Equity can feel unfair to those who have always benefited from equality. That’s the tension nobody wants to name out loud, and it’s the reason a decade of equity arguments hasn’t moved capital allocation in women’s health.
After 25 years in medtech, global health, innovation strategy, and capital markets, I’ve come to believe the frame itself is the problem. Equity as a concept holds up under scrutiny, but as language it fails to land in the rooms where capital decisions actually get made.
The Moment I Stopped Arguing for Equality
I used to talk about equality, by which I meant equal pay, equal access, equal representation, and equal opportunity. It sounded clean and unarguable.
Then I sat in an investment committee where women’s health was described, by serious and well-meaning people, as “niche.” Women represent over half the global population and drive the majority of healthcare spending decisions. But in that room, the category still read as specialized, as edge case, as a subset of the real market. The system was technically open to investment, equal opportunity existed, and yet the structural logic of that conversation made clear that equal access to a system calibrated around other priorities is not the same thing as functional access.
That was the moment the equality argument stopped being persuasive to me, especially as I started watching it happen over and over again.
Equality Is Sameness. Equity Is Fairness. Neither Builds Anything.
Equality means giving everyone the same thing. Equity means giving people what they actually need to achieve the same outcome. Both are useful concepts in a policy debate, and neither one moves capital allocation.
For decades, healthcare systems were built around a default patient who was historically male, historically Western, and historically insured. Then the industry declared, “Everyone has access,” and technically that became true. Coverage expanded, screenings increased, telehealth scaled, and barriers came down. Access is visible, measurable, and photographs well in annual reports.
But equal access to a system that was never designed for women becomes a design failure, and design failures don’t get fixed by arguing for fairness. They get fixed by rebuilding the underlying system.
Neutral Design Does Not Produce Neutral Outcomes
Women present differently in cardiovascular disease. They experience higher prevalence of autoimmune conditions. Chronic pain is more frequently reported by women and more frequently dismissed. Hormonal transitions influence cardiovascular, metabolic, and cognitive risk across the lifespan. Yet care pathways are built around averaged datasets that smooth these differences away.
When systems are optimized around a statistical middle defined historically by male data, women become deviations from the norm. Deviations rarely drive capital allocation. They trigger caution, secondary review, or dismissal.
Underneath the symptoms, this is an infrastructure problem.
Capital Shapes What Gets Built
Rhetoric around women’s health has increased. Funding patterns have not kept pace.
In 2020, only 5 percent of global research and development funding was allocated to women’s health research, split into 4 percent for women’s cancers and 1 percent for all other women-specific conditions, with a quarter of that further limited to fertility, according to Nature Reviews Bioengineering. A National Academies analysis found that just 8.8 percent of NIH grant spending from 2013 to 2023 focused on women’s health research, and that share has actually decreased as the NIH budget has grown.
Capital shapes what gets built. What gets built shapes standards of care. Standards of care shape outcomes. The gap shows up on the balance sheet long before it shows up in patient outcomes.
Without reallocation toward conditions that disproportionately affect women across the lifespan, including cardiovascular disease, autoimmune disorders, mental health, and metabolic conditions, access reforms remain cosmetic. The market signals what it values long before policy language catches up.
The Global Stakes
When you operate globally, the illusion of equal access collapses fast.
Each year, 15 million people die prematurely from non-communicable diseases, and according to the WHO, 85 percent of those deaths occur in low- and middle-income countries, where R&D infrastructure, reimbursement models, and clinical guidelines were largely designed elsewhere and then exported. Calling that an access problem misses the category. The failure is structural.
Technologies designed for high-resource hospitals get retrofitted and dropped into low-resource environments with the assumption that they will work, but they rarely do. Global markets are not scaled-down versions of Western markets; they’re different ecosystems with different starting points and different constraints. Exporting identical systems doesn’t produce fairness; it exports assumptions about what fairness means.
Functional infrastructure has to be designed for context. It has to be infrastructure-aware, workforce-aware, and economically aware. One architecture has never served every market.
Why Infrastructure, and Why Now
The reason to drop equity and equality framing isn’t that the concepts are wrong. The reason is that they don’t move the people who build, fund, and regulate healthcare systems. Equity lives as a values argument. Infrastructure lives as an investment argument, which is why one moves capital and the other doesn’t.
When you frame women’s health as an equity issue, the conversation lives in HR, ESG, philanthropy, and corporate communications. When you frame it as infrastructure, it moves into operations, capital allocation, and product strategy. Those are the rooms where the decisions that shape standards of care actually get made.
Infrastructure framing also removes the political volatility. Roads, electrical grids, and broadband don’t get debated as fairness questions; they get debated as functionality questions. Are they working? Are they sized for demand? Are they failing in predictable places? Women’s health, treated as infrastructure, gets the same diagnostic lens.
This Is a Leadership Question
The real question sits one level up: who defines the system?
Who sets research priorities? Who writes reimbursement codes? Who defines high-burden disease? Who allocates capital? Who shapes regulatory guidance? Who sits on investment committees, and with what authority?
Representation changes optics. Authority changes architecture.
After 25 years in medtech, global health, innovation strategy, and capital markets, here’s what I know. The bottleneck is prioritization, not capability. We have the science, the technology, and the capital. Until those resources get applied through an infrastructure lens, we’ll keep widening gaps while congratulating ourselves on equal opportunity.
The leaders who understand this distinction won’t focus on expanding entry points into existing systems. They’ll interrogate assumptions embedded decades ago, reallocate capital, mandate sex-disaggregated evidence, design for lifespan health rather than episodic events, and rebuild the underlying architecture.
What the industry needs now is structural courage and the willingness to treat women’s health like the infrastructure category it actually is.
I stopped talking about equality because it lets people feel comfortable, and I avoid talking about equity because it lets people feel principled. The reason to talk about infrastructure is that it forces action and builds something real.