Ignoring female health issues: Women are NOT a Minority!

Professor Belinda Pletzer, University of Salzburg, argues that treating women as a minority population in health research is not only bad science—it costs the global economy an estimated US$1 trillion every year

I just recently had yet another menstrual cycle paper desk-rejected with the suggestion to submit it to a more specialized journal because the topic was only of interest to a very targeted audience. Meaning: Women. I could fund a whole research project if I had a penny every time I heard that sentence. I go through that dance with almost all my papers. Not of interest to a general audience. Meaning: Men.

This week, when a PhD student presented data on the association between estradiol and a brain parameter, I had a male colleague in the audience ask if – given this strong impact of the menstrual cycle – it wasn’t better to just study men. As he recognized the profound impact of hormonal fluctuations on the brain, his suggestion was to simply ignore them entirely.

While stories like these may sound like funny anecdotes, they are not isolated incidents. On the contrary: This happens almost every single time, I submit a paper or give a talk. And it doesn’t just happen to me; it happens to many colleagues in my field, all over the world. And I believe there is a pattern to this: A pattern of ignoring female health issues in science and treating women as a minority or framing the female body as a deviation from the default.

And I am done being nice about it! I’ve had it! Enough is enough!

Just a reminder about some basic biological facts

In case you hadn’t noticed: Women make up 50% of the population, across all continents, all ethnicities, all ages – some ages even more than 50%. I can’t believe how often I must point out something so obvious!

And just to highlight – again – some basic biology: the male body is in fact NOT the default. If anything, the female body is. In the absence of androgen signaling (along with additional hormonal signals), at least the external genitalia will develop along the female-typical pathway irrespective of chromosomal sex. So, if anything – being male is the deviation. And this deviation is caused by hormones!

And at the risk of repeating myself, male testosterone is not stable either! It is heavily sensitive to external and possibly also internal signals, and we have not even begun to unravel how this impacts male health. So instead of clinging to the illusion of male stability, maybe take a page out of menstrual cycle research and accept the fact that all humans are variable, and research must learn to deal with this. I am sure that one day this research will not just benefit this targeted audience called women, but everyone!

The economic costs of ignoring women

So, to all the editorial boards, funding bodies and male colleagues in the audience at PhD talks: I’ve heard you loud and clear. You don’t care about women! Fair enough! I could try to morally bait you by asking if you care about children, or the sick and elderly that women so often care for. But I am not going to waste my breath. Instead, I am asking you if you care about money. Because here are some facts and figures about the economic costs of ignoring women’s health.

Ignoring women’s health and psychiatric conditions in research has already resulted in women spending approximately 25% more of their lives in poor health than men. This is largely because of chronic disabling conditions such as depression, anxiety, migraine, musculoskeletal disorders, and autoimmune diseases rather than reproductive disorder(1),(2). These conditions generally account for lower direct healthcare costs than cardiovascular diseases. But they impose substantial indirect economic costs through reduced workplace productivity, increased absenteeism, and lower labor-force participation.

Recent estimates suggest that closing this health gap could increase global GDP by approximately US$1 trillion annually(1). This figure is remarkably similar in magnitude to the estimated annual productivity losses attributable to depression and anxiety disorders (approximately US$1 trillion annually)(3,4), which disproportionately affect women and are exacerbated during periods of hormonal change.

In contrast, an analysis of NIH funding across 74 sex biased diseases found that approximately 74% exhibited funding patterns favoring male-predominant diseases, with diseases that disproportionately affect women more likely to be underfunded relative to their burden and diseases that disproportionately affect men more likely to be overfunded(5).

The discrepancy between observed and burden-expected funding was nearly twofold greater for diseases favoring men than for those favoring women(5). Consistent with these findings, a recent National Academies analysis reported that only 8.8% of NIH research grants were allocated to women’s health research between 2013 and 2023(6).

So, it’s no longer a question of ethics or equality; that is of interest to just 50% of the population. It’s a simple economic equation! Researching women’s health could save the global economy money, and substantially so! To me, the calculation is quite simple: every woman’s health paper that is downplayed as not suited for a general audience, every research question that is investigated in exclusively male samples, is money lost to the global economy. So, think about that in your next editorial or funding board decision!

References

(1) World Economic Forum, & McKinsey Health Institute. (2024). Closing the women’s health gap: A $1 trillion opportunity to improve lives and economies. Closing the Women’s Health Gap to Improve Lives and Economies | World Economic Forum

(2) Patwardhan, V., Flor, L. S., Gil, G., et al. (2024). Differences across the lifespan between females and males in the top 20 causes of disease burden globally: A systematic analysis of the Global Burden of Disease Study 2021. The Lancet Public Health, 9(5), e321–e335. https://doi.org/10.1016/S2468-2667(24)00053-7

(3) Chisholm, Dan, Sweeny, K., Sheehan, P., Rasmussen, B., Smit, F., Cuijpers, P., Saxena, S., & Whiteford, H. (2016). Scaling-up treatment of depression and anxiety: A global return on investment. The Lancet Psychiatry, 3(5), 415–424. https://doi.org/10.1016/S2215-0366(16)30024-4

(4) World Health Organization. (2024, September 2). Mental health at work. https://www.who.int/news-room/fact-sheets/detail/mental-health-at-work

(5) Mirin, A. A. (2021). Gender disparity in the funding of diseases by the U.S. National Institutes of Health. Journal of Women’s Health, 30(7), 956–963. https://doi.org/10.1089/jwh.2020.8682

(6) National Academies of Sciences, Engineering, and Medicine. (2025). A new vision for women’s health research: Transformative change at the National Institutes of Health. National Academies Press. https://doi.org/10.17226/28586