Closing Europe’s gender health gap is Penilla Gunther’s personal crusade – Euractiv

Report on Health Equity and Gender Equality in European Healthcare

Introduction: Aligning with Sustainable Development Goals

This report examines the critical challenges to achieving equitable healthcare in Europe, with a specific focus on gender disparities. The analysis is framed through the lens of the United Nations Sustainable Development Goals (SDGs), primarily SDG 3 (Good Health and Well-being), SDG 5 (Gender Equality), and SDG 10 (Reduced Inequalities). Drawing on the insights of Penilla Gunther, President of the European Patient Safety Foundation, this report outlines systemic failures and proposes policy directions to close the existing gaps in health outcomes.

Gender Disparities in Clinical Research and Treatment

Challenges to SDG 3 and SDG 5

Significant gaps persist in clinical research that directly undermine progress towards SDG 3 and SDG 5. The underrepresentation of women in clinical trials leads to a lack of gender-specific data, resulting in healthcare that is not tailored to the needs of 50% of the population.

• Insufficient Participation: Female participation in clinical trials remains inadequate, particularly in critical areas such as cardiovascular diseases and cancer.
• Need for Individualized Care: A “one-size-fits-all” approach to medicine is ineffective. Equal treatment necessitates care tailored to individual biological and physiological differences.
• Researcher Diversity: Increasing the number of female researchers is identified as a key strategy to attract more women to participate in clinical trials, thereby improving the quality and applicability of research.

Fostering SDG 17: The Role of Cross-Border Collaboration

To address these research gaps and enhance Europe’s competitiveness, strengthening cross-border collaboration is essential, directly supporting SDG 17 (Partnerships for the Goals).

• Rare Diseases: For rare diseases, no single country possesses a sufficient patient population for robust trials, making international cooperation a necessity.
• Industry Attractiveness: A coordinated, pan-European approach to clinical trials is required to ensure the region remains an attractive hub for pharmaceutical and life sciences industries.

Socioeconomic Barriers and Systemic Inequities

The Unpaid Care Burden: An Obstacle to SDG 5

Social and economic factors compound health inequalities, with the disproportionate burden of unpaid care on women being a primary concern. This invisible labor has tangible consequences for health and well-being, hindering the achievement of gender equality.

• Disproportionate Responsibility: Women continue to assume a greater share of household and family management responsibilities, even in societies considered to be advanced in gender equality.
• Health Consequences: The stress associated with this “project management” role often goes unrecognized, leading to chronic health issues. Symptoms like headaches or stomach pain are frequently dismissed by both individuals and their communities as stress-related rather than potential indicators of serious illness.
• Overlooked Symptoms: This normalization of coping with stress leads to women ignoring critical warning signs of disease, resulting in delayed diagnosis and treatment. Penilla Gunther’s personal experience with heart failure, initially mistaken for flu, exemplifies this dangerous trend.

Systemic Failures in Access and Funding

Undermining SDG 3 and SDG 10

Systemic failures related to funding, access, and policy implementation create significant barriers to achieving universal health coverage and reducing inequalities.

1. Policy Implementation Delays: While EU-level initiatives such as the European Cancer Plan, the Critical Medicines Act, and the Pharma Package are positive steps, their slow implementation at the national level impedes progress.
2. Funding Gaps for Basic Services: A lack of consistent financing for fundamental healthcare services, such as cancer screening programs, persists across Europe. This erodes public trust and fails to provide preventative care.
3. Access Inequality: The reliance on private insurance in some national systems creates a two-tiered healthcare structure where access is dependent on financial status, in direct opposition to the principles of SDG 10.
4. Regional Disparities: Significant variations in the quality and availability of healthcare exist between and within European countries, further entrenching inequality.

Recommendations for Policy and Education

A Call to Action for SDG Alignment

Achieving the Sustainable Development Goals requires a concerted effort in policy, education, and systemic reform. The following actions are critical for building a more equitable and sustainable healthcare future.

• Integrate Health Strategies: Policymakers must recognize and act upon the interconnectedness of major diseases, such as the link between cancer treatments and subsequent cardiovascular conditions (cardio-oncology).
• Invest in Education: Cuts to sexual and health education must be reversed. Comprehensive education is vital to combat misinformation, reduce stigma around conditions like cervical cancer, and empower individuals to make informed health decisions, contributing to both SDG 3 and SDG 5.
• Prioritize Equality: The fundamental principle that women constitute half the population must be the driving force for ensuring equality in all aspects of healthcare, from research and funding to diagnosis and treatment.

Analysis of Sustainable Development Goals in the Article

1. Which SDGs are addressed or connected to the issues highlighted in the article?

• SDG 3: Good Health and Well-being: The article’s core focus is on healthcare, including equitable access to treatment for non-communicable diseases like cancer and cardiovascular conditions, the importance of clinical research, and the need for universal health coverage.
• SDG 5: Gender Equality: This is a central theme, with the article extensively discussing the gender gap in healthcare. It highlights issues such as the underrepresentation of women in clinical trials, the societal burden of unpaid care work on women, and the need for policies that specifically address women’s health.
• SDG 10: Reduced Inequalities: The article addresses inequalities in healthcare access based on gender, geographical location (regional disparities within Europe), and economic status (the role of private insurance determining access to treatment).
• SDG 17: Partnerships for the Goals: The text emphasizes the need for collaboration to improve healthcare outcomes. This includes cross-border cooperation for clinical trials and multi-stakeholder partnerships between the life sciences industry, patient organizations, and regulators.

2. What specific targets under those SDGs can be identified based on the article’s content?

• SDG 3: Good Health and Well-being
  • Target 3.4: Reduce by one-third premature mortality from non-communicable diseases. The article’s focus on improving care and research for cancer and cardiovascular diseases directly supports this target. Penilla Gunther’s advocacy for better understanding the links between cancer treatment and heart failure (cardio-oncology) is a key example.
  • Target 3.8: Achieve universal health coverage, including financial risk protection and access to quality essential health-care services. The article critiques systems where “access depends on money” and highlights “financing for some very basic healthcare services, like screening” is lacking, directly relating to the goal of universal access regardless of ability to pay.
  • Target 3.b: Support the research and development of medicines. The discussion on making clinical trials more inclusive and competitive in Europe, and the need for innovation through initiatives like the Pharma Package, aligns with this target.
• SDG 5: Gender Equality
  • Target 5.4: Recognize and value unpaid care and domestic work. The article explicitly discusses the “hidden burden of care,” noting that “Women are still taking more responsibilities in their homes, with their families,” which she calls the “family project coordinator” role. This directly reflects the essence of this target.
  • Target 5.5: Ensure women’s full and effective participation and equal opportunities for leadership. The article points out the need for “more female researchers to attract other women” to clinical trials, highlighting the importance of women’s participation in scientific and public life.
  • Target 5.c: Adopt and strengthen sound policies and enforceable legislation for the promotion of gender equality. The call for effective implementation of policies like the EU Cancer Plan to close the gender gap in health is a direct link to this target.
• SDG 10: Reduced Inequalities
  • Target 10.3: Ensure equal opportunity and reduce inequalities of outcome. The article’s main argument is to close the health gap between genders, arguing that a “one-size-fits-all approach” is inadequate and that care must be tailored to individual needs to ensure equal outcomes. The underrepresentation of women in clinical trials is presented as a source of unequal health outcomes.
• SDG 17: Partnerships for the Goals
  • Target 17.17: Encourage and promote effective public, public-private and civil society partnerships. The article calls for “collaboration between the life sciences sector, patient organisations and regulators” and for cross-border cooperation to run clinical trials, which are examples of the partnerships this target aims to foster.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

• For SDG 3 (Good Health and Well-being)
  • Indicator: Mortality rate attributed to cardiovascular disease and cancer (related to Target 3.4). The article’s extensive discussion of these two major non-communicable diseases implies that reducing deaths from them is a key measure of success.
  • Indicator: Proportion of the population with access to essential health services (related to Target 3.8). The article implies this indicator by highlighting the lack of financing for “basic healthcare services, like screening” and unequal access to treatment based on wealth or location.
• For SDG 5 (Gender Equality)
  • Indicator: Proportion of women’s participation in clinical trials (related to Target 5.c and 3.b). The article explicitly states, “Women’s participation in clinical trials has increased, but we still don’t have enough, especially not in cardiovascular diseases, but also cancer.” This provides a clear, measurable indicator.
  • Indicator: Time spent on unpaid care and domestic work (related to Target 5.4). While not providing numbers, the article describes this as the “hidden burden” and the “project management for women,” implying that the amount of time dedicated to these tasks is a key measure of inequality.
  • Indicator: Proportion of women in research positions (related to Target 5.5). The article suggests progress can be measured by the number of female researchers, citing the idea that “we need more female researchers to attract other women” to trials.
• For SDG 10 (Reduced Inequalities)
  • Indicator: Disparities in healthcare access based on economic status (related to Target 10.3). The article implies this can be measured by examining systems where “private insurers practically decide which treatments people can access” and access “depends on money.”

4. Summary Table of SDGs, Targets, and Indicators

Source: euractiv.com