The changing policy landscape for Women's Health: Where are the opportunities for founders?
The changing policy landscape for Women's Health: Where are the opportunities for founders?
October 31st 2022 / 10 min read
This article is a collaboration from the Healthtech Breakfast Club, set up between AlbionVC and Founders Factory—with contributions from Olivia Brooks (Investor at Founders Factory), Jasmin Thomas (Founder of CBD skincare product Ohana), Kenia Popkin (Investor at Apeiron), and Omar Daniel (Partner at Harbr Ventures)
Gender bias has plagued healthcare research, funding, and policy since the early days of medicine. Lack of funding for female health conditions, underrepresentation in early-stage research and clinical trials, and the trivialisation of female physical complaints are just some of the complex array of issues that contribute to the gender health gap.
The bias is clear in the numbers. While 1 in 3 women suffer from a reproductive or gynaecological health problem, less than 2.5% of publicly funded research is dedicated to women’s reproductive health. It's evident too in how we report on women’s health, where the emphasis in the narrative is to blame the user/customer/patient, rather than focus on intrinsic faults in drug development, product design, or service delivery.
The overall picture is one of poor understanding of the basic biology of female health conditions, leading to far more prevalent misdiagnosis in women than men. This leads to increased suffering, and in some cases, fatality. Women with a total coronary blockage of the artery are 59% more likely to be misdiagnosed than men and more than twice as likely to die in the 30 days following a heart attack.
It’s time for a change: we need a shift away from male-centric medicine and increased focus and funding on women’s health. We’re already seeing changes in the landscape. In July, the UK government published its first Women’s Health Strategy, a policy specifically designed to address the gender health gap, in response to the March 2021 Call For Evidence. The level of response from the public was unprecedented and illustrates the urgent need for action—110,000 responses from women in England (10 times the average response), made up mostly by consumers.
This policy creates a huge opportunity across a variety of stakeholders:
Patients experience improved outcomes
Clinicians access innovations that help them deliver more efficient and effective care
Researchers collect and access better data
Startups have access to projects/pilots/funding pots/new services
Investors see a greater influx of capital into the space
But does it go far enough? We’ll break down the new strategy, understand what it means for women, and identify some of the startups who are already addressing the challenges it raises. We’ll also look at what remains to be answered, to understand what it looks like for founders and investors to truly address women’s health challenges.
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What does the Women’s Health Strategy say?
At the heart of the Women’s Health Strategy is a six-point long term plan that summarises the key areas of improvement for the next decade.
Women’s health startups have a critical role in driving forward innovation here. Some founders are already working closely with the government to help shape policy, and many more are identifying opportunities across these focus areas. For each, we’ll highlight startups already working to address these issues.
1. Ensuring women’s voices are heard
From the policy: “Tackling taboos and stigmas, ensuring women are listened to by healthcare professionals, and increasing representation of women at all levels”
This should be a rule of thumb for any startup, not just those innovating around women’s health, as well as a strong need for female representation at the decision-making level in VC. Dame Lesley Regan, a leading gynaecologist and the first Women’s Health Ambassador for England, believes ending taboos on topics like periods and the menopause is key to closing the gender health gap.
Speedinvest partner Deepali Nangia explains how tackling these challenges drives their investments. “Be it India or the US, where I spent my formative years, many women’s health topics were taboo and we never spoke about them. At Speedinvest, our recent investments in The Lowdown and Fertifa, are normalising exactly these topics like contraception, fertility and menopause. Hopefully, this will lead to better treatment outcomes for women. Hopefully, things will be different for my daughter.”
2. Improving access to services
From the policy: “Services that meet reproductive health needs…prioritising services for women’s conditions such as endometriosis…ensuring conditions that affect both men and women consider women’s needs by default, and being clear on how conditions affect men and women differently”
Bloomful is delivering digitally-enabled care pathways for conditions such as PCOS, fibroids and endometriosis, which see particularly slow diagnosis and treatment times. Founder Dr Dupe Burgess believes “startups and new innovative scalable technologies are the only realistic way to unlock the roadblocks in current NHS services”. Speaking to women and understanding the pain points in their healthcare experience is central to their strategy.
Founded after one of the founders ran into her boyfriend’s mum while buying a pregnancy test, Stix is a D2C women’s health platform offering a convenient and discreet way to access products from emergency contraception to pregnancy tests. Their Real Talk blog shares expert insights on a range of women’s health challenges.
The policy equally stresses the need for improving access around non-women specific conditions, such as cardiovascular help, which are plagued by misdiagnosis. Cordifio is a social enterprise providing early screening, education, and prevention of heart disease.
3. Addressing disparities in outcomes among women
From the policy: “Ensuring that a woman’s age, ethnicity, sexuality, disability or where she is from does not impact upon her ability to access services, or the treatment she receives”
Recent data has shown how health outcomes can be radically different amongst women. For example black women in the UK are four times more likely to die in pregnancy and childbirth than white women. Mae is a startup currently working to improve these disparities through a digital platform that connects expectant mothers with critical resources to drive better pregnancy outcomes.
4. Better information and education
From the policy: “Enabling women and wider society to easily equip themselves with accurate information about women’s health, and healthcare professionals to have the training they need to treat patients knowledgeably and empathetically”
The strategy highlighted how important improved access to education and information is for health and wellbeing, and making informed decisions. The Lowdown is tackling this within contraception through their contraception review platform, connecting women and empowering them through shared experiences. It is critical that the government actively publicises resources like this, which are helping to make women's health less of a minefield.
5. Greater understanding of how women’s health affects their experience in the workplace
From the policy: “Normalising conversations on taboo topics, such as periods and the menopause, to ensure women can remain productive and be supported in the workplace, and highlighting the many examples of good practice by employers”
Despite strides in tackling ‘taboo subjects’ within women’s health, the workplace can still be a difficult landscape to navigate. Startups are innovating to help women throughout their career, from fertility to menopause, to ensure they are supported by employers.
Peppy and Fertifa are just some of the companies tackling this through employee healthcare benefits, supporting underserved areas of healthcare including fertility, pregnancy and menopause by connecting employees with health experts.
6. Supporting more research, improving the evidence base and spearheading the drive for better data
From the policy: “Addressing the lack of research into women’s health conditions, improving the representation of women of all demographics in research, and plugging the data gap and ensuring existing data is broken down by sex”
A lack of quality data sets on women is a key driver of the gender health gap. Caroline Criado-Perez writes in detail about the gender data gap in Invisible Women: “For millennia, medicine has functioned on the assumption that male bodies can represent humanity as a whole.” In studies as recent as 2019, women were found to be drastically underrepresented in clinical trials: in psychiatry, where around 60% of patients are women, mean participation of women was just 42%.
Startups that can collect well designed, sizable datasets will set themselves apart. Tuune is providing personalised women’s healthcare powered by their data-driven, precision algorithm. They are using medical history, genetics and hormone levels to match women with personalised birth control recommendations and insights into their hormonal profile.
Hertility is building the world’s largest dataset of female gynaecological pathologies, as well as running their own clinical trials. This hopes to raise the standard and scientific rigour of female health, and radically reduce time to diagnosis and specialist care. Their digital diagnostic tool (powerered by their algorithm) can screen for 18 reproductive health conditions in just 10 days. Founder Dr Helen O’Neill (who was also an advisor to the strategy), believes huge progress can be made if the NHS starts to adopt these algorithms.
Unanswered questions & challenges that remain to be solved
While the Women’s Health Strategy represents a step forward in terms of creating a more representative approach to healthcare, many challenges remain.
A lack of investment
Where the money comes from to fuel innovation remains a big question. 2021 saw $1 billion invested in women’s health startups: but the space will demand more to reach the level of innovation required.
What are the funding pots, and how large are they?
What do they aim to achieve, and how are we evidencing impact?
How can startups apply?
How will they be assessed?
Will they be ongoing?
“We need dedicated funding pots, investing in the data side and incentivising pharma companies to innovate within women's health,” says Bloomful founder Dr Dupe Burgess.
There’s even less certainty around private capital. Dr Niti Pall, Birmingham Womens and Childrens Hospital Trust NED, laments the lack of commercial investment. “It is largely the impact funders who have stepped into this space. These, however, are not the most sustainable sources of funding for these markets,” Niti says.
All this is before considering the impact of a global recession, which has already triggered a far more cautious approach to investment with a shift to revenue-generating startups (which is hard enough in a recession). Women founders only receive 2% of VC funding as it is—what will this look like in a bear market?
Disconnect to NHS
Another factor to consider is there is currently little central organisation in the healthcare system that makes it easier for startups to interact with the NHS—across the system, but particularly women’s health. Without this, it remains difficult for startups to launch pilot programmes in public health services. Founders need a ‘docking system’ that can help them not just launch these pilots but scale them across the service.
Focus beyond reproductive health
Investment up to this point has focused largely on reproductive health—fertility, period care, menopause, hormone health, and sexual wellness. But focus outside of reproductive health for women remains limited.
Alongside cardiovascular health (heart attacks, strokes, and high blood pressure) where women show unique risk factors, women are more affected by chronic pain conditions, and whilst on average women live longer lives than men, they also live in poorer health than men.
Beyond this, the strategy misses the opportunity to go beyond just health services, and look at health and wellbeing more holistically. The WHO European region, India, and Australia have women's health charters that go beyond, considering social, political, environmental, and commercial determinants of health. Improving health services is not enough to improve health at a population level.
The risk of it being a ‘women’s issue’
There’s a risk that women’s health becomes siloed off from wider healthcare. In particular, it’s important to understand the differences in how women experience medical conditions, and how they respond differently to medication than men.
Crucially, it shouldn’t just be women’s health startups that are focused on including more women’s data. Within the startup space, solutions can often be designed without accounting for gender differences. This is particularly exacerbated with women of colour and ethnic minorities where biases across algorithms occur, exacerbated by the lack of research conducted on people from underrepresented groups.
“The NHS cannot move as quickly as the evidence is calling for."
Much remains to be done in the space to fundamentally transform how women experience healthcare. The number of responses to the Call for Evidence demonstrates the clear demand from women in the UK to influence approaches and see improvements in healthcare. Yet governments cannot act alone. Hertility’s Dr Helen O’Neill believes startups have a crucial role to play.
“The NHS cannot move as quickly as the evidence is calling for. Founders can reach consumers and patients much quicker than the NHS,” Helen says. With the right funding mechanisms, and a deeper understanding of layers of problems that are steeped in women’s healthcare, progress is promising.
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