Gender Impact On Health Is Huge - Women's Health Research Needs More Investments

[00:00:00] Dear listeners, welcome to Faces of Digital Health, a podcast about digital health and how healthcare systems around the world adopt technology with me, Tjasa Zajc. Did you know that migraine is three times more common in women than men? And two-thirds of patients with Alzheimer's disease are women.

[00:00:27] Gender differences are real and they matter. The Women's Brain Project is a Swiss-paced international non-profit founded in 2016. It comprises a diverse team of academic and social scientists, medical doctors, engineers, patients, caregivers, artists and AI experts

[00:00:49] and focuses on understanding sex and gender differences in brain and mental diseases to pave the way for precision medicine. This involves tailoring medical treatment to the individual characteristics of each patient, including factors like sex, gender, genomics and proteomics, microbiome, ethnicity and socio-economic status.

[00:01:16] I spoke with Antonella Santucione-Ciada, medical doctor and CEO of Women's Brain Project and Anna De, head of stakeholder engagement at Women's Brain Project. As we discussed, where are we with data about women's health specifics?

[00:01:35] What's driving research in women's health? What's the negative health and societal impact on women because of their predominant role in caregiving? And more. Enjoy the show! And if you haven't yet, make sure to check out our newsletter, which you can find at fodh.substack.com.

[00:01:58] A summary of this discussion and a broader topic on women's health is also going to be published there. Now let's dive in. Anna, Antonella, thank you so much for joining a discussion for Faces of Digital Health about the Women's Brain Project

[00:02:35] and the importance of taking sex and gender into account when assessing neurological issues. The Women's Brain Project is a Swiss-based international nonprofit organization.

[00:02:50] And for starters, I would like to hear a little bit more from you about what kind of research do you do and how does it get funded?

[00:03:00] First of all, thank you so much for this opportunity and the willingness to showcase the work that the Women's Brain Project is doing.

[00:03:08] What we are addressing is indeed the unmet need and the gap that exists in medicine of not considering sex and gender as a determinant of health. What we know is that women have not been sufficiently included in clinical development starting from phase one to phase three clinical trials,

[00:03:29] even when post-marketing localization studies without that sex and gender reported in terms of safety profile of drugs or clinical efficacy. But another big elephant in the room, it is the lack of consideration of sex and gender in preclinical research,

[00:03:46] meaning our experimental animal models that are used to characterize diseases, the way humans disease and what we need to consider to develop successful treatments.

[00:04:00] Now the same applies for digital technologies and there the bias also exists and that the sex used very often representing just part of the population being predominantly male.

[00:04:13] We do research on all these pillars that I just mentioned from preclinical to clinical development and even novel technology and digital innovation.

[00:04:25] The way we support our research, it is to have a network of highly-scaled researchers working on the science but also having collaboration with stakeholders such as the pharmaceutical industry, policy makers, regulatory agencies, etc. In this way we co-create, we have sponsorship and supports for what we do.

[00:04:47] We are now transforming from an association into a foundation and that's where we hope that even more capital to support our science will come. Now just one final comment, innovation and research has high costs with maybe not a direct immediate return of investment as for other area

[00:05:06] and that's why we need the commitment, support and trust of all stakeholders in fostering this evidence generation based exercise and invest in the great science we do.

[00:05:18] I want to go a step back. You mentioned basically that women have been underrepresented in the studies in clinical trials, in preclinical trials. Why exactly is this happening? Why did this happen? Is there a lack of guidelines in terms of the inclusion criteria? It's obviously a complex topic.

[00:05:44] I think that there are a multitude of reasons. First of all, medicine is an evolving science and learning and discoveries happens on a daily basis. I think that women were for a time period excluded from clinical development for all kinds of good reasons,

[00:06:00] considering also that there was a scandal in the 70s about the heterogenic effects of specific drugs on offsprings of women that were pregnant and included in trials. So there was the reluctancy for a time period to include women, especially in the childbearing age, into clinical development and trials.

[00:06:19] Nevertheless, times are changing. We have the evidence that by doing so, including women, we have not served the female population, rather harm them because they were proactively excluded.

[00:06:31] So we don't know for many drugs the way they really act on women and especially when it's about safety, what we also observe is that the female population experience more side effects than the male one very often. This was the case also, for example, with the COVID vaccines.

[00:06:47] And we believe that we have an opportunity to improve medical care, to improve research, to improve clinical development, to achieve what we call and define precision medicine. So to your question, many reasons, time to change, and it's a great opportunity for better clinical development.

[00:07:09] One other aspect I want to shortly touch base, it is just the bias that it is embedded in medicine, being mainly medicine developed, designed, created by male colleagues, which were the predominant workforce in the healthcare system and in research.

[00:07:28] A few years ago now we have an opposite trend where women are taking the majority of the seats in medical schools and scientific disciplines. Nevertheless, what we just seen published in Nature is that there is a huge drop out from the highly educated, skilled,

[00:07:46] research scientists and doctors from the highest position within academic and research organizations. So again, it is time to reverse this trend. It is time to retain the talent in the room and to correct for this intrinsic biases.

[00:08:02] So in general, humans are intrinsically biased. We are more prone to take care of things which are similar to us. So if you ask me, who will solve the problem? It's going to be the women in the lead that will solve the problem of sex and gender gap in medicine.

[00:08:17] And we need therefore more women in leadership. At the moment we are where we are. We've got drugs that are approved, that are on the market, solutions that are on the market and at the same time we see that they might not have been evaluated properly.

[00:08:35] But they are on the market. So given everything that you said, what's the process of going forward? What's the best approach for solutions that are already out there?

[00:08:47] So one thing is to change the criteria of evaluations for new things that are still about to come to the market. And the second thing is things like vaccines or products already out there that we now see through either side effects reports that have different effects on women.

[00:09:08] So do you think or do you see that there's more evaluation of real world data to figure out how can we still mitigate the knowledge that's lacking because of the differences in the gender responses to solutions and drugs?

[00:09:28] Well, based on my direct interactions with my colleagues which are still within regulatory agencies, I think that there is now a very high level of attention to this problem.

[00:09:39] And certainly big learnings are coming from real world evidences and real world data that are constantly characterized when a drug it is approved on a given market.

[00:09:51] And I think that the entire medical and scientific community is posing huge attention on this unmet need. And the publication, manuscripts, working group research activities are just happening to correct for the unmet need.

[00:10:06] So I think that we live in the era of big data. I think that data do exist. It's just to use the sex and gender lens and realize them and reposition the learning.

[00:10:18] I think it's a great opportunity for everyone because as soon as you take the sex and gender lens and start to look at the data, you will have so many learnings, so many new opportunities of redesign your clinical development to have those sex and gender specific

[00:10:35] tailored solutions to bring to patients. And this will benefit time to diagnose the way we treat the way we manage the patient, the way we reduce costs related to the health care system because by characterizing for example, drug interactions that we know it's a major issue in the female population with even little side effects like problem with deliver, etc.

[00:10:58] Or the immune system for example, it means that while characterizing this drug interaction and reducing possible side effects you will reduce the time to the frequencies of real hospitalization seeking for a new medical advice because a problem arrives.

[00:11:13] So I think that again there is a huge opportunity that it's ahead of us. We have to be the driver of the change and we will have better solutions, more sustainable, more affordable, more accessible for the patients.

[00:11:27] Women's Brain Project has been founded in 2016. So you have quite a few years behind you. Can you talk a bit about the key findings that you came across so far or the biggest successes that you had since the inception of the project?

[00:11:47] I will give the opportunity to Anna now to illustrate the great success on the policy side of things and then I might add something on the scientific side. Please Anna.

[00:11:58] Thank you so much Antonella. It's very important to note at the Women's Brain Project that the science informs the policy. So in terms of our policy activities we very much respond to the global policy agendas across the world.

[00:12:14] We liaise with policymakers. We're talking about the likes of the World Health Organization, the OECD, the United Nations directly, the World Economic Forum, these types of players and to some extent that does tells into EU policy and also of course national policy because healthcare service and delivery is very much a national competence.

[00:12:37] So we're very much involved in trying to shape a more favourable policy environment when it comes to looking at brain health and mental health through a sex agenda lens.

[00:12:49] And then what we try to do is to proactively inform the policy agenda so that from a policy point of view we have a number of Women's Brain Project led activities and also deliverables for evidence generation.

[00:13:05] So one in particular stellar piece of work we did from a research point of view was with the Economist Impact where we put forward a white paper looking at sex and gender and brain health research, how we could have a more inclusive research agenda.

[00:13:26] And this was very much a health economics analysis and basically the rationale was that if we have more of this approach in the medium to long term, we're not just doing for our health and for our brains.

[00:13:40] We're doing also better actually for society as a whole from an economic point of view. So very much going to policy makers saying that it's a bit of a no brainer, it's good for health.

[00:13:51] It's good for people. It's good for women and family communities at large but it also makes economic sense in terms of the benefits medium to long term as regards national gross domestic product and so on.

[00:14:05] So we had this economic piece of work that was issued as a policy white paper earlier this year. And now we're doing the second phase of this research with the London School of Economics and Political Science.

[00:14:19] And this part of the research will be a bit more granular, we'll be coming up with our own economic modeling and that will be launched during the course of Q1 2024.

[00:14:30] And this is how we try to actually further the knowledge base also from a policy point of view. So very much the science is informing the policy but then in terms of policy, we will actually come up with our own research as well and talk about that to key stakeholders.

[00:14:48] We also more from an advocacy point of view, we have awareness raising campaigns. We did one last year where we looked at migraine and we had a specific campaign on women and migraine as migraine is three times more common in women as opposed to men.

[00:15:04] So we had a specific advocacy campaign on that and also at the moment, we have a specific policy led campaign looking at how to enhance care in Parkinson's.

[00:15:16] So we really across the board from a policy point of view are point of departure is very much how can we respond to the policy agenda and that's not just in terms of brain health policy but also looking at social care, looking at technology, looking at education, looking at gender equality.

[00:15:37] So really across the board in terms of policy agenda. And then we also try with that very strong research piece coming up with our own research to inform policymakers of sex and gender differences when it comes to brain health and mental health but also being proactive coming up with potential policy solutions.

[00:15:59] So that's really important for us.

[00:16:02] Can you talk a bit more about the migraine research insights. So what have you discovered? How did the campaign look like? Who was informed about it? I'm, you know, trying to think what the next step could be should women receive different drugs should doctors be aware in a different way about how to treat migraines with women.

[00:16:28] Can you talk a bit more about that? Yes, of course. And then I'll pass over to Antonella who can talk about this more in detail from a scientific perspective. So we had a social media led advocacy campaign at the end of last year and it's still online.

[00:16:44] We still have a page there on our website so you can find all the campaign assets. So this was a specific women and migraine awareness campaign and it was called Not All in Her Head.

[00:16:57] So it was a play on when we dismiss something and we say, oh, it's just all in your head. So we wanted to be creative and we came up actually with our own campaign logo and then also this tagline Not All in Her Head.

[00:17:11] And basically we wanted to reach out to a number of different stakeholders. First and foremost, we wanted to reach out to the patients. We also wanted to reach out directly to healthcare professionals but also looking from a societal point of view of employers

[00:17:27] and then also reaching out directly to policy makers as well. There was a key policy component and we had a policy call to action. So our starting point was very much migraine effects three times more women than men as I've already highlighted.

[00:17:43] Also the symptoms tend to be slightly different in terms of women suffering longer tap duration and also having a higher recurrence rate. And basically we saw that through the campaign that many women are not diagnosed early enough

[00:18:02] and then also in particular in terms of healthcare professionals, they're not very much aware of the differences when it comes to sex and gender in migraine. Also what we wanted to flag in particular that migraine tends to impact women mostly during their peak productive work force years.

[00:18:25] So we very much wanted to highlight the impact this has in terms of the workplace, whether that's missing days off work or actually still going to work but not being fully engaged in the workplace because of the impact of migraine

[00:18:41] and also making sure that people understand that migraine is a really, really very challenging condition. It's not just a headache so it's not just oh you have a headache take a painkiller. It's much more than that.

[00:18:56] It's a serious neurological condition and it can have a huge impact on daily life impacting careers and family life and women tend to bear the brunt of that. So we were putting across all these key measures and then from a scientific point of view

[00:19:14] we do understand that female hormones can be a migraine trigger as well. So that was also looked into from a scientific point of view but certainly Antonella can give more details in terms of the science on this.

[00:19:29] I think that we have an abundant scientific evidence explaining why the female brain and body is more prone to a migraine attack because while it is certainly your head that hurts it's your entire body that stops to function.

[00:19:46] We still don't know why female hormones really play such a major role in many diseases area not only in the migraine. Migraine is just an example. We have the same issue and unsolved mystery in Alzheimer's disease. We have it in multiple square orders.

[00:20:01] Why we have that the female body and the female or moral setting impact those diseases in a different fashion than in men in terms of prevalence, disease progression, diagnostic treatment response etc. So that said I think that our work is really aimed to understand the science

[00:20:21] and then translate the science into those political measures that needs to be taken to facilitate a life of citizens living across the planet and of course each nation, each geography, its geopolitical constellation will have its specific needs.

[00:20:38] One of the findings that I saw in one of the videos that you did was around the findings in Alzheimer's disease and the fact that two thirds of patients are women. Can you talk a bit more about that? Do we know why does that statistic come up?

[00:20:59] Is it related also to age? I was thinking that women have a longer lifespan than men so technically speaking men have a lower chance of actually reaching the age where they might see the symptoms of Alzheimer's disease. So what has science shown so far around that?

[00:21:18] I can start with an answer and then maybe I might want to add. First of all let's say that we have to discuss on the myth of women living longer. Yes, women do live slightly longer so it's not about 10 years or 20 years.

[00:21:35] It's about a couple of years in average in our western societies. So the question is how do women age? And in terms of co-borbidities and quality of life for elderly women the data we have are not very encouraging.

[00:21:51] What we know is that women do have, as you rightly said, a majority of dementia cases. We know that women suffer from chronic diseases like depression much more. We know that women have problems with the mobility system

[00:22:04] and how we move in time and space in terms of muscle strength and so often they become embedded. To a point that the OECD shared data lately pointing to the fact that the majority of the women worldwide, at least for the nations that share data with OECD

[00:22:21] are indeed women. So it's been about nearly 80% of the affected population. But interestingly and sadly the women represent the majority of those that are institutionalized meaning elderly homes or nursery homes. That's because very often they don't have a caregiver, their widow and nobody cares for them.

[00:22:42] This translates into even a higher prescription of antipsychotic. Antipsychotic drugs are a poor indicator of standard of care. So I hope you understand that the problem is huge. The same is true for painkillers. Women had a higher prescription of painkillers when they become old

[00:22:58] pointing to the fact of what I said that they have more co-barbidities. They have a much more painful life at the end of their existence and we need to change this trajectory. Alzheimer it is not really well understood why should be more female in fact.

[00:23:15] Lots are speculated about hormones, the fact that there might be profound changes between the perimenopause, menopausal phase, but I will add that the problem is even rooted in earlier phases of our life. Let's think for example about sleep deprivation.

[00:23:35] Sleep deprivation it is much a female phenomenon due to the fact that women do care give, women are having pregnancies and quality of sleep is very poor while we breastfeed, while we are pregnant or while we care for our toddlers.

[00:23:51] Meaning that this lack of sleep will be also a specific female risk-rector for Alzheimer. These are all things that are at the moment investigated in the medical and scientific community. We need to generate the data, but I think that what is even more important

[00:24:05] is to understand how this translates into a more better care. For example we've had three let's say two approved drugs in the United States and the third one which unfortunately failed in rich in clinical efficacy and we have had some disease as disease modifying treatment.

[00:24:22] What we learned with our big surprise and now we are trying to understand and characterize this data even better at the women's brain project is that the trend shows that those new approved EMT seems to act better in the male population and not in the female population.

[00:24:38] Just to say that it's not all in our head, as Anna said before, the data speaks for the fact that this matters, sex and gender differences have an impact in treatment response in safety profile of drugs and we need to take this into account,

[00:24:52] reduce costs, improve quality of life and avoid, as I said, even little side effects in some cases that actually in the past shown that out of ten drugs that were withdrawn from the market ate because they had major little side effects

[00:25:08] in the female population and that's not a joke. It's not a joke for those who perish, who die, which means women. It's not a joke for those who would devolve and devote their life to the research

[00:25:19] for twenty years, bring the drug on the market and then have it in goes into the garbage and it's not a joke for those who might have benefit of this drug because I strongly believe that even in some set of patients that drug might have worked

[00:25:31] but it's just unfortunate that it wasn't characterizing women mainly causing arrhythmia and therefore little events that this drug is to be completely withdrawn from the market for everyone men and women, tall and short or whatever

[00:25:44] and that's what needs to change if you want to also reduce the cost of the impact of all this because this is a huge economic loss. What I started wondering while you were mentioning all these findings is what is the relationship between research and medical practice

[00:26:06] so to which extent do you see that these findings are recognized in the medical community and also we are now trying to quantify the issues related to gender differences in everything that you talked about but at the same time clinicians see thousands of patients

[00:26:26] they might notice differences and differences in responses already in their clinical practice What are your observations there? I was a clinician myself and I was staying on a daily basis with patients living with dementia

[00:26:42] I was trying to give a proper diagnosis of medical treatment and help the way I could and actually this was less than 12 years ago nevertheless I didn't realize that majority of my patients were women so it was for me a high opening attending an event in Lausanne

[00:26:59] where some advocate came and said that some are female and I said what? I'm seeing patients every day, I've never realized that So to your question it's not a given that the medical community knows about all this sex and gender diversity

[00:27:11] in terms of symptoms, disease progression, treatment response and safety profile of drugs as well as adherence to given treatment so we are educating proactively on this for example we are launching and Hannah would expand on this a series of educational events with Madscape

[00:27:29] just to exactly do what you said Educate the healthcare professional worldwide on those differences these are slight nuances but those slight nuances might lead to a delay in diagnosis of 5 years and here's an example I was the one who diagnosed unfortunately a friend of mine with Marty Brusquerozes

[00:27:49] she was coming back from finally an MRI she says come up, have a look at the scans and tell me what's going on and I was the one who had to convey the very unfortunate message of course she was a friend, a delicate situation

[00:28:02] but the story is that she was 5 years in and out of hospitals in this part of the world so I'm talking about Switzerland, France, Italy highly developed healthcare system where she was told she was depressed she had depression, she was stressed at home

[00:28:19] she had labirin tides, she had all possible diagnosis with even hospitalization until 5 years later someone told let's do an MRI and noticed that she had plaques all over the brain and all over the spine and nobody really thought of that earlier

[00:28:34] so now these slight nuances or this prejudice, these preconcepts these biases we carry as professionals in our brain might lead to a delay in diagnosis of 5 years in a highly educated lady and in a highly advanced healthcare system so imagine what happened in the rest of the world

[00:28:55] and with this I stop Anna did you want to add anything? I would just say that goes back to our starting point that we look always at sex and gender differences so to enter another point, it's not just the sex biological differences between males and females

[00:29:14] it's also the gender differences so it's as a woman goes through the health system how is she acknowledged and treated by healthcare professionals so indeed in a bit that was highlighted during our Migraine Awareness campaign

[00:29:28] but also to enter another point we cover a whole raft of neurological conditions we see that time and time again that women are dismissed or there's a lack of real appreciation and understanding from healthcare professionals it could be that a woman is dismissed as just being depressed

[00:29:47] when there's something else going on so it's educating and informing a whole range of different stakeholders on this and coming with us on this journey to improve patient care for everyone although we're a women's brain project we also care about men's things as well

[00:30:06] we don't just care about the patient we also care very much the caregiver as well because when it comes to neurological conditions the unpaid caregiver burden is quite significant and in most of the caregiver burden in that setting whether that's family members or friends

[00:30:25] is dealt with by women as well so we also have to make sure that we're supporting them and also from the policy and societal point of view what is the impact of that caregiver burden as well so we do a lot of work also in that space

[00:30:40] and then specifically just back to the point of Alzheimer's a lot of people ask us oh it's just because women live to be slightly older in general that perhaps you have two thirds of all patients with Alzheimer's women, that's part of it but there are also other factors

[00:30:59] those might be hormonally led there are other factors but I think a real key statistic is that at the age of 45 you take a woman who's 45 she has a one in five chance for the rest of her life course of having Alzheimer's disease

[00:31:16] you take a man exactly the same age 45 he only has a one in ten chance for the rest of his life course of getting Alzheimer's so there's something else going on there and that's why women's brain project we really want to ask the questions

[00:31:30] but we want to find the answers and many times we start to do the research and we find out people haven't even looked into this area so that's why we look very much we're driven by the research and we're like okay if we don't have all the answers

[00:31:44] we're going to find the answers so whether that's through the science or the policy we try to find the answers I think that's really important and then just more from a public awareness point of view which I find fascinating I'm based here in London

[00:31:58] and I speak to so many women and when I say I'm supporting and leading efforts for the women's brain project as regards policy and advocacy and they're like oh women's brain project what is that and what are you doing and then I mention to them

[00:32:12] in terms of the disproportionate burden or whether it's Alzheimer's multiple cirrhosis, migraine or if you look at even some stroke after menopause that affects more women than men after menopause and stroke is commonly thought as a man's disease but you told many educated and informed women here

[00:32:34] when I'm networking at events in London and they have no idea absolutely no idea so I think a lot of it is quite simple it's us as women having these conversations and informing and educating ourselves so it's only my background as a global and European health policy

[00:32:52] and you would have asked me some years back and I was this women's health and I would have told you it's women's health means reproductive health it's very much connected to that side of things whether that's in C, it's menopause and these types of things

[00:33:08] it affects breast cancer I didn't think women's health was so women's health is also brain health it's also mental health it's also cardiovascular disease so when you think of health differently that we have women's health and we have seeing it from a different angle

[00:33:26] it's very important that we educate informed and as women we empower ourselves and we have these types of conversations so what I'm hearing is that basically we are identifying the right questions but we're in very early stages of getting the right approach to finding the answers

[00:33:44] and which data do we even gather because causation is not necessarily correlation so it's very tricky to even think about where do you start the research well as I said earlier I think we have plenty of data it's just an exercise of analyzing this data

[00:34:02] using the sex and gender lens and making sense out of them it's also about all the data already existing in house and repurpose this data with the question what if I would have had more women included you can do a lot of modeling exercise also thanks to

[00:34:18] novel technologies like AI so the question to pose what if I would have more female patients in this specific disease area in terms of the response I would have had given outcome of a trial that I was designing so the opportunity is huge I think

[00:34:34] we know which are the questions to pose we also know where to find the answer what I think we need to do it is to power for it meaning putting the financial resources behind it to let this change to happen it costs a bit more

[00:34:50] we all know that if you want to make more precise solutions you have to invest more up front but the return of investment in 10 years 5 years from when you started it's going to be much bigger and that's again a very much female way of thinking I think

[00:35:04] that women have the long strategic planning we are trained like this just in our role as mothers even right you get a child you don't think about the child survival just today you just worry for the future of this child by default so

[00:35:18] that's why I re-emphasize the fact that the female scientist the female doctors the female policy makers the female communicators the female decision makers have to take lead and fix this on the long term because it's not going to be a solution that will happen

[00:35:32] tomorrow you need to transform proactively with time and along the journey one thing that I want to emphasize about Alzheimer and women it's one point that it's very dear to me but I know that it's even more dear to our mind the role of caregiving and women

[00:35:48] and a specific risk factor for diseases like depression and dementia itself what we know is that if you are a caregiver and this is a job that comes at 24 hours 7 you have a higher likelihood of being socially isolated which cause you at risk of depression

[00:36:04] and even at some disease this is what WHO says and this is what the science scientific evidence support so even here we need to have a change the policy level to guarantee that a woman which majority of the female caregivers are women paid or unpaid

[00:36:20] end up doing this job for good and night and day because we pose at risk the health of that individual so we need to have policies to support on the caregiving to divide the work which is so overwhelming that can represent a burden for our brain health

[00:36:42] and that's not a joke because then you become yourself the patient that will impose the need of caregiving with burden for society burden for your family, burden for healthcare system so it's all about prevention it's all about putting in place the right strategies the right policy measures

[00:37:00] to prevent this to happen and lift the heavy weight that it is on the shoulder of women and that's all over the world so it's all about our lifetime it starts when we are young girls to till the end of our life if you would have to pinpoint

[00:37:20] to three things that you hope to see happen to move the needle forward what would it be like the three things to just yeah the three key things that need to change I know that you basically talked a lot about that in your last answer but still

[00:37:36] if you would have to for me the most and I'm learning this the hard way on a daily basis there is this striking numbers of just 3% of investment given to innovations driven by women three verses the man who get it all now to solve this problem

[00:37:56] it's not only about innovation it's about putting the money behind the science to answer those questions we discussed so we need funds we need money behind it we need someone that's the check go and do your job across sectors across academia across everywhere we need to

[00:38:14] do this everywhere so for me it is the investment people need to invest and understand that there is a huge return of that investment in terms of quality of the way we do medicine equity diversity inclusion a better world a better society

[00:38:28] and a better care and that's your turn I would love to see sex and gender differences in brain health and mental health prioritised on global, EU and national policy agendas and I think we're starting to get there but in terms of policy it's not

[00:38:46] just regarding brain health policies specifically or even health policy it's beyond that as I mentioned earlier whether that's social care employment policy technology policy gender equity equality education across the board we really need to have this major priority and especially so as we're living in

[00:39:10] an increasingly ageing population and so on and I think to Antonella's point about women and caregiving that I'm particularly passionate about it's, I find it very cruel actually when you think about women as caregivers because I think as from little girls onwards we're seeing more as the

[00:39:30] caregiver and then basically there's a certain point that we as women are socialised to do all the caregiving and then because to the point earlier that women tend to live slightly longer in general than men that when women then need care themselves there's no one left

[00:39:48] to care for them so their care needs at a certain point become very different and then they need to rely on institutionalised care and paid care as well so it's almost oh thank you for the years you've cared perhaps your partner and so on

[00:40:04] and now it's your time to care you're completely, now you're ill you don't have the financial safety net you don't actually have a partner so thanks for your caring but now you need care who's going to help you so also I think that's also not just about

[00:40:20] brain health, physical health emotional health it's also about financial health as well in terms of what is women's health what is women's health what is women's health what is women's health what is women's health what is women's health so that's obviously part of the policy agenda

[00:40:40] so that's what I'd like to see prioritised from a policy point of view and then the second thing I think mainly and that's back to my point earlier is that let us as women as a community come together really educate and inform ourselves

[00:40:54] that it's not just women's health it's reproductive health reproductive medicine it's beyond that it's much more I think I'm really passionate about we as women and I'm talking here more about the lay public as women they're educated informed about the risk factors and also about a woman's journey

[00:41:12] throughout the life course as well so whether that's from young adults right up to the way to perimenopause postmenopause that we're really educated and as women I think that's really one of my my passions that we re-talk more and we support each other as a community

[00:41:34] and I want to make a comment on this we don't even really know what it is menopause that's the truth I think that there isn't even enough evidence of care or consideration of what menopause is so we need to prioritise a lot

[00:41:50] in terms of the research we do and how we shape the patient management a lot of work and I think that the change should come from the younger female generation educated as scientists as doctors, as leaders to make the change to be

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