What would we say about a healthcare system that spent decades learning about the human body while treating one half of humanity as the default and the other half as a variation?

Yet this is, to a significant extent, the history of modern medicine.

Women represent roughly half of humanity, but our understanding of their health has not developed at the same pace as our understanding of the male body. And the problem goes far beyond reproductive health. For too long, women’s health has been disproportionately associated with fertility, pregnancy, childbirth and gynaecology. These areas are critically important, but a woman's body is not simply a reproductive system. Her cardiovascular system matters. Her brain matters. Her metabolism matters. Her immune system matters. So do her bones, muscles, hormones and mental health.

And these systems do not always behave in the same way in women and men.

The Male Body Became the Medical Default

There are historical reasons for this imbalance.

In 1977, the US Food and Drug Administration recommended excluding women of childbearing potential from early phases of many drug trials. The intention was partly to protect women and potential pregnancies following tragedies such as thalidomide. But the unintended

consequences were a major shortage of evidence about how medicines affected women.

It was not until the NIH Revitalization Act of 1993 that the inclusion of women in NIH funded clinical research became a legal requirement in the United States. That changed participation. But inclusion alone does not guarantee understanding.

Basic and preclinical biomedical research has also historically relied disproportionately on male animals and cells. In 2016, the US National Institutes of Health introduced its policy requiring researchers to consider sex as a biological variable in relevant research. Science is changing, but we are still correcting decades of accumulated imbalance.

Women’s Health Is Much Bigger Than “Women’s Diseases”

One of the biggest misconceptions is that women’s health is limited to conditions that exclusively affect women.

We also need to understand diseases that affect women and men differently. Cardiovascular disease is an obvious example. Autoimmune diseases, neurological conditions, osteoporosis, depression, metabolic disease and adverse reactions to medications can also differ according to sex and gender. Sometimes even the same medicine can affect women and men differently.

The sleeping medication zolpidem provides a striking example. The FDA found that women eliminate the drug more slowly than men, increasing the risk of next morning impairment. It therefore required lower recommended starting doses for women.

The molecule was the same. The dosage was the same. But the Biology was not. One principle I return to often in healthcare is that equality is not sameness. Providing the same pathway, dosage or intervention to everyone can look equal on paper while producing unequal outcomes in practice.

The Gap Is Not Small

The consequences of incomplete understanding are measurable.

A major World Economic Forum and McKinsey Health Institute analysis estimated that women spend about 25% more of their lives in poor health than men. Closing the women’s health gap could potentially unlock around 75 million additional disability adjusted life years every year and contribute as much as $1 trillion annually to the global economy by 2040.

The economic argument is powerful, but it should never become the main reason to act. Women deserve better health because health is fundamental to human dignity, opportunity and quality of life.

The research imbalance also remains striking. A 2024 editorial in Nature Reviews Bioengineering reported that in 2020 only around 5% of global research and development funding was allocated to women’s health research. Four percentage points were directed towards women’s cancers and only 1% towards other conditions specific to women.

Meanwhile, endometriosis affects an estimated 190 million women of reproductive age worldwide. The World Health Organization continues to highlight delayed diagnosis and inequitable access to appropriate care as major global challenges.

These are not marginal problems affecting a niche population. They concern half of humanity.

AI Could Close the Gap, or Automate It

This becomes even more important as healthcare enters the age of artificial intelligence, biomarkers, wearables, digital twins and personalized medicine.

I strongly believe these technologies can help us understand human health at a level of individuality that was previously impossible. But technology does not magically remove bias.

An AI system trained on incomplete data can learn incomplete medicine faster. An algorithm developed from populations that inadequately represent women may reproduce the same blind spots at digital scale. A wearable validated primarily on one population cannot automatically be assumed to perform identically across everybody. Precision medicine cannot be truly precise if the underlying science remains imprecise for half of humanity.

The objective, therefore, should not simply be to collect more data. We need better and more representative data.

From Including Women to Understanding Women

Closing this gap will require a shift across the entire health ecosystem.

That means designing research with women in mind from the beginning, analysing outcomes by sex where scientifically relevant, investing beyond fertility and maternity, building datasets that reflect different stages of women’s lives, and involving women themselves in designing research, technology and care.

Most importantly, we must stop treating women’s health as a specialist corner of healthcare. It should be embedded in cardiology, neurology, endocrinology, immunology, oncology, mental health, longevity, preventive medicine and every other major field.

And we should recognise that women themselves are not one homogeneous population. Age, genetics, hormones, ethnicity, socioeconomic conditions, geography, lifestyle and many other factors influence health.

The ultimate destination is therefore not simply gender specific medicine. It is better personalized medicine for every human being.

Understanding the Other Half

Healthcare is slowly moving from a model dominated by sick care towards one that can become more preventive, predictive and personalized. That transition gives us an extraordinary opportunity to correct some of the assumptions inherited from the past.

But we should not use artificial intelligence to digitize yesterday’s blind spots. We should use it to challenge them.

Healthcare equity does not mean pretending that everyone is biologically identical. It means making sure that our research, data, diagnostics, treatments and innovations are capable of recognising meaningful differences while treating every individual with equal value. Women are not a niche population, and women’s health cannot remain a side topic.

Women are half of humanity. Their health cannot remain only partly understood.

About the Author:

Philippe Gerwill is the Founder and CEO of PGEA Ltd, an executive advisory firm based in Abu Dhabi focused on responsible innovation, AI, digital health and longevity. With over three decades of global experience, he advises organisations on AI-enabled healthcare, personalised medicine and digital transformation.Philippe is also an international speaker and thought leader.

References:

Kennedy, E. M. (1993, June 10). S.1 - 103rd Congress (1993-1994): National Institutes of Health Revitalization Act of 1993. Www.Congress.Gov. https://www.congress.gov/bill/103rd-congress/senate-bill/1

Closing the Women’s Health Gap to Improve Lives and Economies. (2024, January 17). World Economic Forum. https://www.weforum.org/publications/closing-the-women-s-health-gap-a-1-trillion-opportunity-to-improve-lives-and-economies/

National Institutes of Health. (2017). History of Women’s Participation in Clinical Research | Office of Research on Women’s Health. Nih.Gov. https://orwh.od.nih.gov/toolkit/recruitment/history

Sex as a Biological Variable. (2025). Nih.Gov. https://orwh.od.nih.gov/sex-as-biological-variable

Research, C. D. E. (2018). Questions and Answers: Risk of next-morning impairment after use of insomnia drugs; FDA requires lower recommended doses for certain drugs containing zolpidem (Ambien, Ambien CR, Edluar, and Zolpimist). FDA.https://www.fda.gov/drugs/drug-safety-and-availability/questions-and-answers-risk-next-morning-impairment-after-use-insomnia-drugs-fda-requires-lower

Nature Reviews Bioengineering. (2024). Funding research on women’s health. Nature Reviews Bioengineering, 2(10), 797–798. https://doi.org/10.1038/s44222-024-00253-7

World Health Organization. (2023). Endometriosis. World Health Organization; World Health Organization. https://www.who.int/news-room/fact-sheets/detail/endometriosis