You're listening to mistreated. I'm Nam Kiwanuka. Back in October, the McKenzie Health Institute published an analysis that showed how women's health and productivity in the workplace [music] are quote deeply interconnected.

It examined how addressing the gaps in women's health would benefit the Canadian economy, especially outside of so-called bikini [music] conditions.

The report states, quote, globally, sexual and reproductive health and maternal, [music] newborn, and child health account for only 5% of the women's health burden. But when you look at the health of Canadians, more than half of the top 10 health [music] issues impact women differently or disproportionately.

And a lack of research leads to worse [music] health outcomes for women. It's startling to see this data. So to put it all into context, [music] I spoke with one of the reports authors, Marie Renee Beaou, who says this is a starting point to address the problem, [music] but there's a lot of work still to be done. Take a listen.

>> Marie Renee, welcome to the podcast.

>> Thank you. It's such a pleasure to be here. Nam,

>> could you please introduce yourself and what it is that you do?

>> Absolutely. I'm Dr. Marani Belo. I'm a partner with McKenzie Company here in Canada and I'm also a practicing emergency physician and co-author of Mckenzie's Closing the Women's Health Gap in Canada, a $ 37 billion opportunity.

I was so excited to see this report. Um, after speaking to so many women, there's this feeling of personal failure of not being able to push through health challenges and there there is a real fear of losing work opportunities. If you speak about these issues in the workplace, um, how is the health of women in Canada tied to the economy?

>> It's so critical and naming the way you're starting the discussion. I just want to say I was always moved by my grandmother who would tell stories of getting the right to vote and my mother, you know, entering the working profession and really pushing for us to have financial and professional independence. And we are lucky in Canada, we have the privilege to work as women. But it's very clear now that if we want to push the gender parity agenda, we absolutely need to discuss women's health. And that means making sure that all of us have access to the best care and have access to the most efficacious treatment to be able to unlock health for us.

>> What did the report find?

>> Well, I wish I could bring good news. I certainly bring news that calls for action.

>> So the first thing that we found is that in fact women's health issues defined as sexual and reproductive health are less than 5% of our gap in Canada. So when we think of women and you know some people will coin bikini health um that's a really small part of what drives the gap. In fact, cancer, cardiovascular disease, and brain and mental health are really what impacts most Canadian women. And if we were able to solve the top conditions, it could give back a full week of health for all Canadian women.

So, let that sink in. for the 20 plus million Canadian women if we were able to address this gender gap, all of us could live across our lifespan one more week of health every year. So that is really critical for Canadian as a whole.

Um, you mentioned the bikini bikini conditions because when it comes to women's health, we I think most of us understand that oh, it has to do with like the breast area or the reproductive area, but then we're missing out all of these other conditions. And your report actually highlights that women in Canada spend 24% more time in poor health than men. Um, that was a shocking statistic for me to try to wrap my head around. Could you talk a little bit more about that?

Absolutely. And frankly, it's heartbreaking, right? When you actually look at the numbers and the facts, the fact that all of us combined will experience poor health at that scale um is absolutely groundbre. And I and I just want to acknowledge the fact that also men experience poor health is terrible. But the fact that women will live it outsides and and one critical point nam that I want to make is you know we often think of that because women lives longer live longer therefore you know we have poor health overall than men but the truth is it will happen all throughout our lifespan due to the different conditions we were discussing a minute ago cancer poor outcomes in cardiovascular health rates of depression anxiety obviously and hormonal health the impact of menopause loss, puberty, chronic pelvic pain.

There's a lot of these other condition that compound and will make that we as women will experience health very differently and that will have meaningful life on our ability to contribute to society, to contribute to our families, to contribute to our own lives, right? And that is really critical and needs to be talked about.

I you know when we talk about women spending more time in poor health and this idea that well women live longer so therefore they're more healthy and again going back to that personal failing like you're supposed to push through the conditions but then we think about the fact that women weren't included in clinical trials in uh the US until 1993 in 1997 in Canada um because your report outlines that women's health and productivity are quote deeply connected Ed in what ways?

>> So the first thing I want to say is our report highlights three main gaps. The data gap which is exactly what you're hinting to nam is not only do we have not collected the data we just don't know. So you know Health Canada does recommend to include women and look at sex disagregated data but there are no enforcement mechanisms. So today when researchers in Canada it's a nice to have. Um so how do we think and in fact I would argue the US has done more on enforcing some of those facts. Um so addressing the data gap as a first gap is critical and then there are two other gaps.

The second gap the efficacy gap when you start unpacking when there is data there is evidence that you know asthma medication may not work as well. Certain treatment and geography. So the the stance that you know people get in their heart when they have heart blockages may not work as well for women uh because of the nature of their diseases. When you start unpacking all these condition these things compound. So not only you know once we have access to these great treatments they don't even work as best as they can for us.

And then third there's the care gap you know are we really getting the care pathways that fully change the way as women. So how do we think of hormonal transition impacting you know postpartum impacting depression, menopause impacting insomnia, anxiety, other mental health issues and then our longer term arc on you know dementia, cardiovascular risk. All these things are deeply intertwined.

And I think you know to your question nam of how do we then tie this to productivity? Well, as I said earlier, this ties directly to our ability to contribute. Uh because unfortunately, we might not be able to show up to work as we should and if some elements are not in place, well, we may not have the levers to stay in the workforce. And furthermore, we are often the caregivers to others in the society. So, when we are not at best, we are not the most, you know, impactful that we can be in our lives and the lives of others.

Earlier in this season, we spoke to Amber Mack, who's an entrepreneur and she's a tech leader, and she was saying that Canada is uh we had these conversations about productivity and right now the big push is AI can solve these productivity issues. And then she said, "Well, wait a minute." because Amber Mack um was talking to me about her journey with fibroids, a condition that isn't studied, and she was telling me how it impacted her work and the concessions that she had to make. And she said the answer is not so much AI, but to focus on women's health. Can you talk to me a bit more about how this impacts women in the workplace?

>> Two big levers to address this are expanding women's participation. So making sure that women because they are healthier can then actually come to work. Um so that's step one and then step two when we are at work that we can be uh as productive as we can be right. So this is really critical for us to be able to then you know be able to show up as I mentioned earlier and um there are critical levers on how both as I mentioned the efficacy of intervention and then the care that we get that allows us to come back in the workplace at the right time.

but I think an underpin element that needs to come with this that you know the the colleague you interviewed mentioned is really the data gap we just don't know because these conditions are not studied these inventions are not pursued in invested in and therefore we do not have access in any meaningful way to these things that can unlock our productivity in the workplace. Um so this is really critical as we think of us showing up. There's a lot of different levers that need to be pulled. What is the employer putting in place to really enable this? What is the care that you're giving and you know is the innovation ecosystem helping us develop the solutions that will help us have the care and then be able to then our employer make sure that we have access to that care.

So these are very complex intertwined elements and one of the case that we make in the paper that I think many women's health advocate in Canada are making now is that means we need a coordinated accountable national health strategy for women south in Canada as a strategy consultant when you have complex strategies that I mean a range of stakeholders with a lot of different levers to pull we need to come together we need to coordinate because the econom omic uplift for a country and for women's themselves is major.

>> What would that strategy look like?

>> Yeah. Uh it has multiple levers. So as we discussed right if we think of the different gaps the first aspect is around research. Currently data suggests that about 6.8% of Canadian research is focused on women's health. That is minuscule.

>> That's a small that's like a percent. Yeah.

>> No. Exactly. So um so one of the first step is making sure that we are funneling sufficient uh dollars into research and that means our panadian research institutions to the Canadian you know institutes of health research but it's also philanthropic dollars and you know innovation dollars into the research and the trials then it's making sure that whatever research we do as you already mentioned have enough women in them. We know dementia is a condition that proportionately affect women. Yet we are still under reppresented in clinical trials and the solutions emerging are not as efficacious for women. That can't continue. This is done right.

So as we think of the research we need to hold researchers accountable to bring uh make sure that the representation and fair and frankly as we're looking at the data and in all trans you know all transparency we are working on a much detailed blueprint for action and the data is clear we need more female representation as researchers as clinicians to advocate for that and you [clears throat] know editorial board of research papers making sure that things get published and incentivized. So all of these thing is tied around this data gap right we mentioned the efficacy DAP well there's a huge role there for our innovation ecosystem how do we think of the different holders that's obviously government industry private capital how does this all come together to really raise the bar in Canada VC money continues to trail in Canada right.

so we need to be able to then come together obviously there's a role to philanthropy as well uh to really kind of jumpstart this and say we will have a commitment and as women how are we investing right and what are we demanding over our investment channels to then be able to move that needle and then finally the care pathway there's definitely a lot of work thinking about medical education training thinking about you know care clinics um and us as women engaging with our healthcare providers and new solutions frankly it's really exciting to look at the feech and the health you know women's health ecosystem and many others are way better than I diverse uh to speak to the details of those but how do we use that to make sure that women are getting the care they need when they need it.

So as I mentioned that strategy has a lot of pillars and that's only us working together as Canadian um coming together coordinating defining a few set of really key uh levers that we want to move. I think there's economic outputs that we want to track there's KPIs around you know woman employment employer engagement industry investments uh there's a lot of things we need to measure that are critical as part of this strategy.

>> I'm glad that you mentioned FEM. are actually going to be covering that in the next episode. Um I I think if you live in Canada or even just globally, Canada has been thought of as a feminist nation. Your report highlights that Canada ranks among quote the top 10 countries globally for gender equality. But that doesn't mean that women's health is a priority. How do we fare up when we think of other jurisdictions that maybe are doing it better?

>> So Canada has the fifth worst gap on women's health in the world. But there's a very subtle nuance here um that I think you'll appreciate. The reason our gap is so high is because as women, we are a very active part of society, especially as it means uh in terms of workforce. There's a lot of countries out there where women are still part of the informal economy, right? Therefore, the gap as measured uh using a G GDP output will appear much smaller.

So what that means is Canada is worse because we are working and therefore we are bearing the consequences of that woman's health gap even more sharply because us as women we are not able to show up in the workplace as we could uh in addition as I said to you know the benefit of being healthy. So I profoundly believe and that's one of the reason McKenzie and the Mckenzie Health Institute and our range of partners here are so deeply committed to this. Canada can lead the global blueprint on how to fix this.

There's no more important time in the current, you know, world context that we can rise and we can say, look, the frontier of voting done check financial and professional independence. I mean, we're still working on it, but much better. Women's health is something we as Canadian can unlock, push and develop and show the way so that all women's globally can benefit.

>> And the thing I think a lot of us um uh learn from firsthand experience is that if you don't have good health, it actually impacts your ability to have that economic freedom. Um we always look for solutions on this podcast and um the framing of this report is that this is an opportunity. This is a $37 billion opportunity. How do you come up with that number and how if you could just explain to us more how this is an opportunity for Canada in this time right now?

>> I'm so l I'm all for solutions and I know sometimes these numbers can sound wildly depressing, but this is a call to action and this is a movement that we as Canadian women who now have the professional and the financial independence can really move on. we are making choices and every day we can make different choices as we discuss with our employers as we discuss in our investment portfolios. So this is really something that is so critical and I love how you're framing this now.

to your specific question on the economic um analysis. So we broke down the economic output in four buckets and I think that's a very important nuance because what I will say is showing that it's only these four buckets. There's actually more. So when we say 37 billion, it's at least 37 billion. So this is only the beginning. So the four buckets are as I mentioned expanded

participation. So making sure that women who today may not be able to enter the workforce because of health issues be able to enter the workforce. That's one. Two, increasing productivity. So when we are in the workforce, we can show up at our best and feel confident and be able to pursue the career that will give us higher income potential and higher impact as we want. Right? So critical piece number two. Number three is making sure that you know we have fewer disease, we are healthier and that has huge that has economic value to the broader society. So decreasing these conditions really matter and that has four consequences on we don't die as early we will live longer healthier life and that too creates tremendous value for our society.

So the buckets that are not included in here are what about the new market opportunities you've mentioned chronic pain fibroids um there are new market opportunities being created if you think of the growth of the fem industry these are brand new industries that are growing that have enormous economic potential and that in Canada could make a huge difference in our innovation ecosystems that is not in the economic potential so Canada has at least a 37 billion and we can make the choices to influence that

>> I I can't thank you enough for creating this report because I think it's going to make people stop and think about how all of this stuff is connected. It's not just well you just need to get out of your head, you just need to be stronger, you just need to push through the pain that this is actually connected. Everything is connected in our economy. Um is there anything that I uh I didn't ask you that you wanted to mention?

>> Thank you so much, Nam. This is only the beginning. There's a lot of work to be done, but each of us have a role to play in how we're talking about women's health. This is not just a side conversation and a nice to have in the bottom of a, you know, cocktail party. This is something that as a society, as women, we can move the needle on. So, as we think of our choices, how we're investing, how we're engaging with our employers, how we're contributing philanthropically to to Canadian society and giving our time back, these are all places that our choice can meaningfully advance the agenda and come together under this coordinated, accountable strategy to make Canada one of the leading countries in the world.

>> Marie Renee, thank you so much.

>> You bet. [music]

This was mistreated. Thanks for listening. You can follow our show wherever you get your podcast so that you can get notified each time a [music] new episode is available. We would love to hear your feedback. You can write me an email at mistreatedodcast@tvo.org or reach out to me on my social channels. Let us know if you like this type of shorter content that breaks down women's health issues through reports, [music] studies, and surveys. We liked producing it. Thanks so much for listening.