Ahead of GIANT STEPS 2019 we caught up with one of our speakers, Dr Zoe Wainer, Head of Public Health and Medical Director at Bupa, to learn about how sex differences are critical to all aspects of healthcare and to find out what’s in store for her session.
You’re joining us at GIANT STEPS to present ‘Sex is a quality issue’. Can you tell us a bit about what we will learn at your session?
More and more we are learning that being male or female can have a significant impact on your health outcomes. For example research published last year showed that a woman in Australia presenting to an emergency department with a serious heart attack is half as likely to get the care she needs as a man and twice as likely to be dead in 12 months.
For men with lung cancer, a man with stage IA disease can have the same five year survival outcomes as a woman with IIA disease. And just recently we have seen that many medical devices are designed on male anatomy and then have higher failure rates in women. These examples represent unacceptable variations in outcomes, present clear safety and quality issues for men and women, and could be addressed by simply and consistently researching and translating research that is disaggregated by sex.
What started your interest in gender and sex differences in healthcare?
When I was a medical intern I presented an article from the New England Journal of Medicine about female patients in cardiology, showing outcomes such as longer times to get to cath labs and worse outcomes. During the debate that followed one senior cardiologist noted it was interesting paper but that we couldn't undertake research into all minority groups. I plucked up the courage of an intern and quietly pointed out that 51 per cent of the population (women) was not a minority. This really peaked my interest.
I then undertook a PhD in lung cancer and we looked at outcomes disaggregated by sex, and found consistently men have worse outcomes, and that this was not new information, but we seem to be failing to translate this into changing how we provide care and in turn improve outcomes.
What are some of the negative consequences of failing to pay attention to sex and gender when providing care?
There are many differences between men and women in drug metabolism, and one such example is stilnox, where in the US research demonstrated when men and women were given the same dose women had a 45 per cent higher blood level 12 and 24 hours later.
Hip implants are sold often as sex neutral, and yet women's and men's pelvic and hence articulation with the head of the femur, with the edge of hip socket bearing greater load in women, resulting in potential failure of the device earlier.
As Head of Public Health and Medical Director at Bupa, what does your average day look like?
No two days are ever the same, and it is possibly one of the most challenging and interesting roles I have ever had. One day might be working with clinicians to develop innovative models of care that ensure a strong clinical leadership approach and focus on outcomes that matter to patients, and the next day might involved exploring how we build on our RAP.
Value based healthcare is a strong focus, and both working with willing partners as well as educating internally at Bupa and externally across the sector is a major element of my job. My role is not focused on insurance, but is about how we build a stronger healthcare system more broadly, and has collaboration always at its heart.
We hear the term ‘value based healthcare’ a lot. What does it mean to you?
Ah my other favourite subject! I hear this term a lot nowadays and hear many different definitions.
I had the opportunity to undertake the value based healthcare course at Harvard Business School in 2015 with Professor Elizabeth Tiesberg and Prof Michael Porter and am heavily influenced by their frameworks and thinking.
What does it mean to me - ultimately how do we pivot the healthcare system to truly be designed to deliver what matters to patients, and align the incentives across the major stakeholders to ensure all are focused on delivering those outcomes? Moving the quality and safety conversation from one just about process and input measurement and the absence of negative outcomes, to also focus on delivering the outcomes that truly matter to patients. For those keen to know more google 'Strategy to Fix Health Care' or ask me after the presentation.
Tickets are now sold out, but if you were lucky enough to grab one you can catch Zoe presenting 'Sex is a quality issue' at GIANT STEPS, 21–22 November 2019 in Melbourne.