洞见 ｜为什么我们要单独的讨论女性的健康？

图源：来自网络

“在过去十几年里的医学研究中，

79%对疼痛的研究仅以男性作为参考，

女性对疼痛的忍耐力与男性有相当大的差异”

“在哈佛大学数据库中找到的71项间歇性断食研究中，

只有13项涉及女性的研究数据。 

除此之外，在对照研究里，没有任何一项专注于女性群体的分析。”

“如果你告诉一个算法基于男性心脏病发作的症状是典型的症状，那它会更擅长诊断男性心脏病发作，

而使它在诊断女性心脏病发作方面变得更糟。”

“这本身就是健康中性别的不平等。”

报名截止日期：2024/11/20 23:59

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生物医学创新是建立在疾病对身体功能，细胞和分子通路的影响上的科学研究。但历史上，男性一直主导医学和生物学的研究，也常常成为主要研究对象。比如大多数动物模型基于雄性标本；性别差异的问题很少被研究或记录。

Biomedical innovation builds on the basic understanding of science around body function and the cellular and molecular pathways involved in disease development and progression. Historically, men have both led and been the subject of the study of medicine and biology. For example, the majority of animal models have been based on male specimens; Questions about sex-based differences were rarely investigated or recorded.

这种男性和女性在除生殖之外的器官和系统功能上没有多少重要差异的假设，已经被证明是错误的，并且导致了疾病在女性身上的体现没有被完全理解, （极大程度上负面的）影响了女性的生活质量，导致了不同性别健康的差距：

With the assumption—now known to be false—that there are few important differences in the functioning of organs and systems in men and women beyond reproduction， it has impacted women's quality of life (mostly negatively) and resulted in gender health gap:

临床试验主要使用雄性动物来制定标准

Clinical trials are overwhelmingly designed to make standards using male animals

常见疾病（如心脏病和中风）症状在女性的表现与既定的男性模型或症状完全不同，这导致了疾病诊断的延误

Female presentsation of common conditions like heart disease and stroke donot resemble established male models or sysmptoms at all, which resulted in delaying dignosis

性别荷尔蒙对中枢神经系统的发展至关重要，这也表明女性的大脑构造与男性的不同 - 据研究，女性患焦虑症与创伤后应激障碍症的可能性比男性高出3倍之多

Sex hormones are vital to the development of the entire central nervous system (CNS), which means women's brains are different to men's. Based on research, women are nearly three times more likely than men to develop anxiety or post-traumatic stress disorder(PTSD)

因此，女性健康不仅仅指生殖健康, 更涵盖广泛的健康领域。根据麦肯锡以及硅谷银行2024年最新的女性健康与FemTech市场研究的相关报告，女性的健康大致分为以下三类：

Women's health is beyond reproductive health, and based on McKinsey's and also SVB's latest report on Women's health and FemTech, women's health have been defined into the below three categories:

在追求女性平等的过程中，健康差距是一个主要因素。女性的寿命较男性长，但她们在健康不佳的状态下度过的时间却比男性多25%。

In the quest for women’s equality, the health gap is a major player. Women live longer than men, but they spend 25 percent more of that time in poor health.

在科技高速发展的今天，医学界仍然不知道许多药物和设备对女性的效果如何。事实上，直到1993年之前，女性都很少被纳入药物临床试验。 这揭示了女性健康在历史的长河中仍然面临着巨大的缺口与挑战：研究与教育、数据偏差和缺失、以及相关的资金与创新支持的缺口。

Even in the advancing Technology era today, the medical field still doesn’t know how well many drugs and devices work for women. The fact that before 1993, women were rarely included in clinical trials has revealed the gaps and challenges historically existing from various domains such as medical research and education, limited data, and lack of funding and innovation in women's health. 

图源：Op-Med

人体解剖学是医学教育的基础，医学教育历来强调女性生殖解剖学，却忽视了外阴解剖学，特别是阴蒂神经解剖学。因此，详细的外阴解剖学仍然在许多医学院的一年级课程中缺失。医学教育历史上一直将女性视作“生育机器”而非性存在，而忽视了与女性性功能密切相关的系统性的解剖学。

Human anatomy is foundational to medical education. Medical education has consistently emphasized female reproductive anatomy and ignored vulvar anatomy, particularly clitoral nerve anatomy. This is a clear indication that medical education has historically seen women as “baby machines” and not as sexual beings. There has been a systemic disregard of anatomy critical to a woman’s sexual function. 

美国国立卫生研究院在今年8月发布了一篇其在女性健康研究知识中仍然存在的长期持续差距的报告。其中，在关于经前烦躁症与心理和表现健康关系的讨论中，专家指出越来越多的证据表明，多种激素的触发和敏感性可能会对该病理生理学产生影响。但在医学研究领域里，这仍然是一片空白，急切的需要大规模的、纵向队列研究，以更好地了解经前烦躁症的自然过程，以及开发更多和更高精度的治疗方法，无论是药物还是行为疗法。

National Institution Health (NIH) has published a report on addressing gaps in women’s health research. In the Women's mental and behaviour health research section on premenstrual dysphoric disorder (PMDD), the sole diagnosis related to menstruation and mental health， researchers pointed out the mounting evidence showing multiple hormonal triggers and sensitivities may contribute to pathophysiology. However this still remains research gaps, including the need for large-scale studies in patients with substance use disorder, longitudinal cohort studies to better understand the natural course of PMDD/PME, and development of more and higher-precision treatments, whether pharmaceutical or behavioral.

现在比以往任何时候都更需要数据来直接参与决策。医疗保健和生命科学也不例外：数据是公共卫生讨论的核心，也是推动持续科学进步的关键。

Now more than ever, data is at the center of engagement and decision making. Healthcare and life sciences are no exception: data is central to discussions about public health and is core to enabling continued scientific advancement.

在阅读来自麦肯锡，德勤，世界经济论坛等多方的报告后，FemTech Weekend将女性健康的数据缺口汇总与校对，并总结为以下三点：

数据来源与收集缺口 Data Sourcing and Collection

除了上文所提及的由于医学史上鲜有性别差异的研究，现有数据的收集十分不均衡。比如说虽然已经有证据表明对围产期女性抑郁的心理治疗的有效性，但相较于围产期之外的研究，并没有针对围产期抑郁相关药物治疗的随机临床试验可以作为临床建议的依据。这导致在怀孕和哺乳期间开处方时缺乏有效性或安全性数据。

Despite robust data on psychotherapies for perinatal patients, no randomised clinical trials of relevant pharmacotherapies exist on which to base clinical recommendations. The paucity of such psychiatry clinical treatment studies versus research outside the peripartum period, leading to prescribing in pregnancy and lactation without efficacy or safety data. 

数据汇总偏差 Data aggregation

数据汇总的过程中会因为固有的偏见导致女性健康数据汇总的缺失。例如，月经用品使用的数据是一项公共卫生、性别平等和人权的重要指标。但在2020年世界银行数据库里，只有不到5%的国家报告了这一数据。

During the data aggregation process, inherent biases can lead to the omission of women's health data. For example, less than 5 percent of countries reported 2020 data on menstrual material usage, which is a critical indicator of public health, gender equity, and human rights.

数据分析与评估 

Data Analysis & Measurement

医学研究中缺少以女性为中心的评估值。例如在过去十几年里，医学研究中79%对疼痛的研究仅以男性作为参考研究表明。因此布洛芬和其它非类固醇抗炎药止痛药对女性身体的作用有效性相对男性更小，并且对女性肝损伤的副作用风险更高。

There is lacking of measurement centred on women. For example, a recent review in the medical journal, Pain, noted that in the previous decade, 79% of pain studies included only male subjects. Ibuprofen and other over the counter NSAID pain relievers have likewise been found to be less effective at relieving women's pain than men's, and cone with a higher risk of adverse effects including liver injury. 

如今，由于女性健康研发资金低，仅有1.4％的资本投资于女性的健康。研究显示，许多男性投资者因为不愿谈论或根本不了解女性的健康的价值主张而回避投资。

Today, in line with the low R&D funding of women's health (four per cent), only 1.4 per cent of capital investment is in FemTech, with research showing that many male investors shy away from talking about or simply don’t understand the value proposition. 

图源：自然杂志

在肿瘤学之外，仅约1%的医疗研究和创新投资于女性特有的疾病。女性在医学试验中一直处于代表性不足的状态, 就目前全球创新健康赛道而言, 女性健康相关的投资和需求比例严重不匹配。

Approximately 1 percent of healthcare research and innovation is invested in female-specific conditions beyond oncology. Women have been underrepresented in medical trials, and the current global innovation pipeline reveals mismatches between health investments and health needs as they relate to women.

1 ► 通过缩小女性健康差距并将女性置于健康创新的中心，各个国家可以为性别平等和经济潜力解锁巨大的好处。

By closing the women’s health gap and putting women at the center of health innovation, countries can unlock massive benefits for gender equality and economic potential. 

世界经济论坛和麦肯锡全球研究所发布的一份新报告《缩小女性健康差距：改善生活和经济的1万亿美元机遇》揭示了弥合女性健康差距的潜在有利影响：如果全球39亿女性更健康的生活，将每年为全球经济增加1万亿美元。因为越来越多的女性进入劳动力市场，并提高她们的收入潜力。

A new report from the World Economic Forum and the McKinsey Global Institute, Closing the Women’s Health Gap: A $1 Trillion Opportunity to Improve Lives and Economies, has revealed the staggering impact of the women’s health gap: Women spend 25% more time in poor health than men. The potential impact of closing this gap? A healthier existence for 3.9 billion women worldwide and an additional US$1 trillion added to the global economy every year, as more women enter the workforce and increase their earning potential. 

2 ► 各国政府正在加大对女性健康研发的投资。2023年9月，英国宣布了新的全球健康资金，特别关注支持研发（R&D），以改善低收入和中等收入国家母亲、婴儿和儿童的健康。 

Governments are stepping up investments in critically needed women’s health R&D 

In September 2023, the UK announced new funding for global health, with a particular focus on support for research and development (R&D) to improve the health of mothers, babies, and children in low- and middle-income countries. 

不久之后，美国公布了白宫女性健康研究倡议，这是一个强有力的行动号召——由前第一夫人吉尔·拜登博士和白宫性别政策委员会领导——旨在激励联邦政府以及私营和慈善部门促进创新和投资，以填补研究空白并改善女性健康。 

Soon after, the U.S. unveiled the White House Initiative on Women’s Health Research, a powerful call to action—led by First Lady Dr. Jill Biden and the White House Gender Policy Council—to galvanize the federal government and the private and philanthropic sectors to promote innovation and investment to close research gaps and improve women’s health. 

二月份，该倡议宣布为女性健康研发提供1亿美元的联邦基金。

In February, the initiative announced US$100 million in federal funding for women’s health R&D. 

3 ► 跨领域的合作。不仅来自政界，女性健康的缺口也受到了慈善界的关注。在今年10月9日，梅琳达·弗伦奇·盖茨推出2.5亿美元女性健康基金，作为她推进女性权益10亿美元计划的第一步。

Not only from the political sphere, the gap in women's health has also attracted the attention of philanthropists. For example, Melinda French Gates launches a $250 million women’s health fund in October 2024，which is part of her $1 billion plan to promote women’s rights.

同时一批女性健康科技企业与高校合作。经期健康追踪程序Clue在与包括斯坦福大学、哥伦比亚大学和牛津大学在内的大学合作，以更好地了解像子宫内膜异位症这样的疾病（目前平均需要八年才能诊断），以及如何利用月经周期中的模式来检测慢性疾病，如癌症。 

Clue, a menstrual health app is working with universities including Stanford, Columbia and Oxford to better understand conditions like endometriosis (which takes an average of eight years to diagnose at the moment), and how patterns within the menstrual cycle can be used to detect chronic diseases, such as cancer. 

“检查出来你没有任何问题”

“那请问医生是哪里出了问题导致我还是觉得不舒服呢？”

“检查出来你没有任何问题”

“There is nothing wrong with you"

"However I still feel I am not 100% healthy"

"There is nothing wrong with you" 

正如卡罗琳·克里亚多·佩雷斯在她的书《看不见的女性：为男性设计的世界中的数据偏见》中所写的那样，“如果一个人自己没有这种需求，就不容易说服他人这种需求的存在。”

As Caroline Criado Perez writes in her book Invisible Women: Data Bias in a World Designed for Men, “It’s not always easy to convince someone a need exists if they don’t have that need themselves. 

加入FemTech Weekend，中国第一个聚焦女性健康的科技挑战赛。我们鼓励社会各界人士，关注女性健康的缺口，以及用科技来推动改善中国女性健康。

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