Women's Health: What it is, how it's funded and what changes do we need? (Joy Rios)

[00:00:01] Dear listeners, welcome to Faces of Digital Health, a podcast about digital health and how healthcare systems around the world adopt technology. With me, Diasia Zajc. Debates around equity and equality, especially when it comes to men and women and female representation can get very heated and divisive very quickly.

[00:00:27] As part of the Healthcare Business Women Association in Slivenia, I organized a meetup in June where we didn't focus as much on the need for diversity in management ranks, but rather on women's health. For a long time, female bodies have been perceived as male bodies with different reproductive

[00:00:47] organs. However, differences go way beyond that. 80% of people with autoimmune diseases are women, 66% of patients with Alzheimer's disease are women and symptoms of cardiovascular diseases present themselves differently in women and men. If women have health issues, that trickles down to their productivity.

[00:01:13] So I invited Joy Rios, founder of Hit Like a Girl Media, to join the discussion on women's health and how the specifics of women are impacting the digital health companies and landscape. While there are still less than a quarter of CEOs among the ranks of leaders of digital

[00:01:32] health companies, if we look at the FEMPTEC space specifically, 76% of co-founders and CEOs are women. So in today's episode you will hear a recording from the Healthcare Business Women Ljubljana meetup. Enjoy the show and if you haven't yet, make sure to subscribe to the podcast

[00:01:52] to be notified about new episodes automatically. And also check out our newsletter which you can find at FODH.substack.com. That's FODH.substack.com. Now let's dive in. I actually decided that we're not going to talk as much necessarily about discussions

[00:02:26] that we usually have about how many men or how many women should be in companies that we're actually going to focus on women's health, which is a field that's not in the process of discovery, just to set the scene a little bit.

[00:02:40] And since you know how they say you can trust in God but everybody else should bring data, I'm just going to present a few things to highlight what actually are we talking about when we're talking about women's health.

[00:02:52] The immediate kind of associations are usually applications and solutions for menstrual health and checking your cycle. Pru is one of the most successful companies in Europe in this field. Then there's LV, another really successful European company that focuses on the pelvic floor training and breastfeeding pumps.

[00:03:11] There's Rosie that focuses not just on OBGYN issues but also sexual health and things that we are uncomfortable talking about. And this is something that's really changing with the field of women's health. Discussions about longevity and ovarian health and how that impacts aging.

[00:03:30] Or for example, two gynecologists from Charité Medical University centers designed an app for rape victims because what usually happens is that they come to the ER, they don't know what to do with them. They go to the police office and they don't know what to do with them

[00:03:45] and you only have 72 hours to collect evidence if you want to prosecute the sex offenders. So these are all the solutions that are being developed in the field of women's health. The majority of people working in health care are women. Women make the majority of decisions in families.

[00:04:04] However, historically only 4% of R&D budgets went into topic specific to women. In drug development, inclusion of women in clinical trials has improved but that hasn't been the case in the medical device space. YAMA research showed that one third of women is involved in clinical studies

[00:04:22] for medical device trials. There's sexual health issues that we actually just don't really talk about, know about. Doctors don't know about it so they don't know what to tell patients. And menopause is something that we don't want to see as a disease

[00:04:36] but we do want to put more research into it so we can understand it better and manage symptoms easier. I mentioned that the research field is still in its very early stages and the sad thing that I hope is going to change is that

[00:04:51] now the field of FemTech is growing but obviously for female VCs can identify with problems more easily so they're more eager to fund these companies. However, research shows that if a woman funds the first round of a company

[00:05:08] that company is going to have a harder time raising the second round because there's this inherent bias that the first round wasn't based on merit but on some sort of peer-to-peer support. But we're talking about these things and also even though the digital health funding

[00:05:24] is falling in the last few years, if you look at the investments in FemTech inside this whole field it's actually increasing. And it's not just about all the problems that I mentioned before, it's also realizing that because we haven't studied the biology of women

[00:05:40] we don't know a lot of things. We don't know why 80% of patients with autoimmune diseases are women that basically cardiovascular diseases present differently in men and women and that dementia and Alzheimer's are more prevalent in women.

[00:05:54] So this is something that we need to address and this WEM report also shows that by investing 350 million in women's health there's a potential 40 billion US dollars ROI on investment which is a huge return on investment. So this is why this topic is important to talk about.

[00:06:13] In Europe there's a Swiss organization called the Women's Brain Project that's in the foundation investing in this research because the problem is that not all clinical trials are nationally funded and what I'm basically saying is that this is not necessarily very...

[00:06:31] So research is not necessarily profitable or straightforward from the beginning. So we need policies, we need awareness to actually know that we need to invest in these things a little bit more. And this brings me to Joy Rios and to our discussion.

[00:06:46] Joy, tell me first of all how did you actually get into healthcare and how did you end from healthcare IT to then founding a hit like a girl? First of all thank you all for having me and thank you for speaking English.

[00:07:01] My entry into healthcare was I took the long path. It was not a straightforward thing. I didn't get to it until I was about 30 years old. I started as an English major. I went to go get my graduate degree.

[00:07:12] I studied sustainability as part of my master's in business administration but really with the focus on social and environmental and how can we look at how corporations can do well but also do good. Do well by doing good. And I had been working for a solar startup.

[00:07:32] I honestly thought that I was going to be in the solar, utility scale solar for quite a while until I got an invitation to join my uncle's document management company that had been coincidentally I'd been part of since I was a kid but without realizing it.

[00:07:49] And as I got older and had this experience with the startup, this solar startup he invited me to join and it was in 2010 and a time when policy was changing. It was the American Recovery Reinvestment and Recovery Act

[00:08:06] where they put billions of dollars and set aside about 60 million dollars for the implementation of electronic health records. And having been new to the industry, I did a lot of research. I didn't know anything about it and wanted to know why doctors should move from paper into electronics.

[00:08:24] So I went in to my English major mind and basically studied the policy and I went down and just like how can I understand what the policies are, why it matters and what are their implications.

[00:08:38] And that has served me well because it essentially helped me learn about why we would be implementing what was in it for doctors. It translated into me writing curriculum and then eventually going, traveling around the country all over the United States,

[00:08:55] going into independent medical practices and then teaching them about those laws. And not only what do they need to know about those policies, but how is it going to affect their reimbursement rates? What kind of training do they need?

[00:09:07] And it essentially felt like being a data accountant, like a tax person. Because ultimately the government wanted this information on an annual basis and so we're collecting healthcare data, quality metrics, how they're using their electronic health records

[00:09:24] and that essentially was scored in a way that turns into their reimbursement rate for Medicare, which then gets copied by commercial insurance. And anyway, it's quite complicated. And for people that already have a complicated job, it's hard to keep track of.

[00:09:40] So my job get to be like, hey, here's this maze, I'm going to help you through the maze. And how did you then get into amplifying women's voices? Or what exactly, why did you choose the name, hit like a garage for the cause and for the community?

[00:09:55] After several years of traveling around and supporting these medical practices, I also would go to a lot of healthcare conferences and I recognized that a lot of the people that I was experiencing and working with were women like you guys have mentioned.

[00:10:10] However, when it go to conferences and summits and whatnot, the people that were up here on stage were most often men. And it just wasn't connecting. And I was like, how is it possible that there's all these women doing the work and yet we're not learning from them?

[00:10:24] We're not asking them about their expertise. We are not leaning the wisdom that they have. And I had read some statistics about amplification and why it matters to speak about other people. It's not to say, hey, I'm the best at this thing.

[00:10:39] If I were to introduce myself and say, I'm really good at this thing, you might not believe me. You might think that I'm arrogant. But if I say, or if Tiage says she's really great at this thing, it's more effective.

[00:10:52] And so I decided to turn that into the podcast and so that I could create a platform of literally just saying, do you know about this woman? She's incredible. Let's hear about all the things that she knows.

[00:11:04] And so I very intentionally only invite women to be on the podcast and it is called Hit Like a Girl, health IT, like a girl, to reclaim that feeling of what it means to be, to do something like a girl.

[00:11:21] I know that we have a connotation that means, oh, if you run like a girl, you're running slower or maybe more awkwardly or something. But I wanted us to reflect. And I wanted to create a place where we could reflect, why do we think that?

[00:11:33] Because women are strong, women are capable. They're perfectly experts in their fields. And if they're doing something like a girl, then it is actually the opposite of weak. It's actually quite strong. You have to remind me of a research that I read around

[00:11:49] the differences between men and women and how we negotiate, but not just how we negotiate also, how our negotiations are perceived. So for example, a job interview was mentioned earlier by Urska and this is research talking, not me. But research shows that if a woman is going

[00:12:07] to negotiate for a salary, she's going to be seen as kind of someone difficult to work with. In contrast to a man negotiating for a salary, it's gonna be perceived that all this guy is going to bring money into the company. And also in research terms,

[00:12:23] women didn't achieve higher salaries in negotiations when they were negotiating for themselves, but were much better at negotiating when they were negotiating for someone else. Going back maybe to women's health more specifically and the fact that we put more money into this research.

[00:12:42] Two big things happened in the US this year, a lot is happening. One was in February I think, so in the beginning of this year, a White House initiative was established to basically put more money, 100 million US dollars into research about cardiovascular Alzheimer's disease,

[00:13:00] endometriosis and other health issues. What kind of discussions do you see after this initiative and what does this signify in the field? I think that one of the things is that it's an acknowledgement of historical neglect. We really have not been,

[00:13:16] like the female body has not really been studied in history, in our clinical research. And so we're lacking a lot of data about why women have these imbalance of Alzheimer's disease and they present in all these other areas. Pain is experienced differently and we don't know why.

[00:13:36] So it's, a lot has happened. We've lost some rights. Of course I'm sure you're aware that the road got overturned and so we lost the right for women to get an abortion. But then other women's health issues are coming up as a response to that.

[00:13:53] And so in a way that's a good thing because 100 million dollars unfortunately isn't that much. There's another push to put an additional 200 million dollars towards it from a different set of funding. And then also Melinda French-Gate has just announced a two billion dollars that she's putting towards

[00:14:15] removing the barriers that women face. And so that also affects how we show up in our health. Another thing, basically, since we're diving a little bit into politics, another thing also happened a few weeks ago and that's a new pack on women's health.

[00:14:33] So can you explain a little bit what a pack is and everything that happens around there? So in the United States, we have political action committees and we also have super packs. That might be a term that you might be familiar with.

[00:14:48] And essentially it's when a group of people come together and they decide what they care about. So they are funders, they are donors and they raise money to put towards candidates that care about the same things that committee believes in. And so for the first time ever,

[00:15:06] a women's health political action committee has been formed to just focus on all of women's health. And so it's across the country, we're collecting money and identifying candidates who align with supporting their research and funding and advancements of information in women's health. And the interesting part about it

[00:15:31] is it's a difficult thing to get bipartisan support on anything right now in the United States. We're very divided in a lot. And the way that they have been able to create that bipartisan support is to actually focus on all of the aspects of women's health except abortion.

[00:15:51] So they have carved that out so that they said that there's plenty of other organizations that are dressing and focused on that particular issue. But there's so many other health issues that women face that they deserve just as much attention. And so that's what that political action committee

[00:16:09] is working towards. And it's great to see advancement and just like a collection of people saying, yes, this is important. I do wanna talk a little bit about the abortion rights because it trickles down to the economy and the options that women basically have.

[00:16:29] So at the moment, one in five women in the US has to go into another state to get an abortion. Abortions are being banned but women are not getting any additional support if they do get a child and need to raise that child.

[00:16:41] And yeah, it's just is a huge economic impact. Do you see also any impact that this has on startups, on digital health companies? I mentioned earlier that a lot of companies focus on menstrual cycles or on digitally tracking or trying natural contraception, interestingly enough while abortion is now

[00:17:05] getting more and more restricted. Last year FDA in January made contraceptive pills available over the counter so you don't need a prescription anymore but now there's coming restrictions for abortion pills. What do you see in terms of the impact

[00:17:22] on startups or initiatives that are trying to mitigate it? There's a lot that is upsetting. And one thing that I feel like we're exacerbating problems, the US already has what we call maternal deserts and there's areas where, rurally, there's not actually, they're not critical access hospitals

[00:17:42] where women have to already before this even happened had to travel either out of state or hours and hours to get the care that they would need. And one of the difficult aspects about trying to navigate it is that the rules are different in every single state

[00:17:58] and trying to, where there's 50 of them plus some territories and so what might be breaking the law in one state you travel two states over and it's perfectly fine. But when we talk about how do you, the technology behind that, how do we secure data?

[00:18:13] If somebody is getting care, what, how their documentation, what gets shared and what stays private, who has access to that? Because unfortunately, there are now punitive damages where people can actually, the physicians can go to jail, patients can be punished and go to jail

[00:18:30] and the part that is scary is for things like, I always bring it to an ectopic pregnancy. So when an embryo is in a fallopian tube and is not viable, they are creating policies in states like Texas, Alabama, Louisiana, Mississippi, et cetera

[00:18:48] where the women's life may be in danger, there's no possibility for that baby to survive and yet it is illegal to give them medical care. Some of the digital health apps that I have seen there is one that has taken

[00:19:03] and it's a bilingual, it starts actually in Spanish and it's modeled off of supporting people in countries like Venezuela where they don't have access to anything but they need to be able to support women to either self-abort or have people within their community help them

[00:19:21] and get access to information where they could get the treatment that they need. And so it would be digital and is one interesting thing. There's also more telemedicine and the ability to get care virtually and have mail in prescriptions so that they can,

[00:19:41] and that was something that was passed during COVID because it made sense that if people couldn't be there in person that they could get their prescriptions through the mail but even now that is being taken away and a little bit about the, it's affecting contraception

[00:19:56] it's even affecting IVF treatment. And so one of the things when we think about like abortion being supportive of families, of choice, families that are going through IVF treatment are finding themselves in a pickle because of the way certain folks are defining what is human life.

[00:20:17] And so if you have an embryo, if a family is trying to get IVF treatment and they have 40 frozen embryos but only one of them is gonna become a baby, the state of Alabama is now leading the charge that if you dispose of those other 39 you're essentially aborting

[00:20:35] and then that can have legal action and then now you're gonna be punished for that. And it is wild. It is like the, it's a wild and crazy reality of trying to navigate that if that's the truth in Alabama then if it gets passed in one place

[00:20:52] it can easily spread in others. And how do we, how that puts doctors, nurses, medical staff in danger because they don't want to necessarily provide those services for fear of being punished and how do we do the best, do no harm?

[00:21:07] And it's just, it's amazed like no other. And so I think that there's a lot of digital health companies that are trying their best and it's okay if we can't do this, let's figure out what we can do and support in those ways.

[00:21:20] And it just seems okay, then the folks decide that is a problem and we just keep pivoting and I'd like to say that good is gonna come out of all of this but it is, it's enraging to be honest. It's frustrating that we're here right now.

[00:21:34] If we try to maybe uplift the mood a little bit What has inspired you lately? Yeah. When it comes to women's health or kind of more broadly? I would start by saying one, I'm gonna stick on one more sad thing, one.

[00:21:51] It's like decision makers and the men who are often in charge of writing policy, creating rules and putting writing checks of deciding where funds go. When they're not understanding the effects and consequences of those decisions and the human lives that affects, it impacts all of us

[00:22:10] and it's very dangerous. The thing that has been inspiring me and so one thing I geek out on is policy and I moved to Mexico about five years ago and I've got my dual citizenship in this last election I had an opportunity to vote

[00:22:26] and this was the very first, I got to vote for the first female president in North America. So Mexico beat both Canada and the United States in accomplishing that goal. And as I was doing my research on the candidates and this is the thing, both candidates

[00:22:45] for president or women. So it wouldn't have mattered who I voted for. Either way a woman is gonna win. And to your point earlier, this whole idea of imposter syndrome of just who knows if she's gonna be a great president? She might be a mediocre president

[00:23:02] but there's been plenty of mediocre men presidents so I'm wishing her luck. I think it will be, like I'm excited for it. But in pulling back why and how this happened it, I've found and discovered that it had to do with a change in policy in Congress

[00:23:20] in the Mexican Congress in 2019. They made it that by law for any political party. So from the federal state judicial, any part of the legislator, any candidate, a woman needs to be on the ballot. And so since then 50% of the Congress members

[00:23:40] are now women and mayors of big, of mayors of Mexico city, mayors of the town that I live in on both sides are both women. And when I was looking at and again the candidate on both sides it had to be a woman. It took five years.

[00:23:56] It took five years to change the equation and it's a massive change. I'm excited to see how, I didn't think that moving to Mexico would actually, I would find myself in a more progressive place. Like that math didn't add up

[00:24:11] but it's really neat to see that's been the result and I'm hopeful that just understanding of how policy can affect and drive change we see that in action. Maybe just to explain that a little bit more. So women just had to be on the ballot.

[00:24:27] It's not that this was a photo that they had to be, like how many women but just at least one or what? There's multiple parties in the US for any position that's out there doesn't mean that you have to put it for it.

[00:24:40] If you're gonna have candidates on the ballot from any political party then if they're going, if they're gonna recommend four people two of them need to be women essentially. You talk to a lot of women that work in business if somebody wanted to start a business.

[00:25:01] Like what are the key three things that you would advise them to do? I have all the answers. No, I would say first is if you're starting a business in healthcare or health IT identify areas that are not yet being worked on.

[00:25:18] I mean that there's a book called Blue Ocean Strategy. I identify if all of your peers are focusing on this, focus on the one thing that isn't being focused on so that there's opportunity and more opportunity there. I think women are challenged by finding,

[00:25:34] by getting funding but ultimately by if you are in a position to start something don't be afraid about the regulations and compliance especially in healthcare bringing that in as part and understanding how it affects your product is something that is really valuable.

[00:25:53] It'll work in your favor more so than not. And then I'd say lastly community. I there's so much value in finding your peers, people that are passionate about this things that you care about and that want to see you succeed. And I think that was it.

[00:26:09] I started a podcast but it has grown into something much bigger and really the community of just becoming visible and being afraid to speak up. Showing yourself so that others can see you and that way you're in a position to make connections,

[00:26:26] leverage what you know and compliment each other's strengths and ultimately we've touched on it before but the collaboration aspect of when I see my peer succeed I don't take it as a failure. Doesn't mean you succeeded so I lost. It's no absolutely not.

[00:26:44] You succeeded which means you open the door for me to follow in your footsteps and really trying to consider each of our wins as a collective win. You've been listening to Faces of Digital Health, a proud member of the Health Podcast Network.

[00:27:01] If you enjoyed the show, do leave a rating or review wherever you get your podcast, subscribe to the show or follow us on LinkedIn. Additionally, check out our newsletter. You can find it at fodh.substack.com. That's fodh.substack.com. Stay tuned.