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1、Blueprint to Close the Womens Health Gap:How to Improve Lives and Economies for AllI N S I G H T R E P O R TJ A N U A R Y 2 0 2 5In collaboration with the McKinsey Health InstituteImages:Midjourney,Getty ImagesDisclaimer This document is published by the World Economic Forum as a contribution to a p

2、roject,insight area or interaction.The findings,interpretations and conclusions expressed herein are a result of a collaborative process facilitated and endorsed by the World Economic Forum but whose results do not necessarily represent the views of the World Economic Forum,nor the entirety of its M

3、embers,Partners or other stakeholders.2025 World Economic Forum.All rights reserved.No part of this publication may be reproduced or transmitted in any form or by any means,including photocopying and recording,or by any information storage and retrieval system.ContentsForewordExecutive summaryIntrod

4、uction1 More than a third of the womens health gap stems from nine conditions1.1 Five conditions affect womens lifespan1.2 Four conditions affect womens health span2 Quantifying the drivers:How to close the gap2.1 Count women2.2 Study women2.3 Care for women2.4 Include all women2.5 Invest in women3

5、The path to progress3.1 Count women:Measure womens health and health outcomes globally3.2 Study women:Understand hormonal health and womens biology3.3 Care for women:Implement CPGs for women-specific conditions and account for sex-specific differences within CPGs3.4 Include all women:Develop accessi

6、ble solutions to enable early intervention and treatment for women around the world3.5 Invest in women:Investors,businesses,governments,philanthropies and universities have a key role to playConclusionTechnical appendixContributors Endnotes3469111213141822262728292930313233344753Blueprint to Close t

7、he Womens Health Gap:How to Improve Lives and Economies for All2ForewordOver the past year,we have been humbled and honoured to receive an outpouring of support and enthusiasm for our report,Closing the Womens Health Gap:A$1 Trillion Opportunity to Improve Lives and Economies.While the numbers behin

8、d it may have come as a shock that women spend 25%more of their lives in poor health compared to men,or that the womens health gap equates to 75 million years of life lost to poor health or early death per year the report,the result of a collaboration by the World Economic Forum,the Global Alliance

9、for Womens Health and the McKinsey Health Institute,tapped into what many readers instinctively felt:when it comes to health,women are second-class citizens.But today,all of us also live in an era of longer lifespans,technological innovation,rapid scientific breakthroughs,economic acumen and the abi

10、lity to advocate for public policy.Global life expectancy has more than doubled over the past 200+years,with economists estimating that about a third of economic growth in advanced economies in the past century has been tied to improvements in the health of global populations.1,2 Healthcare investme

11、nts improve the quality of life and gross domestic product growth up to three times the investment in high-income countries.3 These returns on investment boost the business case for improving womens health and speaking up for those who are struggling the most.This year,we offer a deeper framework to

12、 help close the womens health gap:count women,study women,include all women in research and efforts to improve care and invest in women and girls throughout their lifespan.We also highlight how nine conditions are driving a third of the womens health gap:the lifespan conditions of ischaemic heart di

13、sease,breast cancer,post-partum haemorrhage,cervical cancer and maternal hypertensive disorder;and the health-span conditions of premenstrual syndrome,menopause,endometriosis and migraines.Boosting data availability,care delivery,investment and treatment for the selected conditions could create near

14、ly$400 billion in annual economic improvement by 2040.Focusing on these selected conditions allows us to build a blueprint that,in the future,will be expanded to provide a comprehensive view of womens health and accelerate progress towards closing the womens health gap.Progress happens only when we

15、work towards it together and measure improvement.We invite you to join us on the next step of this journey,to improve and save the lives of women and strengthen economies and continue to demonstrate the business case for investing in womens health.Lucy Prez Senior Partner,McKinsey&Company,Equity&Hea

16、lth Leader,McKinsey Health Institute,USAShyam Bishen Head,Centre for Health and Healthcare;Member of the Executive Committee,World Economic ForumBlueprint to Close the Womens Health Gap:How to Improve Lives and Economies for AllJanuary 2025Blueprint to Close the Womens Health Gap:How to Improve Live

17、s and Economies for All3Executive summaryWomen live 25%more of their lives in poor health when compared to men.Closing the Womens Health Gap:A$1 Trillion Opportunity to Improve Lives and Economies,published by the World Economic Forum in collaboration with the McKinsey Health Institute(MHI)in 2024,f

18、ound that closing the health gap between men and women could unlock 75 million disability-adjusted life years(DALYs)annually and$1 trillion in annual global GDP.4 Closing the womens health gap would be the equivalent of adding seven healthy days per year for each woman.5 Addressing the drivers of th

19、e gap treatment efficacy,care delivery,data and funding could help to extend womens healthy lives and capture the aligned and substantial economic benefits.This report takes the next step:a blueprint for closing the womens health gap and improving lives and economies around the world.(For more on ho

20、w this report defines womens health,see“Terminology”.)Urgent actions needed to close the womens health gap are illuminated when examining in detail nine selected conditions that collectively account for a third of the womens health gap.The selected conditions are women-specific,affect women differen

21、tly or affect women disproportionately than men.This approach,which includes analysis of 15 countries across income archetypes,creates a blueprint that could readily scale to other countries and additional conditions affecting women and their health,with the goal of providing a comprehensive view of

22、 womens health worldwide and inspiring stakeholders to act.Closing the womens health gap for these selected conditions alone could add almost 27 million disability-adjusted life years annually,equating to 2.5 additional healthy days per woman,per year,around the globe,and yield around$400 billion in

23、 annual GDP to the global economy.Selected conditions,in order of potential estimated annual gains in DALYs and GDP if the womens health gap is closed by 2040:Conditions that affect lifespan Ischaemic heart disease is the leading cause of death for women worldwide.Ischaemic heart disease represents

24、potential estimated gains of 9.1 million annual DALYs and$43 billion in annual GDP in the womens health gap.6 Cervical cancer is almost entirely preventable with vaccination yet contributes to hundreds of thousands of deaths each year,mostly in LICs and LMICs.Cervical cancer represents potential est

25、imated gains of 2.4 million annual DALYs and$10 billion in annual GDP in the womens health gap.Breast cancer is the most common cancer diagnosed in women globally.Breast cancer represents potential estimated gains of 1.2 million annual DALYs and$8.7 billion in annual GDP in the womens health gap.Mat

26、ernal hypertensive disorders are a leading cause of pregnancy complications for mothers and infants.7 Maternal hypertensive disorders represent potential estimated gains of 0.85 million annual DALYs and$1.4 billion in annual GDP in the womens health gap.Post-partum haemorrhage is the leading cause o

27、f maternal mortality worldwide and affects more than 14 million women each year.Post-partum haemorrhage represents potential estimated gains of 0.25 million annual DALYs and nearly$200 million in annual GDP in the womens health gap.Conditions that affect health span Menopause and perimenopause,which

28、 can last for more than a decade,are estimated to affect more than 450 million women worldwide at any given time.8 Menopause represents potential estimated gains of 2.4 million annual DALYs and$120 billion in annual GDP in the womens health gap.Nine selected conditions drive a third of the womens he

29、alth gap reducing their effects could create around$400 billion in annual global GDP by 2040.Blueprint to Close the Womens Health Gap:How to Improve Lives and Economies for All4 Premenstrual syndrome(PMS)affects 2040%of women of reproductive age.9 PMS represents potential estimated gains of 2.1 mill

30、ion annual DALYs and$115 billion in annual GDP in the womens health gap.Migraine affects approximately 21%of women globally(0.8 billion women).10 Migraine represents potential estimated gains of 2.7 million annual DALYs and$80 billion in annual GDP in the womens health gap.Endometriosis is an oestro

31、gen-related condition affecting one in 10 women between the ages of 15 and 45 at least 190 million women globally.11 Endometriosis represents potential estimated gains of 0.25 million annual DALYs and$12 billion in annual GDP in the womens health gap.Measuring and tracking progress is an important a

32、nd meaningful first step in the journey to equitable health and healthcare for women and girls.The Womens Health Impact Tracking(WHIT)platform was created by the Global Alliance for Womens Health to address this need.WHIT is designed to measure the impact of health conditions that contribute to the

33、womens health gap(in terms of disability,mortality and consequent economic effect).It also provides country-level indicators of data availability,treatment effectiveness and quality and appropriateness of care delivery.WHIT was designed by stakeholders,for stakeholders,as a practical and tactical to

34、ol to track progress over time and shine a light on opportunities to accelerate the deployment of proven solutions to close the womens health gap.The imperative and actions stakeholders can take to close the womens health gap can be explored with the following framework:Womens health data is often n

35、ot collected,not published in the public domain,or incomplete.Improving the accuracy of data collection and setting standards for sex-and gender-based data collection could help to clarify the true burden of disease,particularly for women-specific conditions.Research funding for womens health and th

36、e drivers of sex-based differences,particularly for conditions that affect the health span,is not proportional to the burden of disability attributed to these conditions.Sex-disaggregated analysis and basic science research into hormone health and female biology could help reveal how women are affec

37、ted disproportionately or differently from men by many conditions.Additional research could help the understanding of conditions specific to women and illuminate disparities.Clinical practice guidelines(CPGs)often do not reflect best-practice clinical care for women,including the understanding of se

38、x-based differences in the presentation and treatment of conditions.Delivering sex-and gender-appropriate and evidence-based healthcare,through healthcare delivery systems designed for women and equipped to address health-related social needs(HRSN),could improve health outcomes for women.Mitigating

39、health disparities could have a greater impact on mortality for the selected conditions than any single treatment recently studied in later-stage clinical trials.Health and social systems can consider how to better acknowledge and address differences in health outcomes and promote global health equi

40、ty.Additional funding in research,clinical education and training,care delivery and the development of innovative interventions is needed to accelerate progress.Each and every stakeholder has a role in advancing the health of women.The impact of these actions can,and will,reach far beyond the lives

41、of individual women.Healthier women are cornerstones of prosperous communities,vibrant workplaces and resilient economies.Better health for women throughout their lives could create at least$1 trillion in annual incremental economic growth by 2040.12 This is distinct from the market for new products

42、 and services that can be developed to address the many unmet needs of women today,the size of which may be more than$500 billion for the selected conditions.Investors,researchers,governments,non-profits,providers,life sciences companies and communities may want to reinvigorate their consideration a

43、nd commitments to womens health.Empowering every woman and girl around the world with awareness and the information needed to take charge of her health is critical.Misinformation and decreasing awareness of womens health stalls advancement and can impair women from living healthier and more producti

44、ve lives.Progress is possible,and closing the womens health gap is achievable.Now is the time for action that will improve the lives of women and girls around the world and strengthen the global economy.Count womenStudy womenCare for womenInclude all womenInvest in womenBlueprint to Close the Womens

45、 Health Gap:How to Improve Lives and Economies for All5IntroductionClosing the Womens Health Gap:A$1 Trillion Opportunity to Improve Lives and Economies,published in 2024 by the World Economic Forum in collaboration with the McKinsey Health Institute,reported that the womens health gap correlates wi

46、th women living in poor health for 25%more of their lives when compared to men.Closing the womens health gap could yield 75 million disability-adjusted life years(DALYs)annually the equivalent of adding seven healthy days per year,per woman and unlock$1 trillion in annual global GDP by 2040.Now is t

47、he time for stakeholders to address drivers of the gap and improve the lives of women,communities and economies around the world.(For more on how this report defines womens health,see“Terminology”.)This years report provides a blueprint for developing a comprehensive,global view of womens health and

48、 illuminates opportunities to help close the gap.The report examines nine selected conditions that account for a third of the womens health gap,with analyses spanning 15 countries representing all income levels.The selected conditions depict a mix of conditions that are specific to women,affect wome

49、n disproportionately or affect women differently from men.Five of the conditions limit womens lifespan,leading to early death,and four impair womens health span,often causing significant distress and resulting in women living extended years in disability.Selected conditions,in order of annual potent

50、ial estimated gains in DALYs and GDP if the womens health gap is closed by 2040,prevalence rate,incidence rate and Global Alliance for Womens Health members expert recommendations are below.For further details on this selection process,please refer to the technical appendix.Conditions that affect li

51、fespan Ischaemic heart disease Cervical cancer Breast cancer Maternal hypertensive disorder Post-partum haemorrhageConditions that affect health span Menopause Premenstrual syndrome(PMS)Migraine EndometriosisExamining these conditions highlights potential opportunities for immediate progress and act

52、ions needed to close the womens health gap over time.These actions can be explored with the following framework:1.Count women,by improving data collection methodologies and setting standards for sex-and gender-based data collection to increase understanding of womens health.2.Study women,by conducti

53、ng research into womens health and the drivers of sex-based differences,sex-disaggregating analyses and supporting basic science and clinical research that focuses on conditions specific to women across their lifespan.3.Care for women,by adopting clinical practice guidelines that align with the acce

54、pted evidence for sex-and gender-based care and by enhancing clinical education and care delivery systems needed to effectively implement them.4.Include all women in initiatives and progress,with a lens on heath equity and inclusion.5.Invest in women,by funnelling resources towards womens health,fro

55、m the bench to the bedside and beyond,to accelerate progress;and by supporting women in leadership positions across health and social systems.Women experience massive health inequities and poor health outcomes worldwide and the global economy suffers as a result.Blueprint to Close the Womens Health

56、Gap:How to Improve Lives and Economies for All6Progress and actions needed to close the womens health gapFIGURE 1Together,these actions could initiate a global shift to close the womens health gap.Based on recent Forum and MHI analyses and expertise from the Global Alliance for Womens Health working

57、 groups,addressing health disparities could create greater impact on mortality for conditions affecting lifespan than any single treatment studied in recent clinical trials.13 Other actions,such as improving clinical practice guidelines and incorporating sex-and gender-based differences into clinica

58、l education and training,could help to overhaul a healthcare delivery system that was not designed for women and is underserving them.Addressing these areas could help to extend the health of women and capture the aligned and substantial economic benefits that come with a thriving population.Closing

59、 the womens health gap for the selected conditions could contribute nearly$400 billion in annual GDP to the global economy and close the burden gap by almost 27 million DALYs each year,translating to 2.5 additional healthy days per year for each woman in the world.These efforts can,and will,reach fa

60、r beyond the lives of individual women.Investors,researchers,academics,non-profits,providers,life sciences companies and governments have reasons to improve the health of women.Healthier women are cornerstones of strong families,prosperous communities,vibrant workplaces and resilient economies.Bette

61、r health for women throughout their lives could create at least$1 trillion in annual incremental economic growth by 2040.This is separate from the commercial market for new products and services that can be developed,which the Forum and MHI analysis shows could add more than$500 billion to the globa

62、l economy by addressing the selected conditions alone.A substantial and strategic allocation of resources through cross-stakeholder commitments and collaboration could improve health outcomes for women globally,as would redesigning the health system to deliver equitable,high-value care.Stakeholder a

63、ction throughout the womens health ecosystem could accelerate progress,reduce health disparities and close the womens health gap.In the past year,hearing from individuals and stakeholders who have shared their path to advancing the health of women has been inspiring.For many,their personal journeys

64、drove them to become investors,advocates,educators or business leaders pushing to better understand womens health at a global scale.For others,efforts are inspired by wanting to change outcomes for women,given that womens health affects each and every person around the world.Initiatives that have la

65、unched in the past year include redesigning components of clinical education,investing in women-focused health start-ups,advancing biomedical research on sex-specific differences and hormone health and advocating for policy changes at local,national and international levels.This momentum should not

66、be halted,as the need to highlight womens health comes in an era in which competition for attention and awareness of any health topic whether it is pushing for investment in womens health-span conditions or reiterating care standards may be increasingly challenging.The past year has,however,demonstr

67、ated that progress is possible on a short timeline,and that champions around the world are motivated to act.Now is the time to make a difference and expand the number of champions driving the agenda across the public,private and social sectors to close the womens health gap.Blueprint to Close the Wo

68、mens Health Gap:How to Improve Lives and Economies for All7Count womenImprove data collection methodologies and set standards for sex-and gender-based data collection to increase the understanding of womens healthStudy womenConduct research into womens health and the drivers of sex-based differences

69、,undertakesex-disaggregated analyses and support basic science and research that focuses on conditions specific to women across their lifespansCare for womenAdopt clinical practice guidelines that align with the accepted evidence for sex-and gender-based care,and enhance clinical education and the c

70、are delivery systems needed to effectively implement themInvest in research,clinical education,training and care delivery,with a lens on heath equity and inclusionInclude all womenInvest in womenFunnel resources towards womens health,from the bench to the bedside and beyond,to accelerate progress an

71、d support women in leadership positionsTerminologyThis report approaches womens health as a market segment to facilitate focused analysis and navigate the complexities of studying such a multifaceted issue.The authors acknowledge the importance of healthcare to the transgender,non-binary and gender-

72、fluid communities and that not all people who identify as women are born biologically female.The authors have often used the term“sex and gender”to reflect inclusive language and recognize the need for future research into health issues that is inclusive of the transgender,non-binary and gender-flui

73、d communities.They also acknowledge the profound differences for women based on factors such as race,ethnicity,socioeconomic status,disability,age and sexual orientation.Additional work and research should reflect on how to tackle these barriers alongside the broader womens health gap.In this report

74、,the term“woman”may include those younger than age 18.iBlueprint to Close the Womens Health Gap:How to Improve Lives and Economies for All8More than a third of the womens health gap stems from nine conditions1Conditions affecting women impinge either on lifespan or day-to-day health over time,with n

75、ine selected conditions driving more than a third of the womens health gap.Analysis from the World Economic Forum(the Forum)and the McKinsey Health Institute(MHI)has found that more than a third of the womens health gap is created by the following nine conditions.Selected conditions,in order of pote

76、ntial estimated gains in annual DALYs and GDP if the womens health gap is closed by 2040:Conditions that affect lifespan Ischaemic heart disease Cervical cancer Breast cancer Maternal hypertensive disorder Post-partum haemorrhageConditions that affect health span Menopause Premenstrual syndrome(PMS)

77、Migraine EndometriosisBlueprint to Close the Womens Health Gap:How to Improve Lives and Economies for All9Nine conditions were selected in year 1FIGURE 2Six of the selected conditions are specific to women.Women are differently or disproportionately affected by the remaining three ischaemic heart di

78、sease,migraine and breast cancer.Notably,how much any condition takes away from a womans quality of life or contributes to the end of her life can vary widely,particularly when considering factors such as race,ethnicity,income level or where she lives.Stakeholders may consider a conditions impact on

79、 lifespan and health span when evaluating and prioritizing how to improve data on health burden,increase availability of effective treatments and reduce healthcare disparities.Note:1.Based on composite score of global burden(DALYs,GDP,prevalence,incidence)and LMIC burden(DALYs,GDP)and expert recomme

80、ndations from Alliance membersSource:IHME,Global Burden of Disease(2019);DALYs(disability adjusted life years)ConditionRank1Premenstrual syndrome100Other gynaecological conditions(menopause)99.5Migraine96.6Ischaemic heart disease84.7Cervical cancer68.5Maternal hypertensive disorders 64.3Breast cance

81、r58.9Endometriosis49.3Post-partum haemorrhage42.4HigherLowerBlueprint to Close the Womens Health Gap:How to Improve Lives and Economies for All10Five of the selected conditions contribute to mortality for women in all regions of the world:ischaemic heart disease,cervical cancer,breast cancer,materna

82、l hypertensive disorders and post-partum haemorrhage.Ischaemic heart disease is the leading cause of mortality for all women,crossing all geographies and ethnicities and resulting in the deaths of more than 4 million women per year.14 Despite a decline in overall deaths from ischaemic heart disease,

83、women are more likely than men to die from an acute cardiovascular event.15 In the United States alone,closing the cardiovascular disease gap between men and women could let women regain at least 1.6 million years of higher-quality life and add$28 billion to the countrys economy by 2040.16 Ischaemic

84、 heart disease represents potential estimated gains of 9.1 million annual DALYs and$43 billion in annual GDP in the womens health gap.17 Cervical cancer,while less common than breast cancer,leads to more than 350,000 deaths each year.18 The prevalence and deaths from cervical cancer are disproportio

85、nately high in lower-income countries:around 85%of cervical cancer deaths occur in low-and low-middle-income countries(LICs and LMICs).19 The highest rates of incidence and mortality are in sub-Saharan Africa,Central America and South-East Asia.20 In the US,cervical cancer causes two deaths per 100,

86、000 women;21 in Tanzania,cervical cancer causes 42 deaths per 100,000 women.22 Globally,a 2022 analysis found that two in three women aged between 30 and 49 had never been screened for cervical cancer;rates of cervical cancer screening ranged from 1%in Bangladesh to 73%in Brazil.23 Despite the exist

87、ence of a vaccine that can prevent almost all types of cervical cancer,some estimates predict that cervical cancer could rise by almost 78%between 2018 and 2030(130,000 additional cases annually).24 Cervical cancer represents potential estimated gains of 2.4 million annual DALYs and$10 billion in an

88、nual GDP in the womens health gap.Breast cancer is the most common cancer diagnosed in women,leading to the deaths of 670,000 women globally every year.25 The number of newly diagnosed breast cancers is projected to grow by over 40%,leading to around 3 million annual new diagnoses by 2040.26 Educati

89、on,early diagnosis and advanced treatments have reduced breast cancer mortality,alongside the availability of generic treatment options.A variety of efforts outside of care delivery including grassroots advocacy have led to monumental changes in funding and policy.27,28 Yet major disparities remain

90、within and between countries:five-year breast cancer survival is more than 90%for women in high-income countries(HICs);in India,five-year survival is 66%;in South Africa it is 40%.29 In underserved populations within HICs,the five-year survival for metastatic breast cancer is 30%,highlighting a need

91、 for better differentiation of the types of breast cancer,earlier access to stage-appropriate treatment and health and social systems that enable treatment adherence.30,31 Breast cancer represents potential estimated gains of 1.2 million annual DALYs and$8.7 billion in annual GDP in the womens healt

92、h gap.Maternal hypertensive disorders,which are variations on high blood pressure,are leading causes of pregnancy-related complications and fatalities for mothers and infants.32 For example,pre-eclampsia one type of maternal hypertensive disorder accounts for 70,000 maternal deaths worldwide each ye

93、ar.33 These“silent killers”may have few early symptoms and often go undiagnosed,particularly in women who lack access to adequate prenatal care.34 In addition to putting a woman at greater risk of post-partum haemorrhage after birth,maternal hypertensive disorders are considered a risk factor for ma

94、ny conditions later in life such as chronic cardiovascular disease,stroke,atherosclerosis and chronic hypertension.35,36,37,38 Maternal hypertensive disorders represent potential estimated gains of 0.85 million annual DALYs and$1.4 billion in annual GDP in the womens health gap.Post-partum haemorrha

95、ge is the leading cause of maternal mortality globally,accounting for around 20%of all maternal deaths:39 Annually,14 million women worldwide have a post-partum haemorrhage,leading to around 70,000 maternal deaths each year.40 A majority of women with post-partum haemorrhage are estimated to suffer

96、from“near-miss”maternal mortality,leading to long-term complications,41 including brain disorders,chronic cardiovascular disease and other disabilities such as severe anaemia.Almost all post-partum haemorrhage deaths occur in LICs and lower-middle-income countries(LMICs)and are largely preventable.4

97、2 Experts have cited barriers in LICs and LMICs that include poverty,a lack of transport/poor road conditions,inadequate communication networks and a dearth of qualified health professionals.43 In HICs,post-partum haemorrhage is still among the leading causes of complications in pregnancy.Post-partu

98、m haemorrhage represents potential estimated gains of 0.25 million annual DALYs and approximately$200 million in annual GDP in the womens health gap.1.1 Five conditions affect womens lifespanBlueprint to Close the Womens Health Gap:How to Improve Lives and Economies for All11Menopause,PMS,migraine a

99、nd endometriosis affect womens day-to-day health over time,and are under-recognized,under-researched or misunderstood relative to the disability and difficulty they can cause.Menopause,an expected and normal transition for women in mid-life,is among the top conditions leading to profound impacts on

100、health and quality of life for women.Perimenopause and menopause,which can last for more than a decade,are estimated to affect more than 450 million women worldwide at any one time.44 Long-term effects of menopause and untreated symptoms lead to increased risk of chronic conditions,such as cardiovas

101、cular disease,neurological diseases(e.g.depression,dementia),osteoporosis,type 2 diabetes mellitus and other gynaecological conditions.Menopause represents potential estimated gains of 2.4 million annual DALYs and$120 billion in annual GDP in the womens health gap.Based on high unmet need for proper

102、 diagnosis and treatment,the estimated global market potential for interventions that address menopause symptoms ranges from$120 billion to$350 billion globally.Premenstrual syndrome(PMS)has the most wide-reaching effect on womens health when considering the number of women it affects,the number of

103、years a woman can have symptoms,how the symptoms can range in severity and how little is known or treated comparatively.Approximately 1.8 billion women menstruate each month,45 and 2040%of women of reproductive age experience PMS.46 Caution is taken to not pathologize reproductive health,particularl

104、y for girls;and yet,given that societies and social systems were not designed to optimize the health of women and girls and schools and workplaces often do not adapt to the effects of menstrual cycles,the impact of PMS on education,employment and enjoyment of life can be significant.PMS symptoms are

105、 far-reaching,ranging from weight gain,abdominal pain and back pain to anxiety and mood changes,with many of these being debilitating for women.47 This can amount to an average of 23 days of lower productivity per year.48 Another recent analysis found that up to 31 million women and girls may have p

106、remenstrual dysphoric disorder,a more severe form of PMS.49 For school-aged girls,PMS and menstruation can lead to lower school attendance and lower educational attainment.50,51 PMS represents potential estimated gains of 2.1 million annual DALYs and$115 billion in annual GDP in the womens health ga

107、p.Migraine affects around 21%of women approximately 0.8 billion women globally.52 While migraines affect both men and women,they are often reported to have a hormonal component,and women report longer attack duration,increased risk of headache recurrence,greater disability and longer time to recover

108、y.53,54 Menstrual migraine,a type of migraine occurring within two days prior to and three days post onset of menstruation,is strongly linked to PMS,causing frequent and debilitating symptoms for many women.55 Women are 3.25 times more likely than men to experience migraines,but lack of research int

109、o understanding sex-specific differences and their clinical implications persists.56 Migraine represents potential estimated gains of 2.7 million annual DALYs and$80 billion in GDP in the womens health gap.Endometriosis is an oestrogen-related condition affecting one in 10 women between the ages of

110、15 and 45 more than 190 million women globally,though data gaps suggest this is a gross underestimate.57 Although textbooks have described endometriosis as a“disease of nulliparous women in their late twenties or thirties”,58 endometriosis is likely an adolescent-onset disease.While the disease gene

111、rally begins when a girl starts her period,it can take decades between onset and diagnosis.59,60 Endometriosis substantially affects all aspects of a womans quality of life.It can cause chronic pain and infertility and is associated with higher rates of depression.61 As a result of its wide-ranging

112、and debilitating symptoms,many women may miss work or reduce their working hours.62 Due to the prevalence,lack of treatments and unmet need,the Forum and MHI have estimated that the commercial market for potential endometriosis treatments ranges between$180 and$250 billion globally.63 Endometriosis

113、represents potential estimated gains of 0.25 million annual DALYs and$12 billion in annual GDP in the womens health gap.Closing the womens health gap avoiding nearly 27 million DALYs each year caused by these selected conditions and boosting the global economy requires the drivers behind them to be

114、understood,quantified and addressed as well as a transformation of health and social systems.1.2 Four conditions affect womens health spanBlueprint to Close the Womens Health Gap:How to Improve Lives and Economies for All12Quantifying the drivers:How to close the gap2The core elements of the womens

115、health gap indicate a need for better data,more effective interventions,improved care delivery,the inclusion of all women,and increased investment.Taking the following steps in 2025 and beyond may help to close the womens health gap:Improving the accuracy of data collection and standards could help

116、clarify the true burden of disease,particularly for women-specific conditions and those that affect women differently or disproportionately.Further,accurately counting maternal health conditions is essential for understanding the implications for the long-term health of all women and children.Resear

117、ch that includes and emphasizes women and their unique needs could help to dispel misperceptions and unknowns about conditions that affect women specifically,differently or disproportionately.Research could help to create a better understanding of conditions specific to women and illuminate disparit

118、ies.Sex-disaggregated analysis of existing and future research could help reveal how women are affected by many conditions disproportionately or differently from men.Sex-disaggregated results enable an understanding of treatment efficacy and effectiveness.Additionally,studying the second X chromosom

119、e,64 hormonal health and hormonal cycles and the role they play in womens health outcomes is needed.Research funding and a focus on women-specific conditions that affect adolescent girls is a large gap and opportunity.Delivering gender-appropriate and evidence-based healthcare,through healthcare del

120、ivery systems designed for women and equipped to address health-related social needs including resources such as food,safe housing,childcare or transport could improve health outcomes for women.The current healthcare delivery system often perpetuates preventable disability and mortality for women wo

121、rldwide.There is a need for rapid translation of known evidence-based medicine into clinical education and CPGs that reflect sex-based differences.No number of attempts to count,study,analyse or deliver better care to women will work without concentrated efforts to address racial,ethnic,geographical

122、,socioeconomic and other disparities within countries and on a global scale.Stakeholders can consider how to acknowledge and address these differences and promote solutions that achieve health equity.Additional funding whether for clinical and translational research,public health education led by wo

123、men in their communities or the development of innovative interventions is needed to accelerate progress.Public and private investments in care delivery,education and social support services can prevent and treat disease and improve healthy longevity.Count womenStudy womenCare for womenInclude all w

124、omenInvest in womenBlueprint to Close the Womens Health Gap:How to Improve Lives and Economies for All13Womens health data is often not collected,not published in the public domain or incomplete,as highlighted in a Forum and MHI analysis of clinical trial results,CPGs and global datasets.When data d

125、oes exist,such as data intended to track condition prevalence,reporting across different datasets is variable.For example,the World Health Organization(WHO)estimates that around 10%of women of reproductive age are living with endometriosis,while the Global Burden of Disease estimates this figure to

126、be 12%.65,66 That variation means between 24 million and 190 million women could have endometriosis,or even more when accounting for underdiagnosis.67 Data discrepancies lead to difficulty with estimating and describing the health of women across the selected conditions.These discrepancies are parti

127、cularly evident in LICs and LMICs,where a lack of modern data infrastructures can lead to missed opportunities for data capture.68Patient registries are critical elements of data collection,resource allocation and service planning.They collect data on symptoms,medication use,service usage,procedures

128、 and patient-reported outcomes.Health researchers and policy-makers can use this information to observe the course of the condition,understand variations in treatment outcomes and assess effectiveness across and within populations.The Forum and MHI analysis found that many countries lack condition-s

129、pecific patient registries for the selected conditions.69 Even when widely used and accepted registries exist,gaps persist:for example,international data collection standards are absent for many conditions.70 Population-level tracking of breast cancer stage and breast cancer recurrence is particular

130、ly poorly and inconsistently documented within the registries.71 The ultimate outcome measure death is neither consistently nor accurately counted.No comprehensive source to track global mortality rates exists.72 Countries often self-report into mortality databases,and data is often missing,particul

131、arly data from LICs and LMICs.Stakeholders could explore how to standardize,collect,report and update mortality data between and within countries to develop a comprehensive picture of disease burden,aid the allocation of resources and support healthcare systems to improve health outcomes.2.1.1 Lifes

132、pan data is poor;health span data availability and quality are worseThe Forum and MHI,in collaboration with the Global Alliance for Womens Health working groups,developed proxy measures to uncover the scale of the data gap.These measures assessed global medication tracking of evidence-based treatmen

133、ts for the selected conditions.Inaccuracies specifically,not knowing how,why or when women are either taking medications or missing opportunities to take medications undermine a chance to inform investment in interventions or to improve care delivery.Lack of data can often impede monitoring and surv

134、eillance of medications and the effects on women.73 2.1 Count womenImproving data collection and standards could increase the understanding of women-specific needs.Blueprint to Close the Womens Health Gap:How to Improve Lives and Economies for All14Notably,no single database comprehensively tracks h

135、ow medications are used and distributed or medication quality.This has implications for the supply chain and patient access.And while knowing if recommended medications are tracked in global pharmaceutical data is important,the sparsity of relevant and accurate data needed for the analysis is reflec

136、tive of broader challenges with data collection,standardization and collaboration between stakeholders for conditions that contribute to the womens health gap.2.1.2 Even if therapeutic products exist,knowing if they are accessible or used is impossible todayThe Forum and MHI developed metrics to rev

137、eal whether medications for the selected conditions are tracked globally.Analyses were conducted to understand if and how comprehensively the medicines for the selected conditions are tracked in global pharmaceutical data.74 Medication volumes are not comprehensively tracked for most selected condit

138、ionsFIGURE 3Note:1.Model List Essential Medicines from the WHO:a list of medicines considered to be most effective and safe to meet the most important needs in a health system.2.Global clinical practice guidelines for each condition,considered best practice.Source:The Forum and MHI analysis,based on

139、 WHO Model List of Essential Medicines,CPGs of countries,IQVIA N/AN/A%of medications tracked in IQVIA050%5075%75%Medications are not fully tracked for 50%of conditions covered in the Model List of Essential MedicinesConditionEML coverage score1EndometriosisMenopausePremenstrual syndromeMaternal hype

140、rtensive disorderMigrainePost-partum haemorrhageCervical cancerBreast cancerIschaemic heart diseaseConditionEndometriosisMenopausePremenstrual syndromeMaternal hypertensive disorderMigrainePost-partum haemorrhageCervical cancerBreast cancerIschaemic heart diseaseMedications are adequately tracked fo

141、r only 44%of conditions;the remainder are poorly trackedCPG2 coverage scoreBlueprint to Close the Womens Health Gap:How to Improve Lives and Economies for All15The WHO publishes a Model List of Essential Medicines;if a medicine is on this list,the WHO considers treating the condition and accessing t

142、he associated therapeutics as essential for a countrys health system.CPGs are standardized recommendations that clinicians follow to diagnose and treat conditions.This analysis demonstrated the presence and absence of global pharmaceutical data across CPGs and essential medicines lists(EMLs)for the

143、selected conditions and,subsequently,the lack of prioritization of treatments for womens health conditions.In carrying out this analysis,the Forum and MHI used comprehensive sources of global pharmaceutical volume data,knowing that no single-source database exists to provide details for all generic

144、medicines,over-the-counter medicines and branded therapeutics.After consulting with experts in working groups,the IQVIA database was used for this analysis to provide the most complete picture.While this database is one of the most comprehensive sources of global pharmaceutical data,quality of medic

145、ations,limited coverage of generics and lack of tracking of non-pharmaceutical interventions are caveats:1.Medication volume data is not indicative of the quality of medications,availability of medications or whether patients are able to access medications across countries.2.Limited data coverage fo

146、r generic medications likely compounds the data gap from regions in which most medications used are generic,particularly for LICs and LMICs.3.Non-pharmaceutical interventions indicated in treatment guidelines are not tracked.Non-pharmaceutical interventions include surgical procedures,which are part

147、icularly important to note for conditions such as endometriosis(for which laparoscopy is used for diagnosis and treatment)or breast cancer(for which mastectomies may be performed)or cervical cancer(for which loop electrosurgical excision procedure LEEP)therapy is a common treatment.Diagnostic tools

148、are also not covered.Overall,the Forum and MHI analysis found that medications recommended in CPGs are not comprehensively tracked in global pharmaceutical databases for 33%of the selected conditions migraine,PMS and ischaemic heart disease.The Model List of Essential Medicines includes medications

149、for only six of the selected conditions(ischaemic heart disease,breast cancer,cervical cancer,migraine,maternal hypertensive disorders and post-partum haemorrhage).This implies that only 67%of the selected conditions are determined to have medicines that offer the greatest benefits to a population a

150、nd should be available and affordable.Even for the selected conditions present in the Model List of Essential Medicines,the Forum and MHI analysis found that only one-third of the medicines included in the Model List are comprehensively tracked in global pharmaceutical data.Women-specific conditions

151、 that affect the health span PMS,menopause and endometriosis lack EMLs.75 This may reflect the lack of understanding of the burden of these conditions on women,families,communities and economies.As a result,the sense of how(and how well)women are managing pain is limited.In other words,for some of t

152、he most prevalent conditions in the world,the WHO does not recommend that countries include the treatments for these conditions as essential medicines,and tracking for the treatments that are being used(e.g.over-the-counter pain relievers)is limited.The Forum and MHI analysis found that 83%of medica

153、tions referenced in menopause CPGs are tracked in the global pharmaceutical data,including oestrogen,progesterone and other hormonal treatments.76 While specific medications are tracked in global pharmaceutical data,limited data on compounded hormone therapies and tailored dosing of hormone therapie

154、s is collected.This potentially underestimates the treatments used and limits the understanding of the effectiveness and side effects for women using compounded and tailored therapies.Additionally,the quality or availability of medications for women is not reflected in this analysis.Understanding wh

155、ether providers and patients can obtain recommended medicines in different geographical areas even for medications deemed“essential”is challenging.Furthermore,the data does not reflect whether therapeutics are reimbursed by payers,either through national mandates or through individual payer formular

156、ies and coverage guidelines,highlighting additional questions regarding access.Blueprint to Close the Womens Health Gap:How to Improve Lives and Economies for All16Sex-disaggregated data for ischaemic heart disease and migraineFIGURE 4In contrast,on the upside,the Forum and MHI analysis found that a

157、ll breast cancer pharmaceutical therapeutics recommended in global CPGs and the WHOs Model List of Essential Medicines are tracked in global pharmaceutical data.Notably,the comprehensive set of interventions for breast cancer(e.g.radiotherapy,chemotherapy and surgical interventions)are not comprehen

158、sively measured across datasets.The breast cancer analysis demonstrates that collecting this type of data is possible and a potentially achievable goal for other conditions.2.1.3 Publishing sex-disaggregated data could help the understanding of sex-related differences for conditions and their treatm

159、entsWomen are not small men:sex-disaggregated data and analyses allow a better understanding of why and how interventions work differently in men and women,as well as the different effects of interventions attributed to sex and sex-specific physiology.The Forum and MHI analysis found that only aroun

160、d 10%of clinical trials for ischaemic heart disease and migraine published sex-disaggregated data.77 Limited understanding of how women and men may respond differently exacerbates the efficacy gap observed in most health interventions.Proportionate participation by women in clinical trials relative

161、to their share of the burden and transparent sharing of sex-disaggregated trial outcomes,side effects and therapeutic dosage could allow scientists to evaluate the efficacy of a treatment.78,79,80 Additionally,none of the clinical trials for ischaemic heart disease and migraine accounted for hormona

162、l fluctuations or menopause in women participants,which impedes the understanding of treatment effectiveness and how therapeutics differ throughout a womans life and hormonal stages.Source:The Forum and MHI analysis based on clinical trials completed between 1 January 2022 and 31 December 2022.Data

163、retrieved June 2024 from clinicaltrials.gov Average%of women participating in trials open to all sexes:Average%of women participating in trials open to all sexes:31%82%17%15326All sexesSex-disaggregated results7%292All sexesSex-disaggregated resultsMigraineIschaemic heart diseaseOut of 320 trials,15

164、3 were open to both sexes and have published data,out of which only 26(17%)publish sex-disaggregated resultsOut of 52 trials,29 have published data,out of which only 2(7%)publish sex-disaggregated resultsBlueprint to Close the Womens Health Gap:How to Improve Lives and Economies for All172.1.4 A dee

165、per look into heart disease and migrainesIschaemic heart disease is the worlds number one cause of death for both men and women,responsible for the deaths of 9 million people annually(in 2019,roughly 4.97 million men and 4.17 million women).81,82 Analysing the results of clinical trials by sex could

166、 illuminate sex-specific differences,including different responses to treatment,different side effects and potentially different cardiovascular biological factors.However,Forum and MHI analysis showed only 17%of ischaemic heart disease clinical trials completed in 2022 and open to both sexes publish

167、ed sex-disaggregated results.Funding is needed,alongside regulatory reporting shifts,to publish sex-disaggregated data and analysis and encourage sex-specific research.The Forum and MHI analysis found that in the US,National Institutes of Health(NIH)funding for ischaemic heart disease increased over

168、all between 2020 and 2022,though the share of NIH research funding for women-specific ischaemic heart disease research decreased from 26%to 21%.83 Migraine,which affects almost 21%of reproductive-age women,impedes productivity and quality of life for women around the world and accounts for a large p

169、ortion of the womens health gap.84 However,the Forum and MHI analysis found that only two trials out of the 52(4%)completed in 2022 published sex-disaggregated data.85 The Womens Health Innovation Opportunity Map,86 among others,has highlighted a need to research sex-related differences in the prese

170、ntation and evolution of migraine given the sparsity of sex-disaggregated research published.Women who are pregnant and lactating are often excluded from clinical trials for migraine and other conditions.While testing new medications on pregnant women may not be advisable in many circumstances,a con

171、sequence of such research safety measures87 is a lack of understanding of how pregnant women may respond to migraine treatments.For example,a knowledge gap exists on how to manage migraines that get worse with pregnancy.Additionally,those with migraine in pregnancy have a higher risk of pre-eclampsi

172、a and maternal stroke.88 When pregnant women with migraine who developed pre-eclampsia in pregnancy were followed over time,they were discovered to have a higher risk of stroke later in life as well.89 The lack of knowledge and limited clinical trials around sex-specific research drives the treatmen

173、t efficacy gap in migraines,particularly for women,throughout their entire lifetimes,and especially during stages of hormonal fluctuations,lactation and pregnancy.Additionally,given the low participation of men in migraine clinical trials and limited sex-disaggregated results,both men and women suff

174、ering from migraines could benefit from sex-disaggregated data that can reflect treatment efficacy,effectiveness and side effects.Research on the sex-distinctive elements of the selected conditions is needed.90 Lack of research limits knowledge about differences in outcome in diverse groups(critical

175、ly,in women and girls)and impairs understanding of the selected conditions and their pathophysiology.Analysis of research funding can be used as a proxy for understanding the research topics being funded and the research priorities of funders.Global research funding is tracked in the NIHs World RePO

176、RT database.This database covers both governmental and non-governmental funding bodies and may not include all funding from life sciences companies,private investors and local funders.Other analyses may be considered for tracking research attention and support,such as cumulative peer-reviewed public

177、ations about conditions;within this scope,global research funding was prioritized.The Forum and MHI compared the value of global investment in research to the size of the global disease burden(measured in DALYs)for each of the selected conditions.The result is a metric that estimates the“dollars per

178、 DALY”of research funding allocated to the selected conditions.This metric reveals the extent to which research funding reflects the fair allocation of research resources whether all DALYs were considered equally important.Additionally,disaggregating funding by type such as basic science research,cl

179、inical trials,translational research and implementation science helps to identify areas of greater investment need.For example,research on how treatment effectiveness changes within the context of a country or community,particularly in LICs and LMICs,is relatively underfunded.2.2 Study womenConditio

180、ns affecting women could benefit from more research funding and focus.Blueprint to Close the Womens Health Gap:How to Improve Lives and Economies for All182.2.1 Among the selected conditions,funding does not match disease burden What and who is studied and how investments are made illuminates resear

181、ch priorities and health equity concerns.Women-specific conditions are relatively underfunded.PMS,menopause,maternal haemorrhage,maternal hypertensive disorders,cervical cancer and endometriosis comprise 14%of the total womens health gap,as measured in DALYs.Collectively,the Forum and MHI analysis f

182、ound that these conditions received less than 1%of cumulative research funding in 20192023 granted to all 64 conditions that drive most of the womens health gap.91 Comparatively,diabetes makes up 2%of the womens health gap,and received 12.5%of the research funding granted to all 64 conditions.92 The

183、 funding per DALY for diabetes is nearly double the funding per DALY of PMS,menopause,maternal haemorrhage,maternal hypertensive disorders,cervical cancer and endometriosis combined.While investments in diseases and conditions may not always mirror the pain and suffering those diseases and condition

184、s cause,questioning the large gaps between funding and health burden is worthwhile.Funding for conditions is not proportionately allocated relative to the disease burdenFIGURE 5PMS is particularly underfunded.It accounts for 4%of the womens health gap,equating to 2.1 million DALYs,yet research fundi

185、ng does not match the burden caused by PMS:almost zero dollars of research funding per DALY was allocated to PMS between 2019 and 202393 and only 16 clinical trials for PMS were registered between June 2023 and June 2024.No funding or initiatives related to PMS were reported from 2019 to 2023 in the

186、 World RePORT database,and only a handful were related to premenstrual dysphoric disorder from 2019 to 2023.94 Lack of research funding likely correlates with not having a clear understanding of what a“normal”period is,or how common irregular periods are for adolescents.One study measured the hormon

187、e levels of a large cohort of women throughout their menstrual cycles and found that not a single participants hormone levels matched“textbook”28-day cycles.95 Another recent study examined variabilities in the menstrual cycle in demographic groups,age cohorts and based on BMI,with those who were As

188、ian or Hispanic,older or having obesity experiencing more cycle variability.96,97 Breast cancer receives the most funding of the selected conditions:cumulative global research funding for breast cancer is$393 per DALY.Source:The Forum and MHI analysis,based on the World RePORT database and Institute

189、 for Health Metrics and Evaluation.Data retrieved June 2024 from World RePORT databaseWomen affected disproportionatelySpecific to womenLimited disadvantage to womenNote:1.Funding is captured in the World RePORT database,which covers all research funding,from early-stage R&D to care delivery and imp

190、lementation.2.Quartiles based on analysis of funding for 64 conditions,which account for 86%of the Womens Health gap.3.Burden is adjusted by McKinsey analyses to account for higher prevalence of endometriosis and menopause based on WHO estimates and population studies.0.9Premenstrual syndromeMigrain

191、ePost-partum haemhorrageIschaemic heart diseaseCervical cancerMenopause3Endometriosis3Maternal hypertensive disordersBreast cancerDiabetes23.225.159.8129.5178.4180.2216.1393.41,155.2Top quartile2Funding per DALY($/DALY)1Cumulative funding from 2019 to 2023 granted to 64 conditions that contribute to

192、 most of the womens health gap represented in the quartiles,with select conditions represented=$663=$212=$36MedianBottom quartile Blueprint to Close the Womens Health Gap:How to Improve Lives and Economies for All19The impact of that funding on improvements in breast cancer mortality over the past 3

193、0 years reflects the power of focus and investment.Research,education,activism and investment have led to huge gains overall breast cancer mortality rates in the US,for example,decreased by 42%from 1989 to 2021.98 Even for breast cancer,the need for research funding persists.The increasing breast ca

194、ncer burden in LMICS and LICs requires a fresh look at where research is conducted,whether the research in different geographical areas is completely transferrable and the areas of research that receive funding.99 Disaggregated data by funding type such as research funding for basic science versus i

195、mplementation science are not available in the database and not covered in this analysis.This data is important given that substantial work remains to understand effective ways to address socioeconomic and racial disparities,including in HICs:for example,Black women in the US are 40%more likely to d

196、ie from breast cancer than white women,despite the presence of life-saving and life-prolonging treatments in the country.100 Across countries of all income levels,research is needed that provides greater insights into the genetic,biological,social and environmental factors of the selected conditions

197、 and helps with understanding different clinical outcomes.Enhanced research may translate into novel therapies,reduced disease burden and greater economic benefit for families,communities and countries.101,102 2.2.2 More than three-quarters of clinical trials for the selected conditions are conducte

198、d in high-income countriesClinical trials can assess the effectiveness of new interventions,different ways to use existing interventions or other variables that could affect health.Reviewing what,how and where trials are conducted illustrates one measure of industry and academic priorities.The analy

199、sis carried out by the Forum and MHI looks at active clinical trials with women enrollees registered with clinicaltrials.gov between 1 June 2023 and 31 May 2024.Clinical trials for the selected conditions are not conducted in LICs and LMICs relative to the burden of those conditions in lower-income

200、countries.The Forum and MHI analysis found that women and girls in LICs and LMICs experience 54%of the womens health gap,yet 23%of clinical trials for the selected conditions focus on these regions.Upper-middle-income countries(UMICs)and HICs have 77%of clinical trials and only half of the global bu

201、rden.While the evidence suggests that menopause symptoms may start earlier in women who live in LMICs,103 only 8%of the clinical trials identified for menopause are concentrated in LMICs.Similarly,85%of cervical cancer cases arise in LICs or LMICs,104 yet only 9%of clinical trials for cervical cance

202、r were conducted in these countries.Blueprint to Close the Womens Health Gap:How to Improve Lives and Economies for All20Treatment effectiveness in LICs and LMICs is difficult to understand when clinical trials are not conducted in those countries or communities.The Forum and MHI analysis did not id

203、entify any clinical trials in LICs for 67%of the selected conditions:migraine,menopause,PMS,endometriosis,breast cancer and ischaemic heart disease.The answer is not“more trials for trials sake”,but to evaluate whether clinical trials consider globally representative samples of the disease burden an

204、d whether or not their results can be extrapolated across populations and geographies.Additionally,research and funding for a selected condition do not imply that unmet need no longer exists.Post-partum haemorrhage and maternal hypertensive disorders have the greatest proportion of trials in LMICs a

205、nd LICs out of the selected conditions,yet significant morbidity and mortality from these conditions persist across these countries.The first step in LMICs and LICs is more funding for wide-scale infrastructure,training,quality improvements and implementation that can enable successful clinical tria

206、ls to take place.Investment in local primary investigator-led trials can improve local participation and ensure that the research questions and end points are aligned with local relevance and community needs.105In HICs,the outsized proportion of funding and clinical trials may mask disparities and i

207、nequities within those countries.Publication and funding bias may affect the rate of trials completed in LICs and LMICs,106 but even when clinical trials are conducted in HICs,patient access to these trials and representation across minority racial and ethnic groups remains imbalanced107,108Global r

208、esearch distribution in the past 12 months based on WHO International Clinical Trials Registry Platform and clinicaltrials.govFIGURE 6Source:The Forum and MHI analysis,based on clinicaltrials.gov,Institute for Health Metrics and Evaluation.Data retrieved June 2024LICs and LMICsUMICs and HICs%of clin

209、ical trials per income archetype,per condition compared to burden(DALY)While most of the womens health research is concentrated in higher-income countries,more disability burden is found in lower-income countries.23487752Premenstrual syndromeTotal number of trials366490102773861411505089948529189249

210、5169442586406094438629623544677Post-partum haemhorrageMaternal hypertensive disordersEndometriosisCervical cancerMenopauseMigraineIschaemic heart diseaseBreast cancerAverage1,6976662641472921481054462ClinicaltrialsBurdenClinicaltrialsBurdenClinicaltrialsBurdenClinicaltrialsBurdenClinicaltrialsBurden

211、ClinicaltrialsBurdenClinicaltrialsBurdenClinicaltrialsBurdenClinicaltrialsBurdenClinicaltrialsBurdenBlueprint to Close the Womens Health Gap:How to Improve Lives and Economies for All21Breast cancer has more registered clinical trials than all other female-specific selected conditions combined 1,697

212、 in total.In comparison,44 trials for post-partum haemorrhage were registered.The prevalence of breast cancer is close to 500 per 100,000 population,and the prevalence of post-partum haemorrhage is 320 per 100,000 population.109 This highlights a one-third higher prevalence of breast cancer compared

213、 to post-partum haemorrhage,and a near 40-fold difference in the number of trials for breast cancer compared to post-partum haemorrhage.In UMICs and HICs,ensuring diverse access to clinical trials across race,ethnicities and geography and decentralizing clinical trial enrolment may provide equitable

214、 access to innovative research while helping to make sure the results of clinical trials are more broadly applicable.Ensuring that innovative research and clinical trial enrolment reaches all women in all countries is dependent upon access to appropriate,high-quality care and care delivery systems.E

215、ven when evidence to support best practices exists,translating the findings from evidence-based research into clinical guidelines and subsequently adopting them into clinical practice is challenging.110 CPGs are evidence-based,nationally recognized and standardized recommendations for healthcare pro

216、fessionals doctors,nurses or other healthcare practitioners on how to diagnose and treat specific medical conditions.Evaluation of CPGs can illuminate the clinical standard set by a country and reveal whether that standard is reflective of evidence-based practice.Examining CPGs for the selected cond

217、itions in 15 countries across all income levels helps to create a scalable blueprint for all countries and all conditions that drive the womens health gap.Evaluating a countrys CPGs for the selected conditions helps clarify whether evidence-based,high-quality clinical guidelines are being recommende

218、d.Outdated,incomplete or missing guidelines can act as proxies to assess whether a countrys care delivery system is prioritizing the condition and spectrum of care associated with it.Yet this metric is only the first step:while CPGs are meant to reduce variability in care delivery,the implementation

219、 of guidelines may differ due to lack of resources or insufficient or different care delivery environments.In well-resourced countries,CPGs may not encourage the best interventions available,and instead aim for universally applicable recommendations(the lowest common denominator).When better technol

220、ogy and interventions are available(e.g.imaging technology),CPGs could encourage them and women could benefit from them.2.3 Care for womenMore than a third of the womens health gap stems from disparities in care delivery.Blueprint to Close the Womens Health Gap:How to Improve Lives and Economies for

221、 All22Average CPG analysis for 15 selected countriesFIGURE 7Source:The Forum and MHI analysis on assessment of national CPGs against global benchmarks.Methodology of grading and specific CPGs are included in the technical appendix25.2%28.9%37.1%8.9%XX%1201020295395030405060No CPG identifiedNo CPG id

222、entifiedNo mention of any criteria0Mention of any aspect of criteria1Mention some,but not all criteria2Recommended practice3Total number of CPGs No mention of any criteriaMention of any aspect of criteriaMention some,but not all criteriaRecommended practicePercentage of CPGsout of totalAcross countr

223、ies and conditions,9%of clinical practice guidelines met recommended global standards of evidence-based practiceAssessment level based on criteria such as:inclusion of female specific risk factors,diagnostic cut off,treatment protocols and pathways 2.3.1 Among selected conditions,less than 9%of CPGs

224、 in the studied countries met recommended global standards The Forum and MHI analysis found that none of the selected conditions had comprehensive or complete CPGs in all studied countries and none of the studied countries had comprehensive or complete CPGs for all conditions.Practice-standard CPGs

225、for women-specific conditions that affect health span were particularly sparse:in 25%of cases,there is either no CPG identified or no mention of any female-specific criteria across risk factors,diagnostic cut-off,treatment protocols or pathways.CPGs for cervical cancer are present in all 15 of the s

226、tudied countries,a feat not achieved by the other selected conditions.However,the country-level CPGs for cervical cancer were often incomplete for example,specifics regarding vaccination targets,screening and time to treatment varied and were not always aligned with clinical evidence.Vaccination for

227、 human papilloma virus(HPV)almost entirely prevents cervical cancer,yet less than 25%of LICs have introduced HPV vaccination into their vaccine schedules and fewer than one in five girls around the world have been vaccinated for HPV.111 Fewer than 5%of women in LICs and LMICs are screened for cervic

228、al cancer,112 reaching as low as 1%of women screened in parts of Africa.113 Screening coverage in HICs is at least seven times higher than it is in LICs and LMICs.114 CPGs for ischaemic heart disease met the standard for evidence-based recommended practice in only one of the studied countries,even t

229、hough ischaemic heart disease is the leading cause of death for men and women worldwide.Few country-level CPGs for ischaemic heart disease acknowledge sex-based differences:64%of CPGs for ischaemic heart disease mention women-specific risk factors and risk scores(e.g.age,menopause and hormone replac

230、ement therapy HRT);64%of CPGs for ischaemic heart disease mention that women may present differently from men with acute cardiac events(e.g.with dizziness,nausea and fatigue);29%of CPGs for ischaemic heart disease acknowledge that women may respond differently from men to treatment or may require a

231、different treatment pathway(for example,blood pressure optimization,given that standard dosing of some medications such as ACE inhibitors and beta blockers can lead to increased side effects in women and personalized adjustment of medication for women may need to account for physiological difference

232、s).Only the Brazilian guidelines mentioned evidence-based diagnostic cut-offs for women.One country lacked CPGs for ischaemic heart disease completely.Blueprint to Close the Womens Health Gap:How to Improve Lives and Economies for All23Providers caring for women with ischaemic heart disease often la

233、ck the education,guidance and support needed to deliver sex-specific clinical care,115 and as a result,women are less likely to receive evidence-based recommendations and treatment for ischaemic heart disease when compared to men.116 This is further exacerbated by disparities and inequities in care

234、delivery,including quality and access.CPGs for migraine lacked complete evidence-based and practice standards in all of the 15 studied countries.CPGs exist for 10 of the 15 countries studied;of those,only seven country-level CPGs included migraine treatment guidelines adapted for menstruation,pregna

235、ncy and lactation.An example that reinforces this is that only about a quarter of adults in the US with episodic migraine receive treatment.117 Even when medications are prescribed,clinical guidelines and healthcare payers often set a high bar for receiving them;patients often have to demonstrate fa

236、ilure to improve on multiple medications before access to third-line therapy is provided.118 For example,calcitonin gene-related peptide(CGRP)-targeted medications are now considered an early option for migraine treatment,119 but less effective and less well-tolerated generic treatment options are o

237、ften prescribed first,sometimes due to prior authorization guidelines from payers.Many womens healthcare providers reported in 2020 that they were not aware of non-medication treatments with Level A evidence,including the effectiveness of biofeedback,cognitive behavioural therapy and lifestyle chang

238、es as treatments for migraines used in conjunction with medications.120 For the conditions affecting health span migraine,PMS,endometriosis and menopause more than half of the studied countries were entirely missing CPGs describing either prevention,diagnosis or treatment of the condition.Of the sel

239、ected conditions,menopause was one of the lowest-performing in the CPG analysis,despite affecting most women globally at some point in their lifetimes.For PMS,a condition that affects 2040%of women of reproductive age,60%of the studied countries lacked CPGs entirely;of the countries with CPGs,most h

240、ad comprehensive guidelines.2.3.2 Global benchmarks may mask disparities within HICs while often creating less feasible expectations in LICsBreast cancer and cervical cancer have higher CPG scores in most countries,although the high scores and the presence of CPGs across geographical areas and incom

241、e levels may not equate to equitable implementation of the guidelines.Mammography,for example,is a globally recognized guideline for breast cancer screening included in most CPGs,although in HICs,access to screening can differ across race,ethnicity,socioeconomic class and geographical area.In LICs,a

242、ccess to mammography may be limited by the presence or lack of a mammography machine,reliability of electricity and availability of a workforce of technicians and radiologists(and surgeons and pathologists for women with a positive screen).Some LICs and LMICs highlight the challenges and feasibility

243、 of mammography within their CPGs.According to Indias CPGs,for instance,“population-wide mammographic screening of asymptomatic women is neither feasible nor as useful”.121Additionally,CPGs may not reflect the evolution of clinical evidence that could help to address these inequities.In LMICs and LI

244、Cs,educating women and the broader society on the signs and symptoms of breast cancer and when and how to seek care or support someone to seek care may promote early detection and intervention.In HICs,in which mammography has become routine,more precise approaches to screening,diagnosis and treatmen

245、t may be beneficial,including earlier and easier access to stage-appropriate treatment and personalized,precision medicine.122 The sensitivity of mammography differs for women with dense breast tissue;both unnecessary biopsies and missed cancer can be risks when other technologies such as MRI are no

246、t made available or reimbursed.123 Implementation science and research and increasing awareness among communities can help reduce access and adherence challenges and demonstrate effective solutions.For example,using artificial intelligence(AI)to identify and connect with patients with gaps in care,c

247、ommunicating through text and phone calls in a patients primary language,identifying and addressing health-related social needs and enrolling women in rural areas or through primary care into decentralized clinical trials may help all women to find and adhere to the highest-quality care.2.3.3 Adopti

248、on and implementation of CPGs can vary within and between countriesCPGs may not be realistic in a countrys current reality.124 For example,the HPV vaccine needs continuous refrigeration,which may be difficult during a widescale power outage,or those with heart disease may benefit from visiting a car

249、diac rehabilitation centre but struggle with the accessible transport needed to get there.These cases reflect potential challenges in adopting CPGs for cervical cancer and for ischaemic heart disease,respectively.125 Given the limited pragmatic research into the implementation of practice standards

250、within LICs,CPGs often developed based on research in HICs may feel unattainable for some providers and health systems,creating a sense of futility.Blueprint to Close the Womens Health Gap:How to Improve Lives and Economies for All24Research on existing,locally relevant practices(i.e.“practice-based

251、 medicine”)may help to encourage clinically useful and achievable CPGs.In India,a randomized controlled trial in Mumbai demonstrated the effectiveness of education and clinical breast examinations to help achieve a lower stage at presentation(also known as“clinical downstaging”,indicating less exten

252、sive disease)in parallel with mammography.126 Standardized protocols and discharge checklists,for example,support better consistency and compliance with higher-quality care.127 More research is needed to develop CPGs that are effective within and across countries,recognizing both clinical evidence a

253、nd local feasibility.Even when resources do exist,such as in HICs,CPGs may not be adapted in day-to-day practice due to other barriers,such as lack of education and training,overstrained workforces,local access and resource challenges and structural discrimination according to race,gender,income lev

254、els or other factors.Implementation of CPGs and clinical education are intimately linked.Medical education and training for the selected conditions particularly around sex-specific differences across all selected conditions and diagnosis and treatment of conditions that affect health span is limited

255、,even for those in specialized programmes and in higher-income countries.For example,country-level CPGs for menopause and endometriosis are incomplete in the US.One US study found that only a third of obstetrics and gynaecology residency training programmes have a menopause curriculum,while another

256、found that of almost 200 respondents,20%reported not having any menopause lectures during residency.128,129 Another study found that out of 67 residents in US obstetrics and gynaecology training programmes,most were comfortable diagnosing endometriosis but far less comfortable with treatment options

257、 or medical/surgical management.130Education and training on clinical best practices improve care.For example,one training for residents paired a podcast series on menopause with an in-class discussion,resulting in an 18.3 percentage point gain(60.8%to 79.1%)in answering knowledge-based questions co

258、rrectly along with an increase in the residents self-ratings of knowledge,comfort and preparedness.131 CPGs for the selected conditions,even when present,are often not translated into clinical care for girls.For example,many of the selected conditions may affect children and adolescents,yet paediatr

259、ic training on conditions that affect girls differently and disproportionately is minimal.Women-specific conditions often present with menarche,132 and continue through adolescence as symptoms change and regulate.Lack of timely intervention may lead to longer-term consequences;for example,adhesions

260、from endometriosis may lead to chronic pain and infertility.Paediatric history and physical exams often lack sexual and reproductive health;the lack of attention given to menstrual cycles and changes in sexual and reproductive health throughout adolescence are often not discussed in paediatrics appo

261、intments;and lack of focus in paediatric medical education and training on the selected conditions is a disservice to girls.For example,a 2020 survey of US paediatricians found that many reported not providing anticipatory guidance or discussing menstruation with patients,with male paediatricians si

262、gnificantly less likely to give patient education regarding menstruation or ask patients about their menstrual cycle.133 Among obstetrics and gynaecology trainees in Europe surveyed in 2021,more than 40%said that no paediatric and adolescent gynaecology training(rotations,electives or lectures)were

263、offered in their curriculum.134 Ultimately,a lack of knowledge and training can mean missed diagnosis for health-span conditions,resulting in girls missing school,having associated mental health conditions,chronic pain and a sense of isolation.As puberty is starting earlier for girls,135,136 ensurin

264、g provider knowledge and training on adolescent gynaecological health is critical.CPGs could be adaptable to populations and health systems while aligning with the latest evidence-based medicine.They could lead to sex-specific education and training,across country income levels.They could be underst

265、ood,recognized and implemented across specialties and age groups to ensure both women and girls receive evidence-based care.CPGs,when fully representative of evidence-based practice and implemented appropriately,could result in multidisciplinary clinical management incentivized by adherence to guide

266、lines,timely and coordinated diagnosis and treatment,the highest-quality care that is achievable for a woman in her community and pragmatic research into the effectiveness of CPGs and effect on clinical outcomes.Blueprint to Close the Womens Health Gap:How to Improve Lives and Economies for All25Bas

267、ed on recent Forum and MHI analyses and expertise from the Global Alliance for Womens Health working groups,addressing inequity could have a greater impact on mortality for conditions affecting lifespan than any single treatment studied in recent clinical trials.No number of efforts to count,study,a

268、nalyse or deliver better care for women will succeed without concentrated efforts to address structural inequities across race,ethnicities,geographical origin or residence and other disparities within and between countries.Among the conditions affecting lifespan breast cancer,cervical cancer,ischaem

269、ic heart disease,post-partum haemorrhage and maternal hypertensive disorders eliminating disparities associated with race,gender and geography could have a greater effect on mortality than the single treatments in completed and resulted Phase 3 clinical trials between 2021 and 2023 for those conditi

270、ons.137By way of example,many of the recent treatment-related clinical trials for breast and cervical cancer focus on halting the progression of metastatic disease.The reasons behind womens mortality are often more complex than disease pathology alone,encompassing social determinants such as race,in

271、come and educational attainment.One 2017 study found that when Black women died of breast cancer in the US,a lack of private insurance was connected to more than a third of the risk of these deaths,while tumour characteristics accounted for 23%of the risk.138 For cervical cancer,Black and Hispanic w

272、omen in the US are more likely to experience delayed follow-up care after an abnormal pap smear,and Black women are 60%more likely than non-Hispanic white women to die of cervical cancer.139,140 In one assessment of Indonesian patients diagnosed with cervical cancer in 2022,almost 90%said they were

273、unaware of cervical cancer prevention.141 Despite a decline in overall deaths from ischaemic heart disease,women are more likely than men to die from an acute cardiovascular event142 and the overall mortality rate for women with ischaemic heart disease remains high.143 Complications are especially t

274、rue for younger women:a study found that women between the ages of 18 and 55 with acute myocardial infarction experience more adverse outcomes than young men in the year after discharge compared to men.144 Within geographical regions,wide disparities exist:for example,the risk of dying from ischaemi

275、c heart disease varies across Europe,with lower mortality rates for women in Germany than Romania.145,146 In India,ischaemic heart disease rates are increasing faster in women than men,attributed to factors such as greater body weight,tobacco use,diabetes and periodontal infections,in addition to di

276、sparities in the delivery of healthcare by gender.147 For maternal health,disparities are well known.Within HICs,Japan has 4 maternal deaths per 100,000 live births;the United Kingdom has 5.5 maternal deaths per 100,000 live births;the US has 22.3 maternal deaths per 100,000 live births.148 LICs,ove

277、rall,have 430 maternal deaths per 100,000 live births.149 But the picture is more complex when looking deeper within a country.In the US,rates of post-partum haemorrhage rose by 26%between 1994 and 2006 and exacerbated disparities:150 Black women in the US are less likely to receive life-saving anti

278、-haemorrhagic interventions than non-Black women.151 Black women in the US are 2.6 times more likely to die from pregnancy-related complications than non-Hispanic white women,with 49.5 maternal deaths per 100,000 live births.152 Health-related social needs limit access to healthcare delivery and are

279、 often a barrier to inclusion in research and clinical trials.Efforts to address health-related social needs and understand the implications of social determinants of health are critical to improving health span and lifespan.While social determinants of health are correlated with health outcomes,add

280、ressing health-related social needs can sometimes have an even greater impact on medical conditions than the care provided,due to their effects on delayed presentation,delayed diagnosis,access to interventions and trust in the healthcare system as when health-related social needs are linked to delay

281、s in the diagnosis and treatment of cancer.153 When health-related social needs and mental health challenges are addressed,improvements in cancer care access and all-cause mortality are observed.154 Closing the womens health gap will require provider education on the impact of social needs on clinic

282、al care and health outcomes,and training on screening for social needs and resources to support women with social needs and mitigate disparities.Cultural barriers can lead many women,particularly those with lower levels of education and socioeconomic status,to avoid seeking healthcare.Feelings of sh

283、ame and perceived stigma also affect care.In sub-Saharan Africa,“women reported fear of the cervical screening procedure and negative outcome,low level of awareness of services,embarrassment and possible violation of privacy,lack of spousal support,and societal stigmatization”,among other reasons fo

284、r non-participation.155 2.4 Include all womenAll women should be included in efforts to improve care.Blueprint to Close the Womens Health Gap:How to Improve Lives and Economies for All26Another example is menopause,an expected transition for almost all women:globally,half of post-menopausal women be

285、lieve that menopause is a taboo subject,and only 46%go to their doctors for symptom management while 28%have no plans to see their doctor.156 Similarly,menstruation is still perceived as a taboo subject by many,including women and girls,leading to meaningful levels of period poverty.157Dignity and t

286、rust between women and their providers are the foundation of clinical relationships and successful health outcomes for women.Awareness and education can encourage individuals to advocate for and institutionalize sex-and gender-responsive care,and ensure providers deliver it.The past year has seen su

287、bstantial public and private commitments for investment in womens health around the globe but the work is only beginning.158,159,160,161,162 Innovative investment and funding approaches across the public,private and social sectors have recently launched.For example,Pivotal Ventures released an open

288、call for organizations around the world that advance womens health and health equity,with$250 million in allocated funding for grants within a broader$1 billion commitment to advance the global power of women.163 The Advanced Research Projects Agency for Health(ARPA-H),a research funding agency of t

289、he US Government,opened a“Sprint for Womens Health”to support health and biomedical breakthroughs.Within six months of the announcement,$113 million was invested to support research on conditions that affect women differently or disproportionately,and 70%of the funded organizations are women-led.164

290、When investments are made,returns are achieved.For every 1 of public investment into obstetrics and gynaecology services per woman in England,there is an 11-fold return on the financial investment.165 Research focused on the biology of health-span conditions requires more funding.For example,a 2024

291、study found that genetically-predicted levels of certain hormones were associated with endometriosis risk.166 While basic science investments may seem distant from treatment gaps and policy decisions,they are intertwined.When the diagnosis of health-span conditions is delayed,fewer women are counted

292、 as having the condition,which can lead to less investment in research.Scientists,life sciences companies and investors require adequate data on prevalence and potential market size to comfortably inform their investments.Investment also means looking at who is leading the research and how a clinica

293、l research programme or clinical trial is run.One recent analysis found that when the principal investigators leading cardiovascular clinical trials were women,they were more likely to enrol women.167 Investment is needed in professorships,funded chairs and other dedicated research tracks for womens

294、 health in academic institutions beyond those in obstetrics and gynaecology departments recognizing that more than half of the womens health gap is tied to conditions that affect women differently or disproportionately from men.Investors,philanthropists and government funders can also consider a hol

295、istic and comprehensive approach to health beyond the healthcare delivery system.This includes social factors such as nutrition,education,housing,water,clothing or transport and how they influence outcomes.For example,UNICEF estimates that more than 400 million children lack access to basic sanitati

296、on services at their school,and only about one in three schools offer bins for menstrual waste.168 The connection between unmet social needs and health stretches into HICs a McKinsey survey found that employed individuals in the US with one or more unmet basic social need were 2.4 times more likely

297、not to receive needed physical healthcare and to have missed six or more days of work in the past year.169 2.5 Invest in womenAdditional investments are needed to support the other actions.Blueprint to Close the Womens Health Gap:How to Improve Lives and Economies for All27The path to progress3Colle

298、cting data is the first step in uncovering the drivers that will end the disparities and inequities in womens health but which data should be gathered and how best to use it?The selected conditions can prematurely end or meaningfully impair the health of women around the world.The societal and endem

299、ic factors contributing to the womens health gap did not appear overnight,and solving each of the drivers in a vacuum will not close the gap.170 Closing the womens health gap driven by the undercounting and under-reporting of womens health data,the lack of understanding of the efficacy of interventi

300、ons for women,inequities and disparities in the care delivery system and a lack of investment in the health of women requires focused action,global commitments,local and international accountability and a fundamental transformation of health and social systems.Some actions for consideration are cove

301、red in the following sections.Blueprint to Close the Womens Health Gap:How to Improve Lives and Economies for All28Measuring and tracking components of the gap are important and meaningful first steps in the journey to equitable health and healthcare for women and girls.Measures that drive action an

302、d direct resources to areas of impact are critical.The Womens Health Impact Tracking(WHIT)platform was created to address this need.WHIT was designed to measure the burden of health conditions that contribute to the womens health gap(in terms of disability,mortality and consequent economic effect)an

303、d country-level indicators of data availability,treatment effectiveness and quality and appropriateness of care delivery.It was designed by stakeholders,for stakeholders,as a practical and tactical tool to track progress over time and illuminate areas of opportunity to scale proven interventions to

304、rapidly close the womens health gap.WHIT allows anyone around the world to view the 2024 baseline,including the most recent data used for this report,with the potential to monitor year-on-year progress and create a previously unavailable level of transparency.It incorporates metrics across the selec

305、ted conditions developed in the Global Alliance for Womens Health working groups and incorporates 15 countries that are representative of each income level.WHIT is an initial step.It highlights important data gaps and creates a path to make relevant data available to stakeholders.Prior to the launch

306、 of the platform,researchers,policy-makers and business leaders gathered data on womens health conditions and outcomes from fragmented sources a process that was inefficient and fails to reveal the big picture.With WHIT,leaders and interested parties can access centralized,tested data.This allows le

307、aders to spend their time and efforts not on collecting data,but on understanding and using it.Additionally,WHIT was built for scale.Over time,it aims to expand to all countries and conditions that contribute to most of the womens health gap.But data is useful only if used effectively,and no one sta

308、keholder can reverse structural inequalities and inequities.Every life matters and so does every death.One meaningful goal could be for all countries to standardize data collection for maternal mortality,pregnancy-related complications and additional conditions affecting the maternal health span.Add

309、itionally,healthy births could be measured.Pregnancy is the“canary in the coal mine”:171 for an individual woman,complications in pregnancy can illuminate potential long-term health consequences;for a society,how pregnant women are cared for(or not)is indicative of investment and priorities in healt

310、h and social systems.For example,women with gestational diabetes are more likely to develop diabetes mellitus,type 2,later in life;women with cardiac-related conditions in pregnancy may have vascular changes that persist after delivery and greater risk of ischaemic heart disease.By standardizing the

311、 collection of health metrics for pregnant women,healthcare professionals can have broader insights into the health of individual women and of populations in the longer term.3.1 Count women:Measure womens health and health outcomes globallyBetter understanding of hormones and the biology of sex-rela

312、ted differences may improve womens lifespan and health span.Researchers have found links between oestrogen,menopause and brain health.One study found that a decline in oestradiol during the menopause transition was associated with changes in the brain,including cognitive changes,effects on sleep and

313、 effects on mood.173 Another analysis of close to 200 women between the ages of 40 and 65 found that menopause tended to affect brain structure,connectivity,energy metabolism and amyloid-beta deposition.174 Research into sex-specific biology across basic science,pathophysiology and clinical trials c

314、ould include the implications of hormones on medication metabolism and effectiveness including a more personalized approach to hormone replacement therapy(HRT)to drive better health outcomes.For instance,a recent study evaluated oestrogen receptor activity across the brain for pre-,peri-and post-men

315、opausal women.Oestrogen receptor density(a measurement of an organs“hunger”for oestrogen)progressively increased in the brain over the menopause transition,and increased oestrogen receptor density in areas of cognition was associated with lower memory scores for women.3.2 Study women:Understand horm

316、onal health and womens biologyBlueprint to Close the Womens Health Gap:How to Improve Lives and Economies for All29Most striking was that,based on PET imaging,the brains of post-menopausal women far past the menopause transition were still“hungry”for oestrogen.175 Basic science research on hormones,

317、such as this study of oestrogen receptors in the brain,has implications for care delivery and healthcare payment.For example,most CPGs recommend the initiation of HRT around the menopause transition,and oestrogen therapy is often reimbursed by health insurance companies only when started in this tim

318、e frame.Yet this research suggests that older women may also benefit from initiation of oestrogen replacement therapy.In other words,near-term research results may highlight opportunities for near-term impact in the lives of women.CPGs offer standardized recommendations for healthcare professionals

319、and could be enhanced to reflect women-specific evidence,particularly for women-specific conditions that affect health span.Having CPGs for women-specific conditions such as endometriosis and menopause and accounting for sex-specific differences in the CPGs for conditions that affect both men and wo

320、men,such as ischaemic heart disease,are essential actions and not currently achieved across all of the studied countries or selected conditions.The time is now for healthcare providers to have access to comprehensive,evidence-based guidelines and the education,training and necessary infrastructure t

321、o implement them in practice.CPGs based on research conducted in HICs sometimes clash with the reality of care delivery in LICs and LMICs.Even within UMICs and HICs,the actuality of care delivery including resources,access and health-related social needs may impair delivery of evidence-based clinica

322、l care.CPGs could help to account for local realities while also ensuring the best evidence-based care available in a geographical area.More research is needed to understand how to ensure the highest-quality care is delivered within and between countries,particularly those with fewer care delivery r

323、esources,and then incorporated into country-level CPGs when appropriate.The studied countries may have locally relevant clinical approaches that are effective within the reality of their communities and care systems,such as Indias emphasis on education and clinical breast exams as a breast cancer sc

324、reening tool,that could benefit from structured research.Overall,though,lower incomes,race and ethnicity,geography or other factors should not determine a womans fate when it comes to her health including and perhaps especially in countries with the resources to prevent disparities and inequities.As

325、 the use of AI/machine learning continues to evolve,countries may also consider AI-enabled functions to ensure timely updates to CPGs.A challenge could be to make sure inputs into the language learning model reflect sex-specific differences and data and considerations specific to a country and its d

326、elivery system.Without this,AI could further perpetuate inequities and disparities in care delivery for women.3.3 Care for women:Implement CPGs for women-specific conditions and account for sex-specific differences within CPGsBlueprint to Close the Womens Health Gap:How to Improve Lives and Economie

327、s for All30Women in all countries could benefit from infrastructure,trained healthcare workforces and innovations that prioritize lifespan and health-span conditions.These solutions can be high-quality and cost effective.One recent study of 78 hospitals in Kenya,South Africa,Nigeria and Tanzania fou

328、nd that providing calibrated blood-collection drapes and using bundled first-response treatment in hospitals helped diagnose post-partum haemorrhage earlier while also using resources more effectively.176 Low-dose aspirin is known to reduce the risk of maternal hypertensive disorders.One study found

329、 that women in the Democratic Republic of the Congo,Guatemala,India,Kenya,Pakistan and Zambia with a singleton pregnancy who received low-dose aspirin were 11%less likely to deliver before 37 weeks.Similarly,the risk of early pre-term birth was lowered by 25%and perinatal mortality was decreased by

330、16%.177 More research is needed in LICs and LMICs to evaluate and overcome the barriers to women taking aspirin when indicated.Digital health can also be an impactful catalyst.A programme in Tanzania and Lesotho,m-mama,connects women to community drivers and local ambulances via a technology platfor

331、m to provide emergency transport for women in pregnancy and labour.m-mama provides a toll-free phone number and connects callers to a government-owned and operated dispatch service,which triages the womans condition and deploys transport nationwide to the nearest and most appropriate facility identi

332、fied by the platform.The programme provides approximately 50,000 rides annually and is set to launch in Kenya in 2025.m-mama found that maternal mortality reduced by 27%and infant mortality reduced by 40%in its pilot regions.178 However,even as digital health solutions become more accessible,stakeho

333、lders may consider how all countries including HICs are assessing their use across populations.A World Health Organization European Scoping Review found that the women studied were among those less likely to have access to digital technology or motivation to engage with digital platforms and that they are among the groups more likely to lack knowledge,skills and confidence in using digital technol