Advocacy doesn’t change systems. Strategy does.

It took me 25 years in medtech to be able to write that sentence and mean every word of it. I’ve spent those 25 years as an operator, an investor, and an advocate, and most of what I learned came from watching the gap between the conversations we were having and the outcomes we weren’t getting.

Why Advocacy Worked, Until It Didn’t 

Early in my career, I leaned hard into advocacy. There weren’t many women in the engineering and manufacturing rooms I was in, and I made a habit of speaking up. I challenged decisions that should never have been controversial. I pushed for outcomes that should have been the baseline. It worked, to a point. 

The conversations shifted. People got uncomfortable in the ways I wanted them to. But the budgets stayed where they were, the product strategies didn’t move, and the investment didn’t follow the rhetoric. Being right turned out to be different from being effective. I spent a couple of years uncomfortable with that gap before I understood what was truly wrong with how I was working.

Strategy Is the Translation

The thing that changed it was getting into the seats where I was responsible for the decision, not just trying to influence it. From those seats, you stop expecting companies to move because something is important. They move because something is prioritized, and priorities live and die by strategy. 

Most advocacy assumes the system will respond if the case is made strongly enough. It doesn’t. The case itself is overwhelming. McKinsey Health Institute put the women’s health gap at $1 trillion in annual economic opportunity. That case still doesn’t move companies unless someone translates it into the language and structure of the decision being made.

The case for women’s health that lands with a CFO is not the same case that lands with a clinical operations lead, and neither is the same case that lands with a board. Strategy is the discipline of knowing which version to bring into which room and being able to move between them.

Last year in Sub-Saharan Africa, I watched a woman bring her child to a clinic for screening and skip her own meal that day because she only had money for one of them. She chose her child. That same week, I was sitting with companies whose technology could have closed part of the gap she was inside of, and weren’t getting it to the region she was standing in. That’s not an awareness gap. That’s a strategy gap.

So I changed how I showed up. I stopped saying “this matters” and started asking “how does this become part of your business?” Then I started building the alignment with revenue, growth, and long-term value that turns the answer into a decision. 

Advocacy appeals to values. Strategy aligns with incentives. Incentives are what drive action.

What “Having a Moment” Requires

You can see this playing out across women’s health right now. There’s more attention than there’s ever been, more panels and reports, more capital starting to flow. But venture funding for the category is still below 2% of total health investment, per Rock Health. Liz Powell, founder of Women’s Health Advocates, put it bluntly: women’s health is not having a moment. It’s a movement. Movements compound when somebody builds the strategy underneath them.

The one question I’d ask anyone reading this: What changed inside your company in the past year. Did capital move? Did a product get built? Did anyone shift a go-to-market strategy or commit long-term resources because of any of it? One side of that line creates momentum, and the other converts it into something real.

When to Be Each 

Advocacy opens doors. Without it, the rooms I’m operating in now wouldn’t have been opened either. There are still moments when the only useful move is to be the advocate, when something is broken and no one is talking about it, when the conversation needs to happen before anyone can move on it. But the trap I see across women’s health right now is people staying in advocacy mode when the case has already been made and the next move is the strategist work of allocating resources, restructuring incentives, and getting the decisions into the right rooms.

I’ve learned to move between both. The best operators in this space do the same. They can stand on a stage and make the case, and walk into a boardroom and operationalize it.That’s what I wrote Undervalued to Unavoidable to do. It’s the framework for everyone who has already won the argument and now needs to win the decision.