishing a b

75、lueprint for achieving improved cardiovascular health outcomes across the region.Share successful evidence-based use cases with key policy-and decision-makers to facilitate adoption and implementation at scale.Get serious about data Boost the collection of data related to CVD and the associated fund

76、ing requirements at local and regional levels to promote effective prevention,recognition,and treatment for women.Ensure data is disaggregated by sex so that data analysis leads to more meaningful results.Gender inequities in health are tied to systemic under-representation and insufficient consider

77、ation of women across all stages of health-care delivery.7Cardiovascular health inequity for women in the Asia Pacific regionStephanie AllenPartner,Sydney Roopa MehtaConsultant,Sydney Sanath Kumar Balasubramanyam Partner,Southeast Asia AuthorsThe authors would like to thank Paula Bellostas,Anna Bode

78、,and Amelia Gosztony for their valuable contributions to this paper.8Cardiovascular health inequity for women in the Asia Pacific regionFor more information,permission to reprint or translate this work,and all other correspondence,please email .A.T.Kearney Korea LLC is a separate and independent leg

79、al entity operating under the Kearney name in Korea.A.T.Kearney operates in India as A.T.Kearney Limited(Branch Office),a branch office of A.T.Kearney Limited,a company organized under the laws of England and Wales.2024,A.T.Kearney,Inc.All rights reserved.Kearney is a leading global management consu

80、lting firm.For nearly 100 years,we have been a trusted advisor to C-suites,government bodies,and nonprofit organizations.Our people make us who we are.Driven to be the difference between a big idea and making it happen,we work alongside our clients to regenerate their businesses to create a future that works for