Healthcare Gaps

Say what you will about Management and Strategy Consulting at scale, they are undoubtedly impactful. A few weeks ago, the McKinsey Health Institute published an Insights report:

Closing the women’s health gap: Canada’s $37 billion opportunity

Not only does it hit the nail on the head on a too-seldom discussed issue, but framing it as a lucrative activity might just convince people who can act on these matters to do so.

Full disclosure, I have a lot of respect for some of the document’s authors I’ve gotten to be a bit familiar with their work. McKinsey’s Ontario and Quebec presence has some of the nicest and most genuine people I’ve occasionally brushed shoulders with in a corpo. environment. That being said, there is perfectly legitimate criticisms to the firm from Enron, to delay, deny, defend, going through the opiate crisis, and consequences of value-based management and pushing Total Shareholder Return. Not surprising when dealing with decision makers for recommendations to reward decision makers.

Setting that aside, there are good, well-meaning people in positions of influence to bring prosperous proposals to fruit. I think this is one of them.

Without discussing the many problems of healthcare, particularly regarding access, there’s a fundamental imperfection to modern medicine. It’s a young science (at least in its modern iteration, scientific approach and whatnot), and for much of its development, the ideal patient has been a white male. This had to do with a combination of social, institutional, and scientific biases.

For much of modern medical history (especially in the 19th–20th centuries), Western medicine was dominated by white male researchers and physicians. They often assumed that white men represented the “default” or “standard” human body.

Women were viewed (and projected as) too different to be included in research (less they skew results). As well, their health was considered secondary to that of men. This brings us to minorities as well, for whom healthcare gaps also exist.

Misguided Assumptions About Biological Uniformity

Researchers often assumed that biological findings in men would generalise to women and all ethnic backgrounds, despite clear differences in genetics, hormones, metabolism, and disease risk.

The male body was considered “simpler” because it lacked menstrual cycles, pregnancy, and hormonal fluctuations—factors that researchers saw as confounding variables rather than important physiological features.

Practical and Regulatory Factors

After the thalidomide tragedy, regulatory agencies discouraged or prohibited including women of childbearing age in druge trials. This to “protect” potential pregnancies, but also excluded most women from trials as medicine and pharmacology was taking giant strides.

There was also a good amount of early pharmacological and medical studies funded by or with the military or universities with predominant white male populations.

Systemic Racism and Access to Research

Racial and ethnic minorities often had less access to healthcare, fewer opportunities to participate in clinical trials, and less trust in medical institutions due to historical abuses (e.g., the Tuskegee syphilis study). This trust issue persists to this day in many communities and is seen as vaccine skepticism and consequential increased prevalence of preventable diseases.

Of course, this broken trust and abuse by the medical system also meant that it was easier to recruit white male participants and contributed to language and views of them as a more “reliable” study population.

Consquences

Drugs, treatments, dosages and side effects, clinical presentation of disease (symptoms), and more were based on white male physiology, leading to:

under or overdosing in women and people of color with different metabolic contexts
Missed side effects or different efficacy across populations.
Health disparities that persist today (we’ve hinted at a few regarding distrust in medicine)

Since the 90s, especially followin the U.S. NIH Revitalisation Act in 1993, there’s been a push for diversity in clinical trials. Modenr medical ethics and research standards now emphasise inclusivity and represantativeness to ensure treatments are safe and effective for all populations.

It’s only in 2020 that Malone Mukende, a second-year medical student at St George’s University of London, created Mind the Gap, a handbook for diagnosing clinical signs in black or brown skin. He noted hearing stories in his own community and the Black community at large about people being misdiagnosed or not being taken seriously by health-care professsionals or even some mistreatment, really, along with distrust for the medical system. As a medical student, Mukende realised that maybe that distrust and misddiagnosis started from people not being taught the differences, which allowed for biases to manifest with fatal consequences on people.

Squamous cell carcinoma (SCC) is particularly, disproportionately-so, deadly in darker skinned people. Evidence suggests this is because lighter skin tones make it easier to see lesions, but also because clinical presentation on darker skin being harder to recognise (for lack of training) means that when it is recognised, the condition tends to be more advanced and dangerous. A 2018 textbook review found that none of the surveyed texts had images of six common skin cancers in skin of colour. Efforts to resolve these biases are recent and ongoing. It’s just unfortunate when very important and legitimate research has the word “diversity” somewhere and sweeping “anti-woke” measures cut its funding for political gain.

I spent a lot of time given ethinc-background-related examples (the stories I happened to recall), but let’s get back to our premise: The healthcare gap for women is significant, and compounds with other difficulties. Let’s discuss a few well-known conditions that are also well-known for being different for women.

Cardiovascular Disease (CVD)

You’ll know this is not a gender-specific group of ailments (breast cancer is quite rare for men), and for decades, heart disease research and clinical trials were male-dominated. To this day, women present higher mortality rates post–myocardial infarction (heart attack). This may well be because heart attack symptoms can present differently for women (e.g., fatigue, nausea, jaw pain, back pain) and are not as recognisable and more easily dismissed by practitioners untrained in flagging symptoms for what they could represent since the chest-pain symptom profile was based on men.

Autoimmune Diseases (e.g., Lupus, Rheumatoid Arthritis)

This is also non-gender specific, research also emphasised male immune responses, despite the fact that women tend to be more frequently affected by these conditions. Differences in hormone–immune system interactions were long ignored, delaying recognition of why women experience more severe symptoms. Moreover, the hormonal context dismissed for making studies of women more complex has immune system interactions that were long ignored, delaying recognition of why women experience more severe symptoms.

Depression and Anxiety Disorders

Can affect anyone, but psychiatric studies historically used male subjects, and male-typical presentations (e.g., anger, withdrawal) informed diagnostic standards. As a result, women’s symptoms are more likely to be labeled as “emotional” rather than clinical, leading to misdiagnosis. Conversely, men may be underdiagnosed because their presentation may differ from “expected” patterns.

Chronic Pain Conditions (e.g., Migraine, Fibromyalgia, Back Pain)

Pain has particular historical biases, (Do not get me started on “hysteria”, at least that’s mostly out of modern medicine), but pain being such a ubiquitous symptom for so many ailments means that medical consideration of women’s pain bleeds into all other chronic pain conditions and gender-specific conditions as well. Chronic pain conditions are particularly susceptible to dismissal, often labeled as psychosomatic or “just stress”. Endometriosis often takes years to diagnose with women being told their severe pain is “bad period” but “normal”. Combine this with women often socialised to be “good patients”, don’t complain too much, don’t be too demanding, etc. which hinders effective communication of severe pain. On top of this, differences in pain pathways and drug response were long overlooked, hindering propoer pain management.

Drug Metabolism and Dosing

This relates to pain management as well.

Pharmacokinetic and pharmacodynamic studies largely used male volunteers. Women metabolise certain drugs at different rates due to hormonal and compositional differences. I mention Zolpiden in the header. This is a central nervous system depressent principally used to treat insomnia in the short term. At the same dose as men, some women were found to have 40-50% greater blood concentration of zolpidem as men and this led to important next-day side effects like impaired driving ability. The FDA halved its recommended starting dose for women. There are other examples:

Aspirin for Cardiovascular Conditions Prevention Differences in platelet reactivity and prostaglandin metabolism, influenced by sex hormones means that where aspirin reduces heart attack risk more in men, it reduces stroke risk more in women.

Antidepressants (SSRIs and tricyclics) Differences in adiposity distribution, hormonal modulation of serotonin pathways, and generally slower hepatic metabolism often make women report stronger effects and side effects at standard doses. The standard dose being based on male patient models.

Statins - Cholesterol-Lowering Drugs As highlighted in the McKinsey publication, cardiovascular health is a big place where this gap exists, plus, statins are some of the most prescribe drug classes.

Statins (e.g., simvastatin, atorvastatin, rosuvastatin, pravastatin) inhibit HMG-CoA reductase, a key enzyme in the liver that drives cholesterol synthesis. They lower LDL (“bad”) cholesterol and reduce the risk of cardiovascular events (heart attack, stroke).

Women have different distribution of fat in the body, statins being lipophilic may distribute and disperse differently in women. We’ve hinted at hepatic metabolism in discussing antidepressors, but the liver is what breaks down most medecines. Some statins may metabolise faster, potentially lowering efficacy in women. If the liver metabolises it, the kidneys handle excretion and since renal clearance tends to be slightly lower in women they may have increased exposure to the drug and its metabolites which in turn carries a risk of increased side effects.

These increased side effects contribute to women being more likely to stop taking statins. This contributes to poorer secondary prevention outcomes in women despite equal clinical need.

What’s Changing

The FDA and NIH now require sex-based reporting in drug trials. Newer analyses (e.g., JUPITER trial, rosuvastatin) included ~40% women, showing clear benefit for both sexes when appropriately studied.

Ultimately, the persistence of male-centered medicine is not just a historical oversight; it is a design flaw that continues to shape outcomes today. The “default patient” model has proven both scientifically incomplete and socially costly, narrowing our understanding of health itself. As new research frameworks embrace diversity not as a variable to control for but as a reality to learn from, medicine can move closer to serving the full range of human experience. Closing the healthcare gap is not only about fairness or representation; it is about precision, trust, and better science. The bodies we study should reflect the people we heal.

The fact that we are having this discussion, that influential organisations, influential women, are highlighting and helping shape corrective action are all good news. Go read the report if you want, the framing of combating this issue as an economic activity feels really effective to me. Moreover, in a time of economic slowdown, it may be a way for Canada to step up and lead on what’s really a global issue.

The publication is a rehash of another one with a more global tone. Find it here