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Opinion

Closing the gender health gap with a patient-first approach

By Valerie Palmieri, scientific advisor at 2San

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Valerie Palmieri, scientific advisor at 2San

It can be argued women are the backbone of families, communities, and society as a whole. We provide care and support, nurture our families, and still play a primary role in the care of children, our spouses and our ageing parents.

However, when we dig under the surface of healthcare in the UK, there is an undeniable and unacceptable imbalance in health equity specific to female based care.

The UK is thought to have the largest female health gap among G20 countries, and the 12th largest globally, with eight out of ten women in the UK feel they’re not listened to by healthcare professionals.

The reality of the gender health gap

Healthcare systems have historically been designed with men as the default patient, both in clinical practice and medical research.

For decades we have known that, biologically, women have different medical needs to men as we are subject to different hormonal pathways which play a significant role in how our bodies operate, the symptoms we show, and how we react to different medication and treatment options. Yet still the odds are stacked against us.

The classic example often given is heart attack symptoms; women are much more likely to get fewer commonly known symptoms and sometimes even the absence of obvious chest discomfort.

With women being underrepresented, including being excluded from many clinical trials in the past, diagnosis, prognosis and treatment outcomes are not clearly understood. The question raised here is – will this really change any time soon?

The longer term impact

Females make up 51 per cent of the UK population so, why are we not doing more and empowering women to take more control over their health on a global scale?

At 2San, we have recently undertaken consumer research in order to gain further insight into how people are managing their own healthcare journeys – and crucially what are the barriers to people accessing support.

Sadly, we found one in three women have avoided going to a GP because wait times are too long or it’s too challenging to get an appointment. This could have serious ramifications on women’s long-term health.

Whether through personal experience or stories from friends and family, there is a genuine belief within the female community that symptoms aren’t taken as seriously as their male counterparts. For example, it can take a woman up to eight years, and over ten GP appointments, to receive a diagnosis of endometriosis and see a specialist.

This is backed up by our recent research which found 25 per cent of women have avoided going to see their GP because they don’t want to be seen as wasting their time with a perceived small issue.

On multiple fronts, women are against all odds from lower representation in clinical trials, lack of research and development specific to women’s health, access to care, and lastly having a real belief that if they do finally get access, they won’t be taken seriously.

When we know the benefits of health equity across the genders for society as a whole, it makes you question why we are not being more proactive or adapting the healthcare processes to ensure everyone who has a health concern feels they can get the help,  access and early support they need.

Is there a solution?

The short answer is there is not one solution – we need a large-scale review of healthcare in the UK and globally, better research and education into the differences between biological males and females alongside different races and ethnicities, and more accurate information which needs to then flow into wider society disease management.

In the short term, we need to educate on alternative first steps on the healthcare journey – moving away from the current model to one which puts the power of healthcare back into the community and back into the patient’s hands. Let the individual be empowered and own their health and wellbeing.

Urinary tract infections (UTIs), for example, impact around 50 per cent of women. The average wait time for a non-urgent, face-to-face appointment is around ten days, but UTI symptoms usually only last around a week.

When not treated, UTIs can cause long term complications, such as repetitive occurrences and serious kidney infections. With new legislation from the UK government coupled with the ability to take a urinary tract infection test at home, pharmacists can prescribe a course of antibiotics or medication and people can receive necessary medical support without the need to see a GP.

Working with 2San has opened my eyes to the possibilities. As we continue to research and develop the possibilities of at-home tests, the healthcare system will evolve. Patients will become more educated and empowered so when they talk to a medical professional, they feel armed with all the necessary information.

Access to support and specialists can be triaged at a community level, saving hours of precious healthcare professionals’ time and re-allocating it to those who need it the most.

What’s more, we hope people will be able to detect serious conditions earlier – especially in instances where early-stage detection can really make a difference in overall outcomes and survival in the case of cancer.

The more steps we take in the right direction to close the gender health gap and secure health equity across the board, the better healthcare all people will receive.

There is still a lot of work to be done and the onus is on all of us to drive and push for change, for better care, better lives and a stronger healthcare system which supports us all. Health for all, now that’s a novel idea!

Valerie Palmieri is a clinical executive leader and scientific advisor at the healthcare company 2San.

Opinion

How the UK’s ‘pharmacy first’ policy will change women’s healthcare

By Katherine Bridges, head of brand and clinical lead at the pharmacy app Charac

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On the January 31, the UK government will roll out its long-awaited “pharmacy first” policy, a measure designed to cut the size of the NHS backlog – which currently stands at around 7.6 million patients.

With “pharmacy first”, patients suffering from various lesser ailments – such as sore throats and shingles – will be directed to their local pharmacy as their first port of call.

Pharmacies will also be able to supply certain prescription medicines. It is hoped that this will ease pressure on Britain’s seriously overstretched hospitals and GPs.

The policy is set to transform healthcare provision in the UK, which is important for women’s health across the country. If the policy can be carried through successfully, women’s access to NHS will improve in a number of ways. The success of “pharmacy first” will, however, rely on a big technological upgrade to Britain’s 11,500 high-street pharmacies.

Improving women’s access

This shift of several key medical functions to Britain’s pharmacies will give women easier access to important medicines and treatments. For instance, under “pharmacy first” patients will be able to pick up prescription medicine for urinary tract infections (UTIs) from pharmacies; previously this required a GP appointment beforehand.

This change will be especially valuable for women, given that this ailment disproportionately affects women, with roughly 50 per cent experiencing one over the course of their lives.

Crucially, under the new policy, women will also be able to purchase contraceptive pills at their pharmacies without seeing a GP. It is vitally important, but easily prescribed and administered medications such as this that will see “pharmacy first” freeing up countless of hours of GP and hospital time.

Further, the reduction of pressure on GPs and hospitals will improve women’s access to critical medical procedures and treatments. For instance, the policy will put a dent in the NHS’s mastectomies backlog, which is currently putting thousands of women in the UK at a greater risk of breast cancer.

Femtech critical to making a success of “pharmacy first”

Of course, “pharmacy first” represents a very large administrative and operational task for Britain’s high-street pharmacies.

It is uncertain whether these pharmacies, in their current state, will be able to meet the challenge. Community pharmacies are often small and family run. As such, they find it difficult to afford key labour-saving technologies that cut costs and free up time.

These pharmacies’ internal systems are often ramshackle and antiquated. Many still run on paper, making everything from prescriptions to payroll arduous and time-consuming.

It is clear that these pharmacies will need to undergo a big technological upgrade as the policy is rolled out this year. Femtech will play a key role in this effort.

Femtech technologies could help pharmacists manage the transition to a greater scope of provision. For instance, femtech companies, such as Vivoo’s at-home women’s UTI test, could help pharmacists manage the task of treating this common women’s ailment.

Another would be the online self-assessment system Tuune, which matches women to the contraceptive treatment appropriate to their particular hormonal profile.

Innovations like these will be an essential part of women’s healthcare in the age of “pharmacy first”, driving efficiencies in high-street pharmacies and expanding women’s access to treatment.

The future of health tech will empower women

Other health technologies will help amplify the impact of femtech. Apps, such as Charac, offer a dashboard for both pharmacists and their customers, allowing customers to book pharmacy appointments and get their prescriptions delivered to their door.

These kinds of accessible, integrated health tech systems that will prove so valuable in the age of “pharmacy first” will also help improve patient outcomes for women. One of the primary hindrances to better healthcare for women is a lack of information and access.

Research by the Department of Health and Social Care revealed that around 85 per cent of British women did not feel comfortable talking to their GPs about their physical health, and a similar percentage can remember an occasion where they did not feel listened to by medical professionals.

Similarly, knowledge of women’s health issues is often low: less than one in five UK women felt that they had enough information on menstrual health, and less than one in 10 felt they knew enough about gynaecological conditions.

What’s clear is that a lack of information and access is leading to worse health outcomes for women than men, but health tech can make a valuable contribution – streamlining appointments and prescriptions, raising public awareness of health conditions and the treatment services that women can access and making patient outcomes and healthcare more equal.

As “pharmacy first” becomes policy, we have a chance to use the latest developments in femtech and health tech to both make a dent in the NHS backlog, and to put women’s healthcare on a surer foundation.

Katherine Bridges is head of brand and clinical lead at the pharmacy app Charac.

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Opinion

Transforming women’s health: a bold roadmap to a more equitable future

By Kavelle Christie, director of the gender equity and health justice program at Community Catalyst

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Equity lies at the heart of progress, demanding a healthcare system that not only provides affordability and accessibility but also centres the distinctive needs of women.

The deliberate inequities affecting Black, Indigenous, and Latinx women, transgender women, those in rural communities, women with disabilities and those with low incomes underscore the urgent need for transformative change.

From alarming maternal mortality rates among Black and Indigenous women to abortion bans, limited healthcare access in rural areas, discriminatory practices against women with disabilities and stigmatisation faced by Black, immigrant, and transgender women, these inequities demand a comprehensive reimagining of our healthcare system.

A robust, truly transformative healthcare system is the cornerstone of a thriving society and it is time for the nation to prioritise women’s health.

Expanding Medicaid in the ten remaining states and extending postpartum coverage to 12 months in every state are crucial steps in dismantling barriers that impede women’s health.

Additionally, improving Black maternal health outcomes and the preservation and enhancement of reproductive rights, which encompasses unfettered access to abortion care, comprehensive family planning services and contraceptives, form other vital pillars.

Improving Black maternal health outcomes

Maternal health remains a significant concern, particularly among Black women. Passing the federal Black Maternal Health Momnibus, introduced by Rep. Underwood and Sen. Booker, can help address inequities and promote access to quality maternal care.

In addition to passing the Momnibus, it’s time for the US to invest in an ethical supply chain to ensure the improvement of necessary pre- and postpartum drug delivery. By guaranteeing the consistent availability of essential medications, we can enhance the overall quality of care.

Power and control over women’s bodies

Every woman should have the autonomy to make informed decisions about her body and reproductive health.

Policies that fail to centre marginalised communities perpetuate existing power imbalances and exacerbate health disparities. Not only is it time to pass the federal Women’s Health Protection Act to re-establish a national right to abortion to create a just healthcare system for women, but it is likewise vital to implement policies that monitor and account for the funding and actions of crisis pregnancy centres  and anti-abortion maternity homes.

These often-unregulated places disseminate misleading information about abortion care, manipulate women and can come with deeply conservative ideologies, such as mandatory church service attendance in exchange for shelter and additional restrictions on reproductive choice.

Building a better healthcare system means we closely monitor and regulate crisis pregnancy centres and maternity homes, ensuring they provide comprehensive, unbiased, and evidence-based information and care to women without imposing ideological beliefs.

It is also essential to note that anti-abortionists are swiftly rolling out policies that would even prevent women from travelling on highways to access abortion services.

These predatory webs of restrictions to deprive us of our freedom are not merely about abortion rights; this is about who has power over you, who has the authority to make decisions for you and who is going to control how your future is going to be.

Therefore, to build a better healthcare system for women, we must fiercely defend abortion rights and dismantle any barriers that may obstruct women’s ability to make choices about their bodies and reproductive health.

We must give women back the power to control their own bodies, especially for those most impacted who have the least resources, who can’t afford to lose a job, who don’t have access to childcare, who have no access to healthcare and who face many more systemic barriers.

Transparency in healthcare decision-making processes is also vital. This extends to hospital ethics committees, which often make critical decisions about abortion access, but whose membership is often shrouded in secrecy.

For a more just healthcare system, we must eradicate this wall of secrecy and ensure transparency in these committees’ composition and decision-making process.

Women deserve to know that their healthcare decisions are made with impartiality and respect for their rights.

Protecting gender-affirming care

Gender-affirming care for transwomen is a critical component of comprehensive healthcare.

This specialised care involves a range of medical, psychological, and social interventions to align an individual’s physical characteristics with their gender identity. Key elements may include hormone therapy, gender confirmation surgery, mental health support, and ongoing medical monitoring.

Gender-affirming care is not only a matter of medical necessity for transwomen but is also closely tied to mental health, overall wellbeing, and a sense of self.

Creating a healthcare environment that offers inclusive, affordable, and accessible services for transwomen is essential to a holistic approach that acknowledges and validates their gender identity, ultimately contributing to better health outcomes and improved quality of life.

Kavelle Christie is the director of the gender equity and health justice program at Community Catalyst, a national health advocacy organisation that works alongside organisational partners across 45 states and territories to build people power and create a health system rooted in race equity and health justice.

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Opinion

The impact of menopause and ageing on urinary incontinence in women

By Lydia Zeller, CEO at Pelvital USA

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Lydia Zeller, CEO at Pelvital USA

The natural processes of menopause and ageing are not the biggest challenge women face when it comes to incontinence. The biggest challenges are the historic silence and assumption that our only options are pads or surgery.

One of the most rewarding aspects of my role as CEO of Pelvital is amplifying the conversation around women’s health, especially on historically stigmatised topics like urinary incontinence (UI) and menopause.

If you suffer from bladder leaks, you’re not alone. Research from 2022 shows more than 60 per cent of US women suffer some form of bladder leaks. It is unacceptable that an issue impacting over half of women has historically been kept quiet and stigmatised.

Women are led to believe that bladder leaks are a natural part of being a mum or growing older. That is not true. Although bladder leaks are common, they are not normal, and women should not accept them as such.

Fortunately, there are effective options for treating leaks and education is the first step in self-advocacy – one of the reasons why I love talking about this topic.

First, let’s talk about the different types of UI. Stress urinary incontinence presents as accidental leakage associated with activities like sneezing, laughing, coughing, or jumping.

Urge incontinence (including overactive bladder) involves the sudden urge to urinate followed by involuntary loss of urine. Mixed incontinence is the combination of stress and urge incontinence. Stress urinary incontinence (SUI) is the most common form and is often caused by weakened pelvic floor muscles.

While one in three mothers report SUI within three months of childbirth, UI prevalence indisputably increases with age: 62 per cent of women in their 40s have UI compared to 68 per cent of women in their 50’s, 72 per cent in their 60s and 83 per cent in their 70s.

But does menopause cause incontinence? Yes and no.

Menopause is defined as the natural event of a woman’s final menstrual cycle. It is associated with reduced functioning of the ovaries due to ageing, resulting in lower levels of oestrogen, progesterone, and testosterone.

While these steep hormonal drops don’t directly cause incontinence, they cause thinning of the tissues in the pelvic floor muscles during perimenopause (the time around menopause when your ovaries gradually stop working).

Combine this thinning with common unresolved pelvic floor weakness or injury (e.g. caused by pregnancy, childbirth, pelvic surgery, falls) and/or with common changes associated with ageing (e.g. lowered fluid intake, lowered activity, constipation) – and urinary incontinence can result.

Stress urinary incontinence is most often caused by weak pelvic floor muscles – and menopause-related changes exacerbate that weakness.

Pelvital on-staff pelvic health doctors of physical therapy Shravya Kovela and Leah Fulker describe how this works in a blog on the menopause / incontinence connection: Weak pelvic floor muscles are unable to contract properly to close the urethral sphincter where urine escapes the body.

When paired with hormonal changes of menopause and the resulting changes in tissue flexibility or elasticity of the vulva, vagina, and urethral sphincter, urinary incontinence will appear or worsen.

Furthermore, discomfort in the vulva and vagina associated with menopause-related vaginal dryness or pain may lead pelvic floor muscles to compensate, worsening urinary incontinence.

Interestingly, menopause and ageing do not equally impact incontinence. Menopause transition has been found to correlate with stress urinary incontinence, whereas increasing age and risk factors such as anxiety, BMI, and new onset diabetes correlate with both stress and urge incontinence. And new onset of SUI is highest in perimenopause as opposed to postmenopause.

But the natural processes of menopause and ageing are not the biggest challenge women face when it comes to incontinence. The biggest challenges are the historic silence and assumption that our only options are pads or surgery.

Tragically, according to the Study of Women’s Health Across the Nation (SWAN) – a historic study to define menopause transition and “characterise its biological and psychosocial antecedents and sequelae in an ethnically and racially diverse sample of midlife women” – fewer than 40 per cent of incontinent women even seek treatment from their healthcare provider.

Women are uncomfortable bringing this topic up with their providers and when they do, too often are dismissed without options.

Menopause gaslighting is occurring to women because historically there has been a significant lack of clinically proven conservative options for women who do not wish to have surgery.

Pelvic floor physical therapy has been the shining light here, but a mere one per cent of physical therapists specialise in the pelvic floor, resulting in significant access gaps.

The continued uptick in virtual pelvic health physical therapy options is a big positive, increasing access and enabling women to fit treatment into their lives. Similarly, evidence-based in-home treatment options allow women flexibility and clinicians the ability to extend their clinic walls and deliver conservative care at scale, with outcomes very similar to surgery.

This conversation is incomplete without mention of economics and gender equity. Not only has research into women’s health been historically massively underfunded, but women bear disproportionate out-of-pocket costs.

Specific to UI, 70 per cent of costs are borne by the woman. And that is also completely unacceptable. I am proud to be part of the growing cohort of femtech companies creating change and step by step moving towards broad access and insurance coverage. Women deserve no less.

Lydia Zeller is CEO at Pelvital USA, Inc., a Minnesota based femtech company providing products to restore pelvic floor health. Flyte by Pevital is an FDA-cleared novel in-home treatment for female urinary incontinence.

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