Sometimes we get the opportunity to work on things that feel especially important, and last week saw the culmination of one of those things. On July 17, 2020, The Commonwealth Fund, in collaboration with Manatt Health, released a two-part report entitled Transforming Primary Health Care for Women. I was so fortunate to get to work on this project with my client, friend and Aspen Health Innovation fellow classmate Dr. Laurie Zephyrin, as well as several of my great colleagues at Manatt (notably Pavitra Viswanathan, Jared Augenstein and Deborah Bachrach. It was a remarkably informative experience in so many different ways.
The project also included a webinar reviewing the findings of the report and a panel discussing the issues, which I got the opportunity to moderate. There is nothing more fun than moderating a panel of powerhouse people who consistently blow your mind with their thoughtfulness, empathy and intellect, so it was a terrific experience engaging on the topic not only with Laurie, but also with Dr. Joia Crear-Perry of the National Birth Equity Collaborative, Dr. Deneen Vojta of United Health Group and Dr. Toyin Ajayi of Cityblock Health. Normally I am not a fan of one-gender panels, but in this case the topic warranted the decision.
There are many lessons in the report and the webinar, and great advice for the industry, but one thing struck me as particularly poignant. In answer to my question, “What is the one most important thing that can be done to improve primary care for women?” the resounding and unanimous answer was this: expand women’s leadership in the healthcare field.
We live in a time when there is a tremendous focus on the essential role of ethnic diversity and the moral imperative of true equality when it comes to race, and appropriately so. It was notable in our research on the paper, and in plain sight as well, how poorly the healthcare system has served black people, Latinx people, and, frankly, most people of color. A couple of years ago, during the sexual harassment revelations that burst onto the scene from all sides, it was gender discrimination that was the talk of the day. But it seems we can only concentrate on one injustice at a time, very unfortunately. Much of the talk about gender has gone quiet, at least for now.
When it comes to primary care, this is a serious problem. As the report demonstrates, there are egregious and medically harmful gaps in the structure and delivery of primary healthcare for women. And this is an even more serious problem during this pandemic for many reasons, including: 1) the pandemic is hurting primary care generally; 2) the pandemic is having an even more damaging impact on women than men when it comes to employment, and thus access to insurance and healthcare; 3) the pandemic is causing a precipitous rise in domestic violence against women; and 4) 80% of frontline healthcare workers are women, and they are disproportionately impacted by risk of exposure to coronavirus.
Since one can imagine many ways to answer the question about how to improve the female experience in primary care, it is notable that increasing female leadership was the one that came up over and over again in our work (and the recent webinar) as the most important catalyst for positive change. And here’s why: it takes one to know one.
In a field where only 4% of all healthcare company CEOs are women and only 19% of hospital CEOs are women (a subset of the other number), policy is made by men. Physician education is also designed by men, who make up 2/3 of active physicians and 84% of the deans and department chairs at the154 member medical schools in the United States. Women in medical school positions make less money than men in equal roles and are promoted less readily. And thus, physicians are trained through a male gender lens and companies design products the same old, tired way. A stark reality: more than 25 million women experience menopause each year, yet 80% of medical residents don’t feel comfortable treating it or even discussing it, despite its impact on heart disease, osteoporosis and many other medical conditions. Um, hello? That’s lame.
Hey guys, time for some desensitization therapy. Repeat after me: vagina, period, menopause. There, was that so bad? If yes, you do not belong in healthcare. Really, I mean it.
If anyone is going to take women’s health seriously, it’s going to be women; and they are going to recognize that women’s health is far more comprehensive than what goes on underneath the outlines of a bikini. So, if we want to make real improvements in women’s health, there is a clear prescription: hire and elevate more women who will reflect their own experience in their work.
I have recently seen a rise in interest in women’s health startups in the venture capital world, and that is great. They seem to have suddenly recognized that half of the human population actually comprises a large Total Addressable Market. Some may even have gotten real religion about the cause. However, I have also seen some real lip service on this topic since some women’s health companies inexplicably forget to hire women into leadership roles. And venture capitalists, themselves mostly men, sometimes forget to notice. There, I am being polite. You’re welcome.
I would like to see our healthcare system get serious about this issue. We cannot address the problem of race inequity without addressing gender inequity, and vice versa. They are tightly linked problems in healthcare and the failure to address these challenges results in bad outcomes and higher costs. I always marvel at the fact that men can miss these issues when they are, frequently, married to women and are the fathers of daughters. Despite this, the failure to recognize the importance of women in leadership continues generation after generation.
Thankfully, as Aretha Franklin and Annie Lenox note, sisters are doing it for themselves, and actively working to make a difference in women’s health by starting new companies, driving policy change, and forcing the issue into public view. At a time when many in business seem to have a renewed openness to change for the better, let’s take the opportunity to address inequities of all kinds to the betterment of all of us. Leadership should represent all of the people who are led, not just a small subset of them. And, if a change in leadership is the single most important factor in changing the prognosis for women’s health, we had better get to it.
Never before have healthcare and social resources been so scarce and so essential to our long-term survival. It is worth noting that the countries that have had the least coronavirus damage have been those with women heads of state. Coincidence? I think not. Women are used to making healthcare decisions for their families and laying down the law about how to behave at home for the collective good, so it’s a skill set that comes naturally. Let that alone be the proof that the time has come to diversify leadership in all of its forms.
Notes:
You can download the CMWF Report on Primary Health Care for Women at the links below:
The webinar from the program will be available HERE shortly and I will update this link when the recording is available.
Thank you so much for your thoughtful insight.