Sumbul Desai, Vice President, Health, Apple 
Michelle Williams, Dean of the Faculty, Harvard T.H. Chan School of Public Health (joining remotely) 
Moderator: Michal Lev-Ram, FORTUNE 

Most Powerful Women 2022 - A New Era For Women’s Health

Sumbul Desai, Vice President, Health, Apple 
Michelle Williams, Dean of the Faculty, Harvard T.H. Chan School of Public Health

Now half of the global population is women. So why aren't women better represented and cared for in health and medicine? Perhaps because women's health has long been considered a niche market? Well, the good news is that seems to be changing and there's recognition that women's health is intrinsically different than men. And with this recognition comes opportunity. According to recent stats, us digital health startups, serving women raised nearly $1.5 billion in 37 deals in 2021, nearly doubling 2020 funding. So let's get more perspective from two women who are experts in this space. Some is Vice president of health at Apple and Michelle Williams is dean of faculty at Harvard's T. H. Chan School of Public Health. Dean Williams is joining us remotely today. Please welcome them for a conversation with my hologram. They're very dramatic entrance. Hi symbol. Hi, Michelle, thank you so much for joining us. Um Hi, hi, great to see you. Um I want to start with the good stuff. Okay, so I want to hear from both of you. What are the developments in the field of women's health that you are excited about today. And Michelle, Let's let's start with you. Sure. Let me also say hello to everyone in the audience and to symbols thank you. Um let me let's start with the good stuff. The good stuff is, you know someone who's been in women's health, reproductive health research in the academia space for close to 40 years. one The things that I point to is over the years since 19 the mid 1990s to the mid-2015 we have seen maternal mortality declined by about 44%. And that's really an important single indicator of the advances we've made. I'd also like to say though, that I look at that goodness with a little bit of concern that there are disparities by race and ethnicity. Let me stay with the good stuff. One of the things that I think about is we're having this conversation around women's health at a convention and a meeting like this that brings together leaders from all sectors, academic, public private sectors to talk about women's health. That for me is the change since the 1980s when win Health was in a shadow. The other thing I want to say is I am deeply, deeply excited to be on this stage with dr symbols aside because together we've been able to form a public private academic partnership called the Apple Women's Health Study which brings the best of technology, the best of advanced analytics and the voices of hundreds of thousands of women into the space of becoming their own a citizen scientists in understanding their own health through research and collaboration. Right, thank you. And we will definitely dive into the partnership a bit more but but symbol over over to you. What are you most excited about what's positive? Well, first of all, thanks for having me. Um just by virtue of you working on this amazing topic and empowering women's conversations. I I think that is also part of the good stuff. So thank you for that. And it's always an honor to work with Dean Williams. Um you know, Dean Williams touched on it. The fact that we're having this conversation around women's health is really, really important. Women's health isn't just about cycles. Those cycles are a critical part of it, It's your health, it's cardiovascular health, it's preventative health. It's all of the aspects that make health. And when we think about health, in terms of how we look at it, we want to empower all individuals and in this case women or those who menstruate to really be empowered with actual insights driven by science. And so the fact that we can partner with such an esteemed partner like Dean Williams and the Harvard T. H chan school of Public Health to be able to work on this important topic is really important. You know, the one thing that I just want to call out is um when you think about health as a physician, we think about our vital signs. We all know our vital signs are blood pressure. But women have this additional superpower which actually is our cycles and those who menstruate, have this additional piece of information that really provides insight into your overall health. And if you all recall whenever you go to the doctor, they will ask you when is the last time you menstruating and the reason that's really important is this additional signal can give you a sense of things are going well or if there's things that need to be potentially looked at. And so the idea to be able to take this area that's largely understudied and under invested in and focus on it um, and drive, you know, features hopefully that will help empower more women to understand this. More importantly, is something that we're really proud of. The last, I'll just say in terms of the good stuff is when you have a company like ours that's willing to actually, within the first few minutes of our keynote talk about cycles and menstruation and actually have features like this driven by women at Apple who actually, you know, advocated to drive this feature work forward is something that makes me really proud and love to see that on our teams. And the fact that we drove it together with um with the Apple women's health study team who is made up of a number of women who are very passionate about this space is something that we're incredibly proud of, so take a step back and explain to us how this partnership came to be and what it is exactly, symbol. Yes. So when we um we, you know, we had a set of women who are really excited about digging into this space and making an impact and the way we approach our work is really focused on starting with the science first and when we started digging in, what we learned is most of the science around understanding our cycles was done many years ago. So we reached out to a number of experts and obviously Dean Williams and her team are preeminent experts in this space where they really have spent time over the years looking into this space. And we started having a number of conversations and got really excited together about the idea of refreshing the science in the space, but actually bringing together biometric signals that are so kind of like your lifestyle. So how much you're moving what your heart heart health is really looking at this space holistically as opposed to just focusing on cycles. And um we started talking and realized that there was a real unique opportunity to study this. So we introduced the Apple women's health study along with the apple heart and move study and the apple hearing study as part of our research app where participants say Apple one more time, One more time. Um, Apple um and uh you're not gonna get me to stop saying that, but but over 420,000 participants actually are part of the study. And uh what you can do is basically, you know, Michelle said at night, we allow people to be citizen scientists and we think that's really important, especially after we've lived through the past few years where we've all been part of a large science study together. Um the ability to actually dig in and understand what those metrics mean. So just some quick highlights from it. one. we've we've learned that when you have symptoms around your cycles are not just the traditional things that we think about what your G. I. symptoms and cramps, things like chills before your cycles are very common. And the reason that's important is a lot of time those things get dismissed by doctors. So the idea to actually have some science to show that hey, these symptoms are common, really allow for individuals to come in and be empowered in their conversations with their physicians. So we think that's really important. And the second is um in this vein of bringing together different aspects of your health, like your heart health and your gynecological health pcos. Um in our study, 12% of our participants who had pcos had 1.5 times higher likelihood of having arrhythmia. Not something that we would normally see, but because we had this data coming in from multidisciplinary areas, we were able to kind of study that. So, just some examples. Great, Thank you, Michelle, I want to ask you, my daughters are in sex Ed. They've both gone through all the regular classes and like they're still, you know, I take a look at what they're doing and it's like all the words that we used to call a period and flow and like, all right. And I know you've done a lot of work on de stigmatizing menstrual cycles. Like why are we even still de stigmatizing it And and and tell us about your work. Yeah. You know, thank you. You know, I want to underscore something that doctors decide brought forward and that women's health is so much more than just reproductive health. And you know, one of the reasons um menstrual cycle was stigmatized, but there's just so much um taboo and stigma brought forward because of lack of knowledge, lack of capacity to talk about women's biology and a lot of that lead to gaps, gaps and knowledge gaps in understanding and gaps in our curriculum. Let me just ground this using some real historical timelines. It wasn't until 1994 I was a graduate student that the NIH in its revitalization act of NIH presented guidelines requiring the inclusion of women and minorities in federally funded studies. And it wasn't until 2014 that there were requirements for the inclusion of female animals and tissue for self culture studies to include women. So there's been a knowledge gap and that gap was filled with misinformation, disinformation and worse, just a complete silence and lack of understanding of women's biology and that can contribute to the stigma that we experience. But things are different today and things are different today because women lead scientific teams are filling in those gaps and young people coming to the field of public health and medicine are also including powerful tool technology to do the study that we're doing together with Apple but also to tell stories at very young ages. I have one of our principal scientists on the Apple Women's health study just collaborated with boston science Museum to create a video film for young girls to understand what menstruation menstrual cycle means. And if we can start early and be very holistic in explaining what women's health is and look at menstruation as a vital sign which it really is 1/5 vital sign. It can help people to see menstruation as a superpower. It is a signal of our capacity to reproduce. Um It is a signal of our health and wellness across the life course then we will move menstruation out of the shadows and in a place where it belongs which is a very important biological representation of women's physiology and function across the life cycle. Thank you. I love that menstruation is a superpower. Um I want to switch gears a little bit. Um You know you you mentioned some of the very late but the advances and guidelines for um for for making research for making studies um more inclusive but we also seem to be really good at taking steps back and we recently took quite a big one. Um You said Michelle just recently that in just seven days last june the U. S. Supreme Court setback public health by 50 years. Can you explain that to us and how and why we can look at this from a public health perspective. Sure. Sure. Thank you for that. I really mean that we have lost um we have lost a very important component in the in the in the in the healthcare toolkit for women and girls in this country. And when I say we've come gone back 50 years, there are, there's evidence that we are going to see upwards of 22% increase in maternal mortality because of lack of access or delayed utilization of reproductive health care. And that 22% is even is for the population as a whole. But For vulnerable populations, particularly African American women where they're already two fold increased risk of maternal mortality. We're going to see increases in mortality that will be reminiscent of where we were 50 years ago. But even worse than that. What this does is again puts women and girls in a very vulnerable situation where the loss of bodily autonomy will impact the course of their life, both biologically socially professionally. And so I think that we have to as a nation really reflect on what the doD act represents. And it does represent a loss of agency and a loss of opportunity to um provide a full available toolkit for women, reproductive health and health and wellness across the life course. So we we we have struggles ahead of us. We've made progress and this God act is threatening the progress that we've made, especially in women's health, it's not just about women's health either. Um Child and family health and wellness, economic resilience of families that are not ready for child rearing are also going to be put at risk and this will expand outward to communities. Thank you um symbol for for you for your work. Does this recent shift um represent any any challenges, any new opportunities, Does it change the way that you pursue what you're doing at Apple? You know when we think about one of the things that comes to light and it is with all of this is the importance of privacy and privacy is an area that we have always spent a lot of time focused on um and even more so in health we've always felt like your health information should be as protected for example as your financial information and it should have that level of protection. So in one sense, I think what it does is reinforce, it's an opportunity to reinforce our approach. Um you know, we often um get asked well why didn't you come out with certain features sooner? And the reality is a lot of times it's because of our attention to privacy that we think that doing and obtaining data the right way is more important than necessarily being first. It's really important to focus on privacy and when we think about privacy especially when it comes to health, we think about it as um the same privacy that you expect from your physician you should expect from your technology and our approach has been if for example for your health data and how we go about this is that if your health data is on your phone, which your health data is on your phone, if you use touch I. D. Pass code or face I. D. That data is encrypted on device locally and if you choose to sync with iCloud then with end to end transcription with a passcode, that data is encrypted. End to end an Apple does not have access to that data. And we also have gone to great lengths to really allow for the user to feel in control of their data. So we meticulously have created granular privacy controls by data elements. So you can choose if you want to share your data with someone, you can choose which elements you want to share and you can turn it on or turn it off it's completely in the user's control. But the net is we've worked really hard with all of this um with this approach and our approach to privacy with health data that Apple cannot have access to the data and that's something that we really hold true and something we've focused on a lot with with even Dean Williams and how we think about our broader work. So I know Apple has end to end encryption across the board including for for health data. Not all apps do. I'm sure you've both been asked this um in recent months, you know, I've definitely heard a lot of conversations and read a lot of articles. Should we delete are period tracking apps? What do you say to women who ask that today? I remind people of the the data security steps that we have put in place specifically for the study and specifically the steps that Apple has taken to really allow the optionality for encrypting that information so that it is really only accessible by the user and her delegates as she chooses. So I I we have been very mindful and thoughtful um and open to answering the questions by describing the ways to reduce the harm of mis use and disuse of the data and we've taken every step possible both in the research space, but also in the context of um users of the device is um to empower them and enable them to protect their data and to not destroy the capacity to have access to information that they are just beginning to be familiar with and are using to understand how to optimize their own personal performance and to understand their own biology. Okay, either or choice. Yeah. Yes, ideally for sure. Um symbol, just just real quick give us a little bit of of a preview of what's ahead for the partnership. What else do you want to, what other areas do you want to go into? Well through the study, we're really excited and digging into areas and and again this ties to our philosophy of grounding in the science. So we're hoping that science will take us in the direction of seeing more connections between other aspects of your health and your cycles. Um We also are very excited about digging in more in the science around Pcos that we've seen some early signals in the study from and um continue to look at all of the elements. I mean one of the biggest requests we get from users is menopause and you know, what can we learn there? Um because as women, I do think cycles are super power, but I also think that we take on additional um healthy variances and superpowers as we as we progress in life. And I think really just understanding that more, I mean I think our goal really is how do we empower people to have more information about their health? So they're they're in the driver's seat of their health and how do we help you do that with a scientifically validated way? I think that's so critical and something that we really are laser focused. Alright, well hopefully next year we will have you both back here and we'll talk about menopause next time. Talk about stigmatization that's definitely needed as well. Um Michelle, thank you so much for joining us. Thank you for your very, very uh you know, uh what's the right word, like your your broadband is fantastic. So we appreciate it. You're fast speed broadband. It has worked fantastically and simple. Thank you so much for being here in person. I appreciate you. Thank you, Dean Williams. It was good seeing you.