A call for action: Need to expand the scope of women's health assessment

Addressing and optimizing the health and well-being of women and girls is an important national and global agenda contributing to society's strength and productivity. Despite significant progress in eliminating gender disparities during the last two decades, the health and well-being of women, girls and gender minorities are still elusive goals because of the limitations of the current women's health definition (Burns et al., 2023), assessment research (Siristatidis et al., 2021) and methods (Weber et al., 2019). A key challenge for the assessment of women's health is that self-reported data related to the biological, social and holistic health needs of women and girls are limited and often unreliable. Limited as they are incomplete and lack women's perspectives and utilitarian as they can be ‘used’ to support or refute points of view and political needs. Three key limitations with the current ‘tools’ or ‘methods’ of women's health assessment today include (1) they do not include many domains that matter most for women's health; (2) they do not capture the opinion/perspective of women themselves; (3) they are not sufficient for population-based studies and comparisons across countries and over time. Appropriate assessment begins with a good definition of women's health. Traditionally, women's health was synonymous with reproductive health and maternal health, but the definition must be broadened (Weber et al., 2019), reflecting complex health needs across a broad spectrum of specialties and life stages. While some conditions associated with obstetrics and gynaecology are unique to women, many other diseases are different in women than men regarding risk factors, symptoms, progression of severity and treatment efficacy. Diagnosis inconsistencies and biases exist in understanding disease states in real-world healthcare data sets (Burns et al., 2023). The available data and evidence suggest that women and men experience disease occurrence, progression and outcomes differently (Crimmins et al., 2019; Siristatidis et al., 2021). Hence, health systems and healthcare providers should consider women's health as encompassing both female-specific and general health conditions that may affect women differently or disproportionately (Burns et al., 2023) as well as respond differently regarding the need for health services, access to care and quality of care considering sex or gender-based perspectives. A gender-based perspective requires going beyond traditional focus to explore biological, sociocultural and gender norms-related factors that influence diseases and related challenges (Weber et al., 2019). Furthermore, consideration of domains of health and determinants of health from individual physical and emotional needs to social determinants of health and their influence that are important should explicitly be the focus of women's health assessment. Women's healthcare models are burdened by several factors. Some of the sociocultural factors that affect women's healthcare outcomes and access to health services include unequal power dynamics between men and women, social norms associated with lower education and paid employment opportunities, an exclusive focus on women's reproductive roles and actual or potential experiences of physical, emotional and sexual violence (Davidson et al., 2011). Enabling equitable access and minimizing disparities and potential for exploitation is vital to women's health. There are rarely available universal measures that were developed from the experiences, perspectives and opinions of and used for women's health assessment. There are fewer examinations of sex or gender differences in health data and women are underrepresented in scientific and clinical studies (Norton, 2016; Siristatidis et al., 2021). The scope of earlier sources of data on women's health was constrained, and they frequently served certain problem-based institutional, political, financial or governmental agendas. There is a need for something novel approach that empowers women and considers factors affecting women's health from their perspectives and their agency to raise awareness of and improve resources for holistic women's health worldwide. Critical data for global, regional and national development and policymaking specific to women's health are still lacking. Many governments still do not have access to adequate data on their entire populations (Burns et al., 2023). This is particularly true for the poorest and most marginalized. Systematic attention is required to understand the scope of multidimensional social and environmental factors and structures that goes beyond sex and gender that can influence women's health and outcomes (Bolte et al., 2021). This is also critical to understanding that health inequalities are never the outcome of any one set of primary predictors, for example, sex or gender, but instead are the outcomes of intersections of different social norms, power relations and experiences (Weber et al., 2019). Importantly, women's health is embedded in the social structure and geopolitical landscape and reflects the function or lack of function of these circumstances. Hence, population-based, epidemiological, studies exploring biological, socio-economic, cultural, political and spiritual determinants affecting the health and development of women are necessary. Women's health data are vital for understanding and addressing unique needs and concerns of women's health and the ability to be autonomous in actions to address these needs. Having population-based data are important to compare the health needs and outcomes of women and another gender and the health of women from different regions and cultures and over time to examine the progress. The Hologic Global Women's Health Index (HGWHI) is a multiyear, comprehensive global, survey about women's health, developed to help fill a critical gap in what the world knows about the health and well-being of the world's women and girls (Hologic, 2023). An important feature of these data profiling women's health is that HGWHI is beginning to get at the complex question of women's health not only of access and affordability but also agency and power to uptake their own healthcare. Including basic needs (food and shelter), individual health (pain and limitations related to chronic disease) and safety and emotional health in the HGWHI begin to address these critically important aspects of women's empowerment globally. A measure of HGHWI can be an example framework and data source to improve women's lives as well as increase their longevity. These data may help identify trends, disparities and progress that have been made in women's health and set goals and priorities for research, practice and policy and most importantly improving women's lives. Yet, the HGWHI signals significant room for progress. Consideration of life expectancy is an insufficient metric to define the quality of health for women. Generally, the improved life expectancy of women can be argued as improved health of women, yet it may offset the fact that greater life expectancy in women is penalized by multiple chronic diseases that entail an increased burden of disabling physical impairment and functional dependence but that do not necessarily increase the likelihood of mortality (Almagro et al., 2020). Hence, the use of HGWHI data in new ways and correlating HGWHI with other measurements of women's health is crucial. It is critical to increase attention to the need of specific groups of women such as the elderly, women with disabilities and minority groups who are often overlooked and marginalized in relation to structural determinants of health. It is vital to examine and consider how women's health has been conceptualized and develop innovative tools, methods and approaches to capture the complexity of the women's health (Burns et al., 2023; Ostrach, 2021; Siristatidis et al., 2021; Weber et al., 2019). Nurses contribute significantly to the health and well-being of women and girls as well as nursing is a highly feminized workforce. Nurses have seen the impact of the COVID-19 pandemic on women and the nursing profession. Social, political and economic factors underscore the importance of approaches specifically in identifying multilevel factors and domains of women's health with the help of women's own perspectives and opinions. This requires not only a recalibration of definitions and models of care but also methods of assessing the current state as well as progress and impact, where nurses can play a substantial role. Improved health and well-being of women is a significant step towards achieving global health including developmental goals. Global and most importantly emerging economies should develop policies to support sex and gender-sensitive collection, usage and interpretation of health data and enhance awareness among citizens and health professionals. Private and public collaborations and engagement of a multidisciplinary and multisectoral approach to understanding, promoting and funding women's health and well-being are all necessary. There is a need for significant investment and commitment from governments, policymakers, all healthcare providers including nurses and other community partners to improve women's health. Taking care of women is taking care of communities. Women need to be educated, kept safe and have deadly diseases detected early. In this way, women are the cornerstones of families, communities and economies. The gaps are many, however, commitment to expanding women's health assessment methods and raising the bar of women's health data could be the next step to unlock innovations and improve care delivery for women globally. Nurses could have a critical role in improving the visibility of women's medical and social needs and enhancing understanding of sex-based or gender-based differences in health outcomes. There is a huge need to expand the scope of women's health assessment methods and promote the role of nurses. Binu Koirala, Susan Harvey, Robert C. Bollinger and Patricia M. Davidson conceptualized the paper. Binu Koirala drafted the paper. All the authors provided expert reviews and feedback with substantial contributions to the final version of the paper. All the authors have agreed on the final version. Dr. Koirala is supported by the NINR P30 NR18093, the Building Interdisciplinary Research Careers in Women's Health (BIRCWH, K12HD085845) program and the Johns Hopkins School of Nursing Discovery and Innovation Award. The content is solely the responsibility of the authors and does not necessarily represent the official views of the supporting agencies. Patricia M. Davidson is a consultant to the Hologic Women's Health Index but has not received financial or in-kind compensation. Robert C. Bollinger is a paid consultant to the Hologic Women's Health Index, but he has not received financial or in-kind compensation for the preparation of this manuscript. His Hologic consulting has been reported to Johns Hopkins University and is being managed by the University in accordance with its conflict of interest policies. Susan Harvey is Vice President of Global Medical Affairs for Hologic. Data sharing is not applicable to this article as no datasets were generated or analyzed.