Women's Digital Health

Federal Investment in Women and Digital Health

• Women's Digital Health • Season 1 • Episode 6

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If you're a woman living in the US, you're probably like me and assume that when you pay your federal taxes, they're going to be put towards really important things, roads, food, and, you know, safety, education. You also assume that the money is going to be allocated to really important agencies like the National Institutes of Health, the CDC, and other agencies to fund healthcare. 

However, when you learn that only 2.5% of the federal budget is spent on healthcare for women, you have to question whether that reflects good outcomes for women!

In this episode, we'll delve into how federal investments can address women's health issues, where the money is going, and the impact of digital health on women's healthcare. We'll explore key challenges like lack of access to quality healthcare, gender bias, privacy, security, and the lack of diversity in digital health solutions.

In 2014, 22% of women were using mobile health apps and that figure must surely be higher now. So investing in digital health solutions can help bridge gaps in women's healthcare. While there are challenges to overcome, with proper funding and development I'm excited to see how digital health has the potential to transform and improve women's health significantly.

Topics include:

  • The flow of money and how the federal government is investing in women's health and digital health
  • The key gaps in women's health care and how digital health can address them
  • Digital health trends, including apps and wearable technology, and how these can impact the healthcare gender bias
  • The use of AI in health settings


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The information in this podcast is for informational purposes only and is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare providers with any questions you may have regarding a medical condition or treatment.

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Welcome back. Welcome back to episode six. And in this episode, we'll be talking about

 federal and or public investment in women's health and digital health. I'm going to start

 with a question. And this question is specifically directed to my tax experts, my economists,

 my financial savvies, my consumer spending connoisseurs. So I'm going to give you a scenario.

A single woman, I make $100,000 a year. And let's just assume my taxes are simple. I don't

 have any special things in my taxes. I don't have any exemptions, no deductions, no nothing.

 Simple. I'm going to pay roughly 20 to 22% of my income in federal taxes, about $20,000.

Okay. To the federal government. Now, I assume that when I give the federal government this money,

 it's going to be put towards really important things. Roads, food, and, you know, safety,

 education. And I also assume that the money is going to be allocated to really important

 agencies like the National Institutes of Health, the CDC, and other agencies to fund health care.

 So when I see that only 2.5% of the federal budget is actually spent on health care for women,

is that right? Does that reflect, like, good outcomes for women? I mean, the NIH should

 certainly invest in men and women. Don't get me wrong, it's crucial. It's really crucial. We need

 healthy, thriving men. Without both, it's really hard to build a community of connection. But if

 it wasn't until 1990 that we actually started saying there's a need to actually explore women's

 health and we should probably invest in that, aren't we a little behind from the get-go?

 They're asking, please help me out. Help me understand. Does that percentage, 2.5% of the

 federal government investment sound right? Welcome back to episode six. And like I said,

 in this episode, we're going to be looking and diving a little deeper into how, you know, public

 federal investments address some of the issues in women's health, where the money is going. We got

 to follow the money. We're going to answer some questions that I think are pretty relative to

 women's digital health, but certainly more broadly, how does this impact women's health as a whole?

 We'll get into some of the key challenges and gaps in women's health and why digital health can be

 useful if we invest and innovate in that space. We'll look specifically at the federal government's

 budget for women's health. We'll look at, you know, multiple agencies and how they allocate

 funding. We'll start to look at some of these really important federal initiatives and programs

 that support digital health programs to support some of these challenges. And we'll take a look

 at some of the current trends in digital health that have the potential to transform women's

 health care. So stay tuned. Steve, as a note, I am so sorry. There's like so much talking in the

 background. I'll try to, I hope that you're able to edit it out, but this is what I was talking about

with the sound. All right. So the first question we're going to answer is, you know, what are key

 challenges and gaps in women's health and where can we specifically invest in digital health

 to address some of these key gaps in women's health? The first one is lack of access to quality

 health care. Whether you're in a rural area or you're even in a major city, it's just hard to

 find a quality health care provider. You know, you could be low income, medium income.

 Quite frankly, these days, it's really hard to find that top notch doc. And even if you find one,

 you like want to hold onto them for dear life until your health care insurance provider says,

 oops, they are out of network. And now you have to scramble all over again to find someone that

 meets you where you are. And so access to digital health solutions can be a great starting point

 It could be a great resource to help you understand what's out there. And so if you heard my interview

 with Dr. Milhouse in the May, 2023 newsletter, you know that she offers telehealth and because

 she recognizes how rare and how difficult it is for people to find someone like her. And so

 she has telehealth as a part of her practice. And she's also really excellent in digital health

 literacy. She informs the public with social media humor about questions you were too embarrassed or

 too scared to ask. And so I think Dr. Milhouse is a great example of someone who balances this

 digital health literacy while increasing access to, you know, physicians like herself. And so

 investing more in concepts like that, I think would really improve, you know, accessibility for

 women. The second is gender bias. There's a lot of challenges with women every day. I hear a woman

tell me that they felt dismissed in a health care clinic. And these dismissals are not to be taken

for granted. These dismissals can result in misdiagnosis and delay of care. And it's a pretty

frequent phenomenon. You know, if you're feeling like you're over talked, you're not listened to,

you know, digital health resources as more of them become available to help you become aware of

providers that might be a good fit, you know, you may not have to be dependent upon who's assigning

your health care insurance company, assigning you someone, you can find someone on your own.

But we need more investment in offering visibility to these providers so that you can have these

options and choices. The third one is privacy and security. So I'm pretty passionate about this.

I feel like, you know, if you love digital health, you've got to have a concept of what's going on

from a privacy and security state. I love digital health. I love all its bells and whistles. It's

he reason I started this podcast. But in light of everything that has happened, I think that we

all can agree there's a great need for women to feel safe and feel protected when they are disclosing

personal information. It's still a huge challenge. There are data breaches that happen

 every day. And so trust is a big issue if we're going to encourage women to use digital health.

 And so it's one of the reasons why I sat down with Andrea Downing, with the Light Collective,

 who spoke so eloquently about her experience on social media, having one of the largest breast

 cancer BRCA mutation groups that was private. It was a social media group that was private

 that she would discover her data and members of her private group were easily accessible to

 marketers and others who could use their data in unintended ways. And I think, you know,

 Robi Wade has made, you know, even the use of period apps, you know, questionable in terms of

 their trust, even though they're convenient and accessible solutions, you know, there's a lot of

 uncertainty there. And, you know, I'm going to have a lot more experts on to discuss this very issue,

 since for me as a doctor, it becomes an ethical issue very quickly. I have a right to do no harm.

 I have a right to protect. So we definitely need more investment in data privacy and security

 to protect women. The thing I was looking into, so, you know, of course I'm going to be talking

 about artificial intelligence. Our promise is coming. In the background, what I want you to

 know is I've been experimenting with different artificial intelligence sources and one that I

 actually had a conversation with conversation, quote unquote, with artificial intelligence,

 but it was with Bard and, you know, I had a very frank, you know, concern about data breach and it

 actually brought up some other things that I didn't even think about. One is which is if you've

 already, you know, and I think for persons of color meet this criteria is that if you already

 have a distrustful relationship with the health care system and then there's a data breach,

 that distrust only gets exacerbated, right? And so it is so in the problem with that, it further

 limits, you know, your desire or even your options. If you do see care, it limits your options to even

 get that care. And so if you're, you know, low income or marginalized and you're facing even

 higher risks, you know, the risk of discrimination is there. And so I have to make sure that, you know,

 moving forward as we talk about data breaches, that those data breaches include and consider

 some of these scenarios as the data breaches impact larger and larger health care systems.

 So the last one is a tricky one. It's but it's one of the reasons why I actually another reason why

I started this podcast is that there's a lack of diversity in digital health. What I love,

 I love exploring digital health. I love trying new technologies, learning more about new things

 that are coming on the horizon. And I really look up to the pioneers of this sector. But

 digital health solutions are very rarely designed for women. And they're very rarely designed for

 women of color, LGBTQIA communities, or those with various expressions of ableness. And you know,

 this is a touchy one, because sometimes when I dive into these inequities, I feel like I'm billifying

 the pioneers, the beginners of this really incredible new way of practicing medicine.

 But then I had to pause and say, hold up, if you build any product or you build any solution,

 and it works, time for an upgrade. It's time to update, it's time to improve. And so

 just like any other product or solution, it's time to invest in diversity, because diversity can

 address a lot of these issues and it can benefit everyone.

Okay, so now I'm going to talk about the money. Like where is, if we invested, you know, more in

 women's health, and we invested more in digital health, where does that money flow? And what are

 the current ways in which money is being invested in? So the first thing we have to understand is

 the budget. So, full disclosure, these numbers get pretty tricky pretty quickly. You know, I'm going

 to try to keep this simple and just focus on basic concepts of funding. All right, so here's where

the numbers get tricky. And if you are a health care economist, you're a health care economist,

 and you know how the federal budget allocates money for women's health, I would love for you to

reach out to me, you know, because the way that I found the money to flow, it seems as if money is

flowing through different buckets and it gets very complicated to follow what is actually being

`

flowing through different buckets and it gets very complicated to follow what is actually being

allocated to women's health. But for simplicity, what I will discuss is how the money flows,

which agencies are getting money for women's health and women's health research, and how that

 compares to how money, federal dollars, are invested for men's health. Okay, so let's start

with the flow of money. The flow of money, from my understanding, starts with the Congressional

 Budget Office. Okay, the Congressional Budget Office approves money for large agencies like

 Health and Human Services. Okay, and that agency is set up to focus on health and health care services

 and research for all people who live in the United States. So Health and Human Services

 funds NIH, CDC, FDA, Agency for Health Research and Quality, Health Resources and Service Administration.

 Okay, now the Health and Human Services includes women's health focuses, things like

 women's health prevention, women's health care, and women's health education.

 Women's health research is funded through the NIH. So Health and Human Services funds the NIH, NIH focuses on women's health research. Now, the total budget for NIH for 2023 was $45 billion.

 The NIH invested about $4.7 billion of that money to women's health research, roughly about 10 and 11% of the NIH budget was spent on women's health research.

 Within the NIH, there are multiple offices. I'm not going to list all of them. One that I want to make sure we include here, however,

 is the Office of Women's Health Research. And this is the agency I was alluding to at the very beginning of the podcast.

 This was the office that was founded in the 1990s that was basically saying, hey, I think we should invest exclusively in women's conditions.

 And, you know, their goal is to achieve health equity for women and girls. And they get a lot of they they fund a lot of different grants and research and outreach programs.

 For, you know, supporting research on sex and gender differences.

 All right, now, in addition to the Office of Research on Women's Health, there's one other institute I want to mention here.

 And that is the National Institute of Heart, Lung, and Blood.

 They are among with among other institutes, they also fund the Women's Health Initiative, which is the largest and longest clinical trial that looks at multiple health conditions of women across a long period of time.

 They look at things like heart disease and cancer over a large cohort of women.

 So these two institutions, amongst other national institutes, are responsible for funding women's health research.

 Okay, so, you know, it sounds great that, you know, we have offices specifically allocated to women's health and women's health research.

 And, you know, $4.7 billion sounds like a lot of money being invested in dedicated to the advancement of women's health research.

 So how does that compare to how we invest in men? I mean, technically, if you look at the budget, you could argue that we spend more for women, 11% of NIH budget compared to the 4% in men.

 So, you know, shouldn't we say, yay, we're all done with investing in women's health and women's health research?

Well, the answer lies in how the funding is allocated for conditions that impact men.

So things like mental health and prostate cancer, which are conditions that directly impact men more than women, are significantly more invested in by national institutes of health.

Compared to things like breast cancer that will disproportionately affect women, even though breast cancer affects more women and has a higher morbidity and mortality.

And so the question is not so much how much is spent on male versus female.

It's which conditions are the federal government investing in? And without a doubt, those things that impact men are invested in at a higher proportion compared to women.

Now, more specifically, as you know, the largest receiver of funding for women's health research, the NIH also does invest in digital health solutions.

They invest in research and development of technologies like medical imaging, telehealth, digital therapeutics, and mental health.

And so it's really cool to understand that even at a federal level, the largest funder of women's health research is looking at digital health and understanding the opportunity and benefits of digital health at a federal level.

So the next agencies I'm going to mention, I'm going to mention with the understanding that the federal government invest in women's health throughout multiple agencies.

But I'm choosing to speak about these specific agencies because of their investment, both in women's health as well as digital health.

You know, at its highest level, there are allocations of dollars that are being spent on women's health.

But on this particular podcast, we want to know where the money is going for digital health.

So I'll start with the FDA. The FDA plays a huge role in regulatory support and overseeing the safety of many of these digital health technologies.

They are the check for overseeing mobile health apps, wearables, and all of these medical devices that are coming.

 And they also review and approve various regulatory standards as these devices and digital health technologies evolve.

 The next agency that is invested in digital health for women would be the Health Resources and Service Administration, HSRA, HRSA.

 They focus particularly on underserved populations trying to promote, you know, telehealth and the use of a lot of these digital tools that can address maternal health, family planning, and reproductive health.

The CDC also invests in digital health initiatives.

They look at divisions of reproductive health, you know, Office on Smoking and Health, to really use, you know, mobile health and other forms of digital health literacy to promote smoking cessation, family planning, and other women's health related issues.

And the other really important agency at the federal level that's really invested in women's health would be the Office of National Coordinator for Health Information Technology.

So I know that's a long name for an office, but they're really important. They are part of the Health and Human Services, and they are responsible for the advancement of electronic health records, standards and policies.

That address, you know, EMRs and other forms of information technology throughout our entire country.

And so they are very much invested in how digital health technologies will be integrated into our EMRs as they advance and what security as well as what interoperability challenges will that mean as this sector grows?

All right, I just mentioned a couple of words here that I just want to make sure we're clear on.

The first was information technology. That's what the ONC oversees.

 Information technology describes the collection and process and management of data within the health care system.

So traditionally, I think about electronic medical records and the medical devices that you would see in a hospital or in a clinic.

And so information technology or the practice of informatics is a form of digital health that we traditionally see within the hospital setting.

Now, when I talk about mobile health and sensors, typically I'm speaking about those devices that are used outside of the health care setting.

 So you might use your watch or, you know, various sensors to track your data outside of a clinic.

And those are also forms of digital health, but they're consumer or patient facing.

 So both information technology and mobile health and sensors are both forms of digital health.

One's inside the hospital, one's outside the hospital.

The second term that I mentioned was interoperability.

And interoperability describes the ease of flow of your data moving from one health care technology to another.

So the scenario is you got a new job and you moved from one place to another.

And for many, it's incredibly difficult for your health data to move through one health care system to another one.

It's gotten better, but interoperability describes the flow of data or the ease of flow of data moving from one health care technology to another one.

So in this particular episode, we've answered a few questions.

You know, what are some of the key challenges and gaps in women's health care and how can digital health address some of those things?

If we invest more in it, we explored how the federal government invests in women's health and more specifically, how the federal government is investing in women's health and digital health.

And we looked at some of the initiatives that the federal government is doing to address some of these very much needed initiatives to address women's health and digital health.

The final question I'm going to answer is, like, you know, what are some of the current trends in digital health that can really have a big impact on improving and transforming women's health?

And there are a number of trends in digital health, many of which I think will reflect some of those key gaps that we mentioned at the beginning of the podcast.

So we began by talking about the lack of access to quality health care.

You know, the trend that we're seeing in the use of digital health runs parallel to this, which is that the use of mobile health technology among women is rapidly growing.

In 2014, it was like 22% of women were using mobile health apps.

And the last statistic I have is that it was up, it doubled within a five year period.

And if I had to guess, it probably is even much higher than that. I would argue it's way above 60 to 70% now.

You know, more women are just adopting mobile health technologies to manage your health.

And so I think that there's, with more investment in these sort of tools, including the ones that we addressed in this particular episode,

 we have an opportunity here to close that gap in terms of the lack of access, particularly those in rural environments where, you know, you may not be able to access a physical health care provider for miles.

So I'm really excited to see, I'm really excited to see this trend in digital health growing.

We're seeing the same trend in the use of wearable devices.

And when I say wearable devices, I mean like smartwatches that can track things like your steps, your heart rate, your calories and blood pressure.

But because we've kind of accepted wearable devices, you know, where we're comfortable with them,

we're now advancing the types of wearables. And we'll talk a little bit more about what those wearables look like.

One in particular that I, you know, had featured in my newsletter was the ROGA device that was a stress management wearable.

But there are just so many other things beyond, you know, smartwatches that are really being able to capture more than just your steps.

And so we're seeing an uptick in the use of those types of devices by women as well.

The other trend that I think is notable, since it's been all over the news lately, and I promise to devote several episodes to it, is artificial intelligence.

You know, we are seeing a host of new services offered that I think has the potential to improve women's health.

I'm just not sure yet. The data is not out, but I'll at least mention them here because they do exist, but we don't have the data yet.

 The first would be artificially intelligent powered breast cancer screenings.

 So there's new technologies that can detect breast cancer abnormalities on a mammogram that may not be visible to the human eye.

 And so as I prepare for, you know, giving you more information on AI, I'll be investigating what the data shows on how effective that approach to breast cancer screening is seeing now.

 The other trend that I'm seeing is, you know, AI powered virtual consultations.

 So these are the chat bots, you know, chat bots that are being used to provide virtual consultations with women who may or may not have access to a provider, a human provider immediately.

And so these chat bots are a great way to unleash triage.

Certainly they may come with some of their own, you know, challenges in encryption.

Excuse me.

So I'm really excited about chat bots. Certainly they come with their own challenges.

I think the biggest challenge that I'm concerned about is accuracy.

If someone is really in trouble being able to educate the public on how to use a chat bot, what to use it for, that it's not a replacement for 911 or major, or, you know, major urgent medical conditions.

Chat bots are not always accurate.

And, you know, the level of comfort that a person might have with a chat bot is very different than if they had a human provider.

And certainly, you know, that human interaction matters.

Certainly privacy matters with chat bots.

And again, as I as I expressed at the beginning of this podcast, the need for investment in privacy is an issue.

And so that's something I'm going to have to explore more as artificial intelligence becomes a part of health care culture.

 And so with that, that concludes episode six of Federal Investment.

 I hope you enjoyed this episode.

 Make sure that you subscribe to our newsletter to get access to all of those guests that I mentioned.

 Dr. Milhouse, the Roga app with Dr. Dr. Allison Smith.

 I'll make sure I put all of those references in the show notes.

 And I hope that you've learned something that the federal government is doing a lot for digital health and digital health for women.

 Thank you so much for listening to this episode.