Women spend 25% more time in poor health

than men do. [music] And this carries

big economic consequences to the tune of

a lost trillion dollars of economic

opportunity [music] each year.

>> Welcome to Radio Davos, the podcast from

the World Economic Forum that looks at

the biggest challenges and how we might

solve them. This week, why do women tend

to get worse health outcomes than men?

And what are some simple cost-effective

ways to make that better? So women

[music] spend 25% more time in poor

health than men do. And many people

think that that [music] makes sense that

because women live longer than men that

they would spend more time in poor

health because it's concentrated at the

end of life. But [music] actually that

big health gap happens during women's

prime working years. It's actually much

more pronounced between ages 20 to

[music] 60 and that is why it has such

huge economic implications taking women

out of the workforce. A report from the

World Economic Forum and the McKenzie

Health Institute sets out three

relatively simple ways that health

systems around the world could improve

women's health outcomes, [music]

including when it comes to the massive

killer heart disease.

>> Women are 50% more likely to die in the

year following a heart attack than

[music] men are. We're leaving

opportunity on the table in terms of how

we can help those women be in better

health.

>> Follow Radio Davos wherever you get

podcast or visit. podcast, we'll also

find Meet the Leader and a gender

dialogues. I'm Robin Pomeroy with this

look at how to improve the health of

women, but also of children and of

[music] men.

>> So, if we want better health for

everyone, we really need to put that

study of sex-based differences front

[music] and center.

>> This is Radio Davos.

>> Welcome to Radio Davos. And on this

episode, we're talking about health and

in particular women's health. And to

help me with that, I'm joined by my

guest Lucy Perez. Hi, Lucy. How are you?

I'm doing well, Robin. Thanks for having

me.

>> Tell us what you do.

>> I am uh a senior partner at McKinzian

Company where I'm also one of the global

co-leaders of the McKenzie Health

Institute. And the Mckenzie Health

Institute, we have what I consider the

best mission, how to add years to life

and life to years. And one of the things

that we've realized in looking at how

much progress we've made in terms of

growing human lifespan is that we have

not done the same when it comes to

health span. the amount of time that we

spend in good health. And a big reason

for that is because we have been have

not been looking at sex-based

differences and thinking about how male

biology and female biology are

different. So, I'm excited to spend some

time today talking about how we can

close that women's health gap.

>> And you've recently published this

report with the World Economic Forum,

Care for Women, investing in care

delivery to improve women's lives and

livelihoods.

How do you pitch that report? What's

what's the elevator pitch for it?

>> I will put that report in context first

because I think that may be helpful for

folks who are not familiar with this. We

started a partnership with the World

Economic Forum 3 years ago under the

premise of understanding the economic

impact of investing in women's health.

As part of doing that work, we showed

that women spend 25% more time in poor

health than men do. And this carries big

economic consequences to the tune of a

lost trillion dollars of economic

opportunity each year. And about a third

of what drives that are gaps in care

delivery. And so this latest report is

showcasing how we can address those gaps

in care delivery to help women have many

more days in good health and as a result

have stronger economies for everyone.

>> Give us that figure again. H how much

more percentage of of their life does a

woman spend in ill health? So women

spend 25% more time in poor health than

men do. And many people think that that

makes sense that because women live

longer than men that they would spend

more time in poor health because it's

concentrated at the end of life. But

actually what we showed is that that big

health gap happens during women's prime

working years. It's actually much more

pronounced between ages 20 to 60. And

that is why it has such huge economic

implications taking women out of the

workforce. Another reason you might say

potentially it's logical is women give

birth and this is a huge stress on the

body.

>> It is a huge stress on the body. But

actually what we found is the majority

of the gap ties to conditions that

impact both men and women but that

impact women disproportionately or

differently. Heart disease is a perfect

example. Women, for example, are 50%

more likely to die in the year following

a heart attack than men are. And

interestingly is because people often

say, "Oh, women present in atypical

fashion." But the reality is women are

51% of the population. So is that really

atypical or do we need to think

differently again about male biology

versus female biology and follow the

science and what it shows us.

>> So interesting. Right. Atypical meaning

not like a man.

>> Exactly.

>> Right. Okay. All right. Now, this

report, what you've done is identify

three kind of concrete cases of what

could be done to improve this. And I'll

just quote a bit. Actually, this is from

your blog. I don't know if this is also

a line taken from the report. You wrote

a blog for the World Economic Forum.

Link in the show notes to that. Well

worth reading. It's a very um concise

kind of summary of what's in this

report. But here's the line that should

surprise people.

Investing in preventative care such as

integrated screenings and standardized

reporting could create health care

system savings delivering a three to six

times return.

>> Those are massive numbers, right? Very

attractive when you think about that

value of prevention and investing

earlier to avoid downstream worse

events. So what we did is we said we

wanted to take a look at three

conditions that allowed us to understand

what is happening today. What are those

pain points that women experience in

their care journey and focus on things

that happen to a lot of women. So one of

the things we did was look at pregnancy.

There's over 200 million births every

year, right? Women who are going through

pregnancy each year. There's also about

200 million women who are getting a

mammogram each year. And in both of

these circumstances, what we find is

that we're leaving opportunity on the

table in terms of how we can help those

women be in better health. So take the

mamogram, right? It is well known as a

breast cancer diagnostic. But what many

people don't realize, it can also be a

great indicator of heart health. Because

on mammograms, we can take a look at

breast arterial calcification. This is

the buildup of calcium in your arteries

there. And by looking at that, we can

get an indication of how much more

likely that woman is to have a

cardiovascular event. And because we can

detect it earlier, especially if she's

getting routine annual mammogs, we can

intervene earlier and help prevent a

cardiovascular event down the line. So

you're talking about an intervention

that today maybe I'm going to use you as

numbers cost you on the order of

hundreds of dollars to avert something

that can cost multiple hundreds of

thousands of dollars to treat. That's

how you get that very positive ROI.

>> So the situation is in

countries where women are regularly

getting mamograms which is a screening

of the breast for breast cancer. If you

added a bit of a bit extra,

>> I would argue it's not adding. It's

literally annotating that mamogram.

>> It's the same

>> it's the same test, right? The same

image that's giving you that information

that just needs to be annotated in a

standard way, right? So you can compare

and contrast over time against different

populations. That's all we need to do.

>> Is it already happening? Does that are

there clinics where they'll say, "Okay,

we're going to screen you for cancer,

but we'll also give you an idea of

whether you're at risk of heart

disease."

>> Indeed, there's a few places um

primarily in highincome countries that

are indeed beginning to incorporate this

that they will also even have a standard

of care for how to report on breast

arterial calcification. But the reality,

it's very much the minority. And that's

why we hope this work helps shine a

light on it and reflect anywhere where a

mammogram is happening, whether you're

talking about a high-income country or a

lowincome country, but anywhere that a

mammogram is taking place, that there's

that opportunity to annotate for breast

arterial calcification that then

triggers a referral sometimes to a

primary care physician, sometimes to a

cardiologist depending on the severity

of that measure so that that woman is

better looked after.

Have you any any anecdotal evidence of

this? Do you know women who've actually

experienced this?

>> I do. I I mean sadly um too many, right?

That um because the reality is I live in

the United States, right? And and their

routine mamograms are are fairly common.

And so what what you often find is that

in some instances I have a friend who

literally went for her mamogram last

week and she was asking me what should I

ask about right because she's been

hearing me talk about preparing for

launching this report and I said you

should ask your doctor the radiologist

to comment on your breast arterial

calcification

and she did and he asked why.

That speaks to the change that needs to

happen, right? That everyone needs to

understand this is an opportunity, a

screening opportunity that we have that

it's not costing anything additional and

that ultimately can help save lives. In

her case, you know, after a lot of back

and forth, right, it was clear he said

she didn't have any meaningful breast

arterial calcification, but what if she

had had and she had missed that

opportunity to then go consult with a

cardiologist, for example.

Now you mentioned the differences

between richer countries health systems

and poorer ones.

Some countries won't have regular

mammograms won't be set up for that. In

other countries where there's maybe a

state

um health care system like most

countries in Europe, I wonder if there's

a reluctance to kind of seek out

underlying illnesses that are there

because if they do detect that patient

has potentially a heart disease. Oh no.

Well, they've got to spend more than

diagnosing and treating that. You would

be saying, well, they'll end up if they

don't with a heart attack victim. is

going to cost them a lot of money. Is

that so?

>> It is exactly the business case of

prevention, right? That by intervening

earlier when you have that data, not

only do you improve the odds for that

patient of having a better health

outcome, but you do it in a way that

costs the health system a lot less.

>> Let's look at um the other ones. So,

we've got three as I mentioned your

report. That's one. You already

mentioned one of the other ones which is

pregnancy. So tell us how you could

enhance women's experience there.

>> So when women are pregnant, that's

actually the period of their life that

they typically are most engaged with the

health system, right? Much more

frequently going to the doctor, getting

tests. Um and what we see is that it is

not uncommon for many women to

experience hypertensive disorders like

preeacclampsia or gestational diabetes

during pregnancy. Those women who

experience that during pregnancy, it's

almost like the canary in the coal mine

if if you've heard that expression,

right? They are twice as likely to

develop more serious heart disease later

in life. But what often happens is that

those women while they're being

monitored, their condition is being

treated. But the moment they give birth

and typically, you know, preeclampsia

goes away, right? gestational diabetes

has been managed.

The health system almost forgets that

she has had those conditions and there's

no proactive care management and

monitoring. So then years later, decades

later, heart disease shows up in an

aggressive form that had this been

monitored much more routinely, right? If

when she was going to the doctor year

down the line talking about some

symptoms, that doctor is able to make

the connection to that gestational

diabetes she had years earlier, you

would again have a much healthier

outcome and a reduction in the number of

adverse events related to that

underlying heart disease that went

unchecked for so long.

>> And it's so important to to know if you

are at risk of heart disease because

it's a silent kill. I have a certain

amount of personal experience. I have to

say I won't go into that here, but it

can grab you out of the blue and there

are risk factors, genetic factors,

whatever. But you're saying women with

those conditions that can appear during

pregnancy are, did you say twice as

likely as the average to have that? So,

they really should be looking into it.

>> I mean, heart disease is the number one

killer of women globally, right? And so

here you have a couple of instances

where you're getting that alert, right?

Like that flashing red light. We should

be paying attention a little bit more

closely because we can help that women

live healthier longer. I'll cite these

figures. I mean, you probably know them

off the top of your head, but I'll just

read from the report here. Improving

follow-up and long-term care costs about

$400 to $450 per woman.

far lower than the cost of treating a

major cardiovascular event, which you're

talking about upwards of $100,000.

In the US alone, this could avert

between 6 and $25 million

in avoided costs, roughly a three to

five times return on investment, which

was my initial question.

>> Exactly.

>> How do you come to that figure? Well,

that that's how you do. Let's look at

the third one then which is perinatal

depression. Um just tell us what that is

and what you found there.

>> Yeah. Um as we did this work we work

with a consortium of more than 20 health

systems around the world representing

five continents. Earlier you were

talking about how do we make sure we

solve not just for those high inome

countries but we wanted to make sure we

were representing you know a wide

variety. And I start by saying that

because when we started this work, you

can say we had a bias towards we wanted

to look at postpartum depression. And

one of the big learnings from doing this

work with the consortium members is that

actually we're thinking of it too

narrowly because it doesn't begin

postpartum and we should be thinking

truly about perinatal depression and

begin to look for the signs of

depression earlier in pregnancy.

>> So perinatal would mean the whole period

before, during, after. Exactly. From the

moment basically the woman is pregnant

all the way typically to the year after

delivery is what we're looking at. And

it is really important because today

when you look at the data and the data

that we have is most focused on

postpartum about 20% of women experience

postpartum depression. When you look

broader right that number is naturally

going to grow. And we know from some

real world evidence that indeed in many

instances it'll manifest earlier than

birth. And this becomes really important

because by the way this is a condition

that has a lot of stigma associated with

it. It also has a lot of validated tools

for how we can screen and check if a

woman is experiencing paranatal

depression. And so by giving it a voice,

by making it standard and leveraging

these tools that already exist that have

been clinically validated and think

about how they can be incorporated

earlier, any one of these times that the

woman is engaging with the health system

during her pregnancy,

we again increase the odds of helping

her be healthier and her child because

we see the correlation between the

mental health of the mother and the

health of that baby. So, it's a question

of kind of integrating

the mental health awareness and

treatment and diagnosis into the wider

health care for a pregnant woman.

>> Exactly. And distigmatizing it, right?

So that we're indeed making sure that

we're identifying earlier, intervening

earlier to get into those better health

and economic outcomes.

>> It all makes perfect sense. So do do you

now go to health systems and they all

welcome you with open arms and say

thanks for finding ways to save us

multi-millions of dollars on or or is it

trickier than that to turn these kind of

policy suggestions into reality? Well,

the reality is that health systems are

very complex as I think we all know and

experience it every day. And that is one

of the things that we wanted to do with

this work is really understand where are

those discontinuities in care because if

it if this were easy to do, it would

have happened already, right? There's a

lot of good intent towards improving

health outcomes overall. In this case,

we have the evidence, so we know what it

takes. But what has been really

challenging is to connect the dots,

right? It is to think about what is for

example the diagnostic tool that I'm

putting in place. I'm thinking the

screening that I may do for example for

paranatal depression. Then what do I

need to activate? Think in the case of

the mamogram. So that when the breast

arterial calcification score is high,

how do I help make that transfer happen

of the data, the information of

connecting the patient to the right

cardiovascular specialist? Those things

are not easy to do typically in health

systems. They're part of different

departments, different budgets. And so

what we've tried to do working with the

consortium members is actually integrate

in one place what is the suite of

changes that need to happen. And by the

way, recognize that health systems

really vary in terms of the resources

they have. Some are very tech enabled,

right? So you can think about what's a

clinical decision support tool that you

want to code to facilitate those

transfers. Others are much more manual,

right? In terms of how things happen. So

in the work that we did, we really try

to solve for different levels of

maturity, resources, sophistication that

health systems have so that we can bring

not only a perspective on look at all

the value at stake but look at the

changes that need to happen in terms of

the capabilities you have, the processes

that you need to change and the

technology that you want to put in place

to facilitate that more seamless

journey.

>> People get excited about technology,

don't they? and particularly artificial

intelligence at the moment. I wonder if

some of that enthusiasm and hype maybe

overshadows

some kind of simpler, more human things

to say, well, okay, I you came here for

cancer, but let's also remember we've

got some great information now that

might relate to heart disease. That's,

you know, it doesn't take

a huge leap in technology to arrive at a

system that just works better with what

you already have. Do you think sometimes

kind of sensible policy gets kind of

drowned out by some of the excitement

over AI which oh we can use AI to look

at that mamogram and find this that and

the other. Yes. But if you're not using

it to to deliver this outcome for

patients it's what's the difference? I

mean clearly there's a lot of enthusiasm

about AI right I don't think you can

have any conversation in health these

days without touching on it but

essential to AI is the quality of the

data right that you're feeding the

models when it comes to women's health

for too long we've actually almost

forgotten to ask the question of sex as

a biological variable and that is

foundational because even during co

there were data sets that were not coded

for sex if you don't do that coding You

don't know if there's a sexbased

difference. And so when you go and ask

about what are those basics that need to

happen, that is number one. Are we

collecting? Are we counting right the

women who are for example participating

in the trial that are in the health

system and then doing the the studying

right asking the question of are there

sex-based differences? Because back to

what we were talking about earlier with

the atypical presentation, that

rationale that is, you know, very

misinformed when talking about the

different outcomes in cardiovascular

disease. If we're not tracking that data

from a sexbased perspective, we cannot

have the doctor who's using clinical

decision support software is looking at

how that woman manifests in when she

shows up to the emergency room and he

may think she has indigestion because

the symptoms are not matching the male

physiology, right? And so I get very

excited about especially in places like

these where we have the evidence, how is

that evidence translating into better

clinical decision support tools that for

example one of those first variables

should be oh I'm talking to a female

patient.

What should I be looking for? It may be

different than what I would be looking

for if I'm looking at a male.

>> So Lucy, tell me

kind of h how your journey

towards this happened. Did you have an

aha moment when it was like, "Oh my

goodness,

this has just not been taken into

account by clinicians, by by

researchers, the fact that women are

different from men [laughter]

in a lot of these things. You know, was

was there a moment? Is there an incident

that happened? Did you read a paper? Did

you have a personal experience? You

thought, hold on a minute, you know,

that woman found out she didn't have

indigestion. she had a disease or

whatever it was.

>> Part of it at first is a collection of

small moments that happen, but then

indeed I I I will speak to to two things

um that happen. one is um I've always

been very passionate about health equity

and one of the things that always struck

me when we were looking at health equity

is that we didn't really talk about sex

and gender as a variable in health

equity and so that made me very curious

to start looking at the data and so many

years ago

>> so what what were what were you talking

about then when it came to equity

>> there's much more focus on racial

disparities or geographic disparities

which are extremely important, right? Um

but back then what struck me was why are

we not also talking about sex and

gender, right? And so that took me down

a path with some colleagues in having

conversations about this. I'm a

scientist by training. You know, I have

a PhD in organic chemistry, so asking

questions is something that comes very

very naturally. to take a look at some

of the data around conditions that are

unique to women and unique to men and

understand do we see any differences in

how they're diagnosed or does the sex of

the doctor doing the diagnosis change it

answer

and this paper right what what we showed

was that actually conditions that are

unique to women are diagnosed much less

frequently than those that are unique to

men. And then when you doubleclick on

what was the sex of the provider doing

that diagnosis, you see that

men tend to diagnose male specific

conditions in the same rate that women

diagnose male specific conditions. But

when you're looking at women's specific

conditions, males doctors diagnose them

a lot less. And so that was probably one

of for me like seeing that data it

really struck me. Then the next thing

was having a friend who suffered from

endometriosis

really wanting to learn more about this

condition because until I got to in a

way live it side by side with her.

Frankly I didn't know much about it and

now I'm embarrassed that I didn't know

more about it earlier because

endometriosis impacts one in 10 women.

It's actually the same numbers as

diabetes. One in 10 women suffer from

diabetes. But yet you look at diabetes

and we have so many options to treat,

right? We don't, you know, there's still

plenty of room for more innovation, but

you know, there's multiple products in

the marketplace, more than 500 drugs in

clinical development, and yet you look

at endometriosis

and you say, okay, same numbers, one in

10 women, and yet no approved drugs and

only about 20 clinical drugs in

development. It's a very stark

difference.

And so that was the beginning of wanting

to know more. And I think then the big

insight for me was

it is about so much more than the

conditions that are unique to women. And

that is when you realize for example

heart disease was probably the most

shocking to me that we just don't talk

enough about those sex-based differences

in heart disease. And again that's the

number one killer of women. And when you

start going through the data, you just

find over and over again that sex-based

differences are much more prevalent than

not. But yet, for so long, we've

operated in a world that assumes there

are no sex-based differences. So, if we

want better health outcomes for

everyone, cuz by the way, sometimes it

it is to men's, you know, disadvantage

on the sex-based differences. So, if we

want better health for everyone, we

really need to put that study of

sex-based differences front and center.

endometriosis. We did an episode of

Radio Davos on that. It's going back two

or three years now. If if you're

listening to this and you have never

heard of endometriosis.

A lot of people haven't, but as you say,

it's very very common and it's

chronically underdiagnosed.

Most women almost never get it diagnosed

first, second, third time they visit the

doctor. I'd invite people to go back and

listen to to that episode. I wonder when

you have conversations about this issue

now, does does it ever kind of butt up

against gender politics and kind of uh

identity politics? Do you find that that

there's kind of a a pendulum that shifts

away that it's actually it's a bit

sensitive now to talk about women's

health or are we and I hope you're going

to say no that's not the case. People

are grown up and sensible and we talk

about this normally. Is there a

political aspect to this?

>> What I would say is for too long, I

mean, you were talking about doctors,

right, and the biases they may bring to

the table. It is not surprising because

medical schools were not teaching

sex-based differences, right? We just

again were not asking the question. What

you're finding now increasingly is a

recognition that women are not just

small men, right? for too long when we

thought about it is we have to adjust

the dose because women on average are

physically smaller than men and that

takes care of it. I think fortunately

what we're seeing now is that people are

understanding we're talking science,

we're talking human biology. Women are

different from men not only in terms of

their reproductive organs, but it's it's

genetics, right? It's hormones. It's

it's so many more variables. And it's

actually really fascinating scientific

questions that are getting asked now.

Why is it that women are more likely to

suffer dementias, right? And when you

think about what's going to be a massive

cost burden to society, dementia is very

high on that list. It is hard to imagine

that we're going to solve and think

about the cure for dementia without

taking into account the understanding of

sex-based differences. So while it is

true that there's a lot of debates, you

know, I I think the majority of folks

recognize that we're talking about we

need to do good science, with good

science, we fuel good clinical care that

takes us to better health outcomes and

stronger economies.

>> People can find that report uh links to

it in the show notes to this episode.

Where can they find out more about the

work you and uh the Mckenzie Health

Institute do? um they should check us

out online Mckenzie Health Institute

which you can find at mckiny.com

and we hope that folks will also look

for ways to take action right because I

think what's really important in this

space is I mean the first step towards

action is educating yourself right

building awareness about closing the

women's health gap but then all of us

have a role to play whether it's the

next conversation you're having with

your doctor where you're asking about

those sexbased differences or the ways

where you think you want to contribute

economically or in other ways to

advancing the science and the innovation

that will help us close the women's

health gap. I would just encourage all

our listeners to [music] to take action.

>> Lucy Perez, thanks very much for joining

us on Radio Devils.

>> Thanks so much, Robin.