Based on recent Forum and MHI analyses and expertise from the Global Alliance for Women’s 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, analyse 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, ischaemic 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 conditions.137 By 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 women’s mortality are often more complex than disease pathology alone, encompassing social determinants such as race, income 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 women 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 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 true 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 ischaemic 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 disparities 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, overall, 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-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 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, addressing 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 delays 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 women’s health gap will require provider education on the impact of social needs on clinical 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 shame 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 for non- participation.155 2.4 Include all women All women should be included in efforts to improve care. Blueprint to Close the Women’s Health Gap: How to Improve Lives and Economies for All 26

Blueprint to Close the Women%E2%80%99s Health Gap 2025