13 March 2023

Bridging Europe's gender health gap

Despite living longer than men, women in the European Union spend a greater share of their life in ill health. Following International Women’s Day, we reflect on how the European Union and its Institutions can bridge the gender health gap.

By Carolina Santos, Senior Account Executive, Evoke Incisive Health

In 2020, the European Union committed to making significant progress towards a gender-equal Europe by 2025. By systematically including a gender perspective in all EU policy areas, the European Commission has set out to create “a Europe where women and men, girls and boys, in all their diversity, are equal.” 

In the European Union, women are said to have a “mortality advantage”, with life expectancy at birth higher for women in all EU Member States. However, despite this advantage, women actually spend a greater share of their life in ill health when compared with men.[1] While this is not currently reflected in the way that our healthcare systems are designed, there is no better time than the present to invert this trend. 

With so many health files on the legislators’ table, in the EU and beyond, policymakers have a unique opportunity to ensure that healthcare policies and services are designed to meet the unique needs and challenges faced by women. They can work on improving access to healthcare, particularly for women in marginalized communities, investing in targeted outreach programmes and in healthcare infrastructure, and promoting gender-sensitive research and data collection to better understand and address the health disparities between men and women. Moreover, promoting gender equity and addressing social determinants of health, such as poverty and discrimination, can have a significant impact on improving the health outcomes of women.

Here are a few things we think could be addressed through ongoing discussions.

Ensure representation in clinical trials
Historically, women were excluded from clinical trials due to concerns about possible long-term effects on their fertility and unborn children. Despite positive efforts to improve inclusion, women are still underrepresented.[2] Exclusion of women from clinical trials have deeply affected how healthcare systems were built, with care being provided based on a male standard and failing to appropriately address women’s health needs.[3] For example, despite cardiovascular diseases causing the greatest mortality burden for women in Europe and known gender differences in response to cardiovascular pharmaceuticals and devices, only 38% of all participants in clinical trials from 2010-2017 were women.[4]

By reforming and modernising the EU regulatory framework, policymakers can help design a more inclusive framework for clinical trials.

Ensure women’s voices and concerns are listened to
Historically women are more likely to feel challenged to prove the legitimacy of their symptoms and pain levels.[5,6] There has certainly been immeasurable progress to distance ourselves from the “hysteria narrative”, but women are still going un- (and under-) diagnosed in more than 700 diseases, including cancer and cardiovascular diseases.[7] Studies have also found that women are 50 per cent more likely to be misdiagnosed following a heart attack,[8] receive less medical attention when diagnosed with dementia, and are less likely to be prescribed painkillers.

Women’s voices should be integrated at the source, in those initiatives which bring different stakeholders together and help shape the healthcare policies of the future.

Increasing access to healthcare for marginalised communities
Gender inequality can intersect with other forms of oppression (such as those linked to gender

identity, sexual orientation, ethnicity, or disability) leading to specific challenges in access to healthcare.[9] Numerous studies have found that women, particularly those from marginalized groups, face significant barriers when it comes to accessing healthcare services. For example, research has shown that migrant women often experience difficulties in accessing healthcare due to language barriers, lack of insurance, and discrimination.[10] Additionally, less-educated women are more likely to experience poor health outcomes due to factors such as poverty, limited job opportunities, and inadequate access to healthcare.[11]

Therefore, a holistic approach to policymaking, that, for instance, looks at the impact of marginalisation and education on health, is key as we strive to build more equal and accessible healthcare systems across Europe and the world.

What is the way forward?
On the back of International Women’s Day, and while Europe is at a crossroads when it comes to rethinking and rebuilding its healthcare systems and creating a resilient European Health Union, the question is: what can the Institutions do to close the gender gap and what role can healthcare stakeholders play in supporting this progress? It is important to note that gender discrimination in healthcare is deeply interlinked with other forms of discrimination and social, economic, and environmental circumstances. To quote the World Health Organization, “unequal power leads to unequal health”.[12]

EIGE, Gender Equality Index, 2019. [2] Sosinsky AZ, Rich-Edwards JW, Wiley A, Wright K, Spagnolo PA, Joffe H. Enrollment of female participants in United States drug and device phase 1-3 clinical trials between 2016 and 2019. Contemp Clin Trials. 2022 Apr;115:106718. doi: 10.1016/j.cct.2022.106718. Epub 2022 Mar 2. PMID: 35247632. [3] Health Canada: Considerations for Inclusion of Women in Clinical Trials and Analysis of Data by Sex - 2013 Guidance Document. [4] Jin X, Chandramouli C, Allocco B, Gong E, Lam CSP, Yan LL. Women's Participation in Cardiovascular Clinical Trials From 2010 to 2017. Circulation. 2020 Feb 18;141(7):540-548. doi: 10.1161/CIRCULATIONAHA.119.043594. Epub 2020 Feb 17. PMID: 32065763. [5] Zhang L, Losin EAR, Ashar YK, Koban L, Wager TD. Gender Biases in Estimation of Others' Pain. J Pain. 2021 Sep;22(9):1048-1059. doi: 10.1016/j.jpain.2021.03.001. Epub 2021 Mar 5. PMID: 33684539; PMCID: PMC8827218. [6] Claréus B, Renström EA. Physicians' gender bias in the diagnostic assessment of medically unexplained symptoms and its effect on patient-physician relations. Scand J Psychol. 2019 Aug;60(4):338-347. doi: 10.1111/sjop.12545. Epub 2019 May 23. PMID: 31124165; PMCID: PMC6851885. [7] Westergaard, D., Moseley, P., Sørup, F.K.H. et al. Population-wide analysis of differences in disease progression patterns in men and women. Nat Commun 10, 666 (2019). https://doi.org/10.1038/s41467-019-08475-9. [8] British Heart Foundation, Women are 50% more likely than men to be given incorrect diagnosis following a heart attack, 2016. [9] WHO Regional Office for Europe, Women’s health and well-being in Europe: beyond the mortality advantage, 2016. [10] Pérez-Urdiales I. Undocumented immigrants' and immigrant women's access to healthcare services in the Basque Country (Spain). Glob Health Action. 2021 Jan 1;14(1):1896659. doi: 10.1080/16549716.2021.1896659. PMID: 33975531; PMCID: PMC8118419. [11] WHO Regional Office for Europe, Women’s health and well-being in Europe: beyond the mortality advantage, 2016. [12] WHO Regional Office for Europe, Women’s health and well-being in Europe: beyond the mortality advantage, 2016.

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