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The promotion of gender equality has been a long-standing theme in the philosophy and operations of the EU. However, it has been over 60 years since the Treaty of Rome, where gender equality was enshrined into EU law, and to date, no EU country has reached it.
There are huge disparities both between and within countries that directly and indirectly affect women’s health. While women can generally expect to live longer, this does not necessarily ensure a better quality of life. Even in countries where women do live longer, studies have found that they are sicklier and more disabled than men throughout their life cycle. This means that women are spending on average 19.5 years in poor health compared with 14.5 years for men.
To get a comprehensive picture of the inequalities women face in accessing high-quality healthcare we have to look across the healthcare continuum from the design of research protocols to the very delivery of healthcare. Historically, women’s health issues have focused on reproductive health. Some attention has been devoted to the social determinants of health issues, including how societal constructs—such as behaviour, socioeconomic factors, culture, and lifestyles—influence biological development and health.
We must move from the description of sex differences to a more systematic approach of implementation into regulatory and clinical practice for the benefit of patients and, ultimately, to improve health and healthcare for all.
Women and men have different sex- and gender-related risks for developing certain conditions and responses to treatment. For example, biological differences between males and females can affect how a medicine works in the body. Additionally, patterns of gene expression differ between males and females. Research on cardiovascular disease (CVD), osteoporosis and depression has identified significant differences between women and men with respect to the distribution of certain diseases.
These sex and gender differences have important implications for health and healthcare. It is imperative to target medicines to these patient population sub-groups by utilising the correlation between sex and the incidence, prevalence, symptoms, age at onset and severity of disease, as well as the reaction to medicines.
Given that the scientific knowledge on sex differences is now well-known and a more supportive legislative environment in Europe exists within the EU’s Clinical Trial Regulation, the time has come to address remaining barriers. We must move from the description of sex differences to a more systematic approach of implementation into regulatory and clinical practice for the benefit of patients and, ultimately, to improve health and healthcare for all.
While the EU’s Clinical Trials Regulation is welcomed and will improve data transparency, we need other measures to ensure that the level of representation of men and women in clinical research is efficiently monitored and reported, and that data is disaggregated according to sex and age. This is crucial for robust risk/benefit analysis for both sexes, as well as to direct advances in healthcare and health policy.
Rethinking of policy, medical training, and treatment will be needed to better address the chronic disease burden for both women and men.
The impact of gender in the use of health services is not limited to individuals’ health-seeking behaviour; gender biases also influence the provision of services. Women and men use healthcare in different ways. Women are more likely than men to present ‘invisible’ illnesses and disabilities which are often not adequately recognised by the healthcare system. Health systems may fail women as service users, patients and carers. It is often assumed that women experience conditions such as cardiovascular diseases, cancers, chronic respiratory diseases and diabetes in the same way as men, an assumption that can result in misdiagnosis and ineffective and unequal treatment, as demonstrated by the evidence on cardiovascular disease.
Doctors sometimes mistake symptoms of CVD in women for stress, panic disorder, or even hypochondria. Also, mental health problems which can be responsible for women failing to adopt a healthier lifestyle and which would prevent another heart attack are not always recognised. In the complex field of chronic diseases, treating each disease in isolation would seem to be one of the biggest challenges to overcome. Rethinking of policy, medical training, and treatment will be needed to better address the chronic disease burden for both women and men.
Read more on the Forum Network: Rebel Bodies: A guide to the gender health gap revolution, by Sarah Graham, Health Journalist & Author
In an inclusive and empowering manifesto for change in women's healthcare, Sarah Graham explores the systemic and deep rooted sexism within medicine, and offers actionable ways for women to advocate for themselves and others and get the diagnosis and treatment they need.
Apart from reproductive health, it is rare that sex and gender are considered in healthcare professional education curricula. Over the last ten years, the importance of sex and gender in medical healthcare research and treatment of medical conditions has been increasingly recognised. However, the need for integration of this knowledge into healthcare professional education curriculum remains a challenge.
One example of where this has been done well is at Monash University in Australia, where sex and gender issues have been integrated into all parts of the undergraduate medical curriculum, as well as in tutorials and cases for teaching, meaning that gender competence is included also in the assessment of doctors.
Improving women’s health requires a strong and sustained government commitment, a favourable policy environment, and well-targeted resources. In the short-term, significant progress can be achieved by strengthening and expanding essential health services for women, improving policies, and promoting more positive attitudes and behaviour towards women.
Women’s health is an unfinished agenda with large gaps as unmet needs continue to persist. Sex and gender are not systematically integrated into policy, programmes, education, research, data collection and analysis. Long-term improvements in education and employment opportunities for women will have a positive impact on the health of women and their families. Gender-responsive health systems ensure that the links between biology, gender and social determinants are addressed. Mapping women’s health needs across their lifespan in health policy and developing a robust evidence base would produce better-targeted women’s health policies, reduce inequalities, ultimately resulting in better outcomes for both women and men.
The OECD Gender Initiative examines existing barriers to gender equality in education, employment, and entrepreneurship. Find out more!
And learn more about how we may ensure that the global community is ready for the next crisis with the OECD report: Ready for the Next Crisis? Investing in Health System Resilience (February 2023)