Introduction

Women spend more than 25% of their lives in poor health compared to men (6). The failure to deliver consistent, high-quality healthcare contributes to one-third of the women’s health gap, equating to 26 million disability-adjusted life years (DALYs) per year globally by 2040, or 2.5 days per woman annually (6). Addressing underscreening, underdiagnosis, and undertreatment is critical.

Understanding gaps through three pathways

Care delivery accounts for 34% of the women’s health gap, with cardiovascular diseases representing the largest share (7). Despite cardiovascular diseases causing approximately 35% of all global deaths for women, many providers feel underprepared to treat them (8). The report focuses on three pathways. First, breast arterial calcification (BAC) is present in 20-30% of mammograms and is linked to a 58% increased risk of cardiovascular events over time (9). Second, gestational hypertensive conditions, such as pre-eclampsia, affect up to 8% of all pregnancies, while gestational diabetes affects roughly one in seven pregnancies, elevating lifetime cardiometabolic risk (11). Third, an estimated 20% of women experience perinatal depression, highlighting the need for routine screening using validated tools (13).

The challenges and chance to act: Key gaps in care pathways

The report introduces the CARE framework to address care delivery challenges: Conduct research and gather clinical evidence; Align care and integrate referral pathways; Report using clear guidelines and standards; and Engage patients and health system stakeholders in patient-centred care (15). Current gaps include a lack of clinical consensus, fragmented patient pathways, absent standardised reporting, and low provider awareness (15-16).

The economic case for strengthening care pathways

Closing the women’s health gap could generate at least $1 trillion in annual GDP by 2040 (18). Across the three pathways, preventive care offers conservatively a 3x or greater return on investment compared to costly events averted (18). In the US, scaling improved BAC reporting could avert 17,000 to 60,000 cardiovascular events over seven years, yielding a 3-5x return (19). Similar returns of 3-5x exist for pregnancy-related cardiovascular care, while addressing perinatal depression could yield a 3-6x return by avoiding 5,000 to 10,000 adverse events (19).

Solutions

Solutions are categorised into basic, intermediate, and advanced levels based on implementation complexity (21). Healthcare systems should standardise routine reporting of BAC on mammograms, integrate obstetrics and gynaecology with primary care for lifelong monitoring of cardiovascular risk, and enhance the use of universal screening tools for perinatal depression (23-27). Providers must also increase patient awareness regarding disease management and follow-up care (17).

How the broader ecosystem can act to enable effective care delivery for women

Payers should embed best practices into guidance and reimburse hospitals for maternal health pathways, telehealth, and follow-up care. By introducing value-based payment models, early identification becomes financially viable (30). Stakeholders across governments, the private sector, and academia must also provide accountability mechanisms, develop effective services, and empower patients (30).

Conclusion

Closing the care delivery gap requires improving current workflows while redesigning future care models. The CARE framework demonstrates how stakeholders can act to deliver healthier lives for women while achieving financial and strategic benefits for healthcare systems (34).