Hologic’s first global index of women’s health serves as powerful resource for policymakers
International Hospital speaks to Tanja Brycker, Vice President, Strategic Development, Breast & Skeletal Health and Gynaecological Surgical Solutions at Hologic, about Hologic’s first Global Women’s Health Index developed from a poll of more than 120,000 women in 116 countries.
International Hospital: The Hologic Global Women’s Health Index is part of the Gallup World Poll, which has been running for several years. However, this is the first Global Women’s Health Index derived from this poll. What were the reasons that prompted Hologic to develop this Index?
Tanja Brycker: Healthy women are the cornerstone of families, communities and economies. As a company that strives to be a global champion of women’s health, we saw a clear need for more robust, quality data to track and measure women’s health on a global level. This is particularly important in light of the disproportionate impact the Covid-19 pandemic has had on women’s socioeconomic wellbeing. As societies build back from the pandemic, global leaders must use this opportunity to address the causes of the health disparities faced by women and girls.
As the first global survey of women’s health, the Hologic Global Women’s Health Index (GWHI or Index) uniquely draws from women’s perspectives to understand the global gap on the state of women’s and girl’s health. Throughout 2020, Gallup interviewed over 120,000 women and men in 116 countries and territories in more than 140 languages. While the survey was initiated before the pandemic, it has created an even more urgent need for this data. The survey addresses a host of complex factors that contribute to women’s health on regional, national, and international levels. The resulting Index summarizes the data into an easy-to-interpret report, by country. Each country report is a powerful resource that country leaders and policymakers can use to identify priorities, track progress over time, communicate understanding clearly with the women of their region, and promote local and global accountability.
Our aim for this first year of the Index is to engage with governments and through the Index, enable them to create a necessary baseline, determine the priorities and identify and implement appropriate solutions, to address and improve the health and socioeconomic wellbeing of women and girls in their region. The conversations we have had and are continuing to have with leaders across the globe around both the Index and the priorities it is highlighting for women’s health are promising.
IH: Why is the focus specifically on women?
TB: A study by Kristine Husøy Onarheim, Johanne Helene Iversen and David E. Bloom found that how countries develop and perform depends upon how the country educates and provides opportunities for women and girls. Societies that invest in women’s health are more likely to have better overall population health and increased productivity levels for generations to come.
Our goal for the index is to spur world leaders – in and out of government – to improve women’s health. This, in turn, will change lives, support greater development and address longstanding inequalities. Women’s health is global health and the cornerstone of families, communities, societies, and economies globally. Improving women’s health means stronger families, more income and more effective, thriving societies and economies.
IH: The survey questions are based on five dimensions, namely: Preventive Care, Basic Needs, Emotional Health, Opinions of Health and Safety, and Individual Health. Can you explain why these dimensions were chosen as a basis for framing the questions?
TB: The Index identified five dimensions of women’s health that could help countries and territories map out a strategy to ensure a healthy future for women and girls. Similar to the ‘Maslow Hierarchy of Needs’ these GWHI dimensions identify the universal needs of women around the world and collectively, and these five dimensions account for more than 80% of the variance in female life expectancy. They provide an important foundation for developing strategies to improve health outcomes for women and girls, because any positive improvements could potentially help women live healthier, longer lives.
The survey questions were developed and reviewed by global women’s health expert advisers to Hologic and Gallup, representing thought leaders at leading institutions such as John Hopkins University, George Washington University and RAD-AID. This enabled us to prioritise dimensions and questions that are considered leading impactors on women’s lives and success.
To allow for consistent and measurable benchmarking along the five dimensions and to be able to gauge year-to-year changes effectively, the core set of questions will remain the same.
One minor change is that for 2021 and 2022 only, we will add Covid-19 testing to the existing question asking about conditions that the individual has been tested for in the past 12 months (currently High Blood Pressure, Cancer, Diabetes, STDs/STIs). We did this to provide country level and demographic data for Covid-19 testing. Additionally, in regards to the 2021 survey, data collection has been expanded to 124 countries and territories and analysis is currently underway. We will share data and insights later this year.
IH: How often will Hologic conduct this survey and produce this index?
TB: Hologic and Gallup have committed to conduct the survey annually until at least 2027.
IH: The Index provides a score for each of a 114 countries or territories in which women were surveyed. The average global score is 54 out of 100. What does this Index actually represent as far as women’s health is concerned?
TB: It shows that women’s health is a global issue and that the health needs of women and girls are not currently being fully met in any of the countries surveyed. Leaders in all countries and territories should be concerned that they are not meeting the health needs of all their residents especially as women’s health is societal health. In addition to the study previously mentioned, the British Medical Journal found that healthy women return investments in areas which promote income growth and poverty alleviation, including labour and education. Modelling based in the United States has suggested that reduced maternal mortality between 1920 and 1970 resulted in a 52% increase in labour force participation among women of reproductive age.iii Whether due to their contribution to the paid workforce, or to the unpaid carer workforce, the socioeconomic benefits of healthy women are clear.
IH: Taiwan has the highest Index of 69 and Peru the lowest Index of 36. Are there clear factors that explain the variation in these scores between countries?
TB: The Index shows that most countries and territories with the highest scores have higher-than-average preventive care, while the countries and territories with the lowest scores all share high income inequality and weak or destabilized infrastructure for healthcare.
IH: What are some of the most important findings of the Index?
TB: Most notable, and worrying, were the findings on preventative care. Among those surveyed, 40% said they had not talked to a healthcare professional in the last year – that equates to about a billion women and girls who had not been tested or screened prior to the pandemic. Additionally, while international testing standards differ, the Index found that within the past 12 months, more than 1.5 billion women (or 60% of those surveyed) were not tested for any of four critical diseases for women: cancer, diabetes, high blood pressure and sexually transmitted diseases/infections.
High blood pressure is linked to heart disease, which kills an estimated 17.9 million people and is the leading cause of death for women globally each year. However, in 2020, only one in three women had been tested in the 12 months prior to the survey.
In 2020, cancer accounted for nearly 10 million deaths, but worldwide that same year, only 12% of women said they had been tested or screened for any type of cancer in the 12 months prior to the survey. In some countries and territories, only 3% of women were tested.
Globally, in 2020, fewer than one in nine women were tested for STDs/STIs in the surveyed countries and territories, despite the serious health consequences they can have beyond the initial infection.
When appropriate levels of prevention in healthcare are utilized, there is a decrease in the prevalence of ill health and this in turn results in a sustainable growth of productivity. By providing effective preventative care, screening and testing, global leaders will not only be supporting the health of half of the population, but also children and the economic productivity of society.
IH: Hologic says they plan to work with healthcare leaders to help improve women’s health on the basis of this Index. What initiatives does the company have in mind to do this?
TB: Yes, we are actively engaging with leaders across the globe to discuss the data in its entirety, but also at an individual country level. We are sharing the data with country leaders and governments and urging them to use it and the five dimensions to guide the development of health strategies that will make a tangible difference to women’s quality of life and life expectancy worldwide. This multiyear index will contribute to international awareness that women’s health is a critical foundation for the advancement of humankind and that more needs to be done to improve the healthcare, and ultimately life expectancy, of women and girls everywhere.
To that end, Hologic has created the Global Access Initiative, a partnership with the Clinton Health Access Initiative (CHAI) and MedAccess (backed by the UK Government), to bring lifesaving infectious disease testing to over two million men, women and children in resource-limited countries.
With cancers, diabetes and heart disease being the leading causes for death of women worldwide, it is essential women have access to the tests and screenings which have the capability to save their lives. That is why we advocate for and support measures such as the Protecting Access to Lifesaving Screenings (PALS) Act in the United States Congress. This legislation enables full insurance coverage of routine screening mammograms for women in the United States, starting at age 40, instead of 50.
We have also partnered with leading non-profit organizations to deliver Hologic’s Project Health Equality. This is a multifaceted, multiyear initiative that uniquely combines research, education and access to address the structural and cultural barriers to women accessing healthcare. It is actively ongoing in the US with pilots launched in 2021 for the United Kingdom and Canada. Project Health Equality will be rolled out across more countries, in each case addressing a specific health equality challenge for that country, which was revealed in the survey.
Hologic is dedicated to improving access to healthcare for all women, and hopes this survey serves as a catalyst for change as we continue to gather data and learn more about the barriers to healthcare that impact the population on global, regional, and national levels.
Tanja Brycker, Vice President, Strategic Development, Breast & Skeletal Health and Gynaecological Surgical Solutions at Hologic.
References
i. Onarheim KH, Iversen JH, Bloom DE. Economic benefits of investing in women’s health: a systematic review. PLoS One, 2016;11(3):e0150120. doi: 10.1371/journal.pone.0150120. PMID: 27028199; PMCID: PMC4814064
ii. Remme M, Vassall A, Fernando G, Bloom DE. Investing in the health of girls and women: a best buy for sustainable development. BMJ, 2020;369:m1175 doi:10.1136/bmj.m1175
iii. Wang F, Wang JD. Investing preventive care and economic development in ageing societies: empirical evidences from OECD countries. Health Econ Rev 11, 18 (2021)
