For generations, women have had to navigate a healthcare system that too often fails to understand their symptoms, take their concerns seriously or provide them with the information and care they need. New research now shows that the consequences extend far beyond their health, affecting women’s ability to work, care for their families, participate in their communities, pursue opportunities and exercise power over their own lives.

A report commissioned by Pivotal , the group of organizations founded by philanthropist Melinda French Gates, in partnership with Gallup, puts striking numbers behind those experiences and illustrates the connection between women’s health and women’s power.

The survey of more than 5,000 U.S. adults—one of the most expansive ever conducted on women’s health and opportunity—found that over half of women report having had at least one negative experience with a healthcare provider in the past five years, including misdiagnosis, dismissal of their pain or receiving no recommendations for next steps. Three in ten say they have had to push to be taken seriously or receive the treatment they need.

One in four women report being in fair or poor health, while more than 40% say their health has limited their career. Among women who were unable to get needed care, that figure rises to 66%. This number is even higher for women of color, with Black women being more likely than white women to say their health has affected their career.

The effects reach beyond the workplace. One in four women said their health had made them less involved in their communities or unable to participate in civic activities. More than half of women report at least one health-related impact on their family life or relationships in the past five years. Women of color were twice as likely as white women to say health challenges affected their status within their families and their vision for their futures, including giving them less of a voice in household decisions and changing their plans for having children.

The gaps span women’s lives: One in three women ages 18 to 44 report reproductive health issues beyond pregnancy; half of women report experiencing a mental health challenge during pregnancy or in the year afterward; and nearly half of women over 65 have been diagnosed with a cardiovascular condition.

The findings point to a broader connection between women’s health and women’s ability to fully participate in their careers, family and communities. “I want to make sure women can do anything they want to do in society,” French Gates told me. “But if that’s the goal, you actually have to go all the way back and start with their health, because women have to be well to do well.”

For French Gates, the issue has also become personal. In a New York Times op-ed earlier this year, she wrote candidly about navigating menopause herself and the gaps she encountered even with access to high-quality healthcare. Her experience reflects one of the new survey’s particularly striking findings: more than one in three women first learn about the symptoms of menopause when they are experiencing them themselves.

The urgency to accelerate systemic change in women’s healthcare is reflected in French Gates’s growing investment in the issue. In June, she announced an additional $215 million commitment to women’s health, bringing her commitments in the area to more than $600 million over the past two years and expanding the scope of her work across areas including contraception, maternal health, mental health and menopause.

I spoke with French Gates ahead of the release of the new Gallup-Pivotal findings about what the data reveals about the true costs of neglecting women’s health, why so many women still struggle to get the information and care they need, the connection between health, opportunity and women’s power, and what it will take to build a healthcare system that better serves women throughout their lives.

Marianne Schnall: These findings paint a striking picture of how women’s health affects virtually every aspect of their lives. What made you want to undertake this study, and what stood out to you most in the data?

Melinda French Gates: We were hearing from so many women anecdotally about their experiences, and I wanted to understand, is this widespread? And what do we really know? Because the only real way to really make progress—I know this from working in health for over 20 years—is to measure something and see where you are and understand it, systematically make investments so that you can then measure it to see in three, five, 10 years, have you made progress? So that’s why we did the Gallup survey.

Overall, it was not surprising to me, but there were parts that were just shocking to me. I mean, 40% of women take a step back in their career because of their health. Wow. Just wow. Talk about an off-ramp for your career and for your life and the downstream implications of that for your family. I was shocked how many women said that.

Schnall: Women have been saying for decades that the healthcare system doesn’t adequately understand, address or prioritize their needs. Why do you think the area of women’s health has remained so chronically underfunded and underserved, and what will it take to finally change that?

French Gates: Let me start by saying, women deserve so much better than what they’re getting. That is beyond clear. And if you look back in history, who set up the healthcare system originally? Who were the healthcare professionals, the doctors? Well, they were men. And who was graduating medical school? Men. Who were applying for research grants? Men. Who were funding the research grants? Men. So part of it is, we’ve had this system that has just carried forward, and we have assumed that the man’s body is the default body, when in fact a woman’s body is completely different than a man’s. So because of how things started, we have not updated the system. And, boy, is it way overdue and is it time.

Schnall: We see the real world implications of this in so many areas. We hear about how a woman might not recognize they’re having a heart attack—things are just not looked at from how they manifest in a woman’s body. One of the findings I found particularly troubling, and sadly, one that I’ve experienced both for myself and for my daughters, is that half of women report having a negative experience with a healthcare provider in the past five years. What does that tell us about the current culture of medicine and the experience of being a woman seeking care?

French Gates: It says that her experience is really poor. Here we are in the highest income country in the world, and yet women across the system are experiencing negative impacts from the system. To use your example of a cardiac event, women experience the pain, they experience the symptoms. They’re actually going into the system and 50% are coming out without a clear diagnosis. Wow. So not only is their pain being dismissed, they’re often told it’s “just anxiety.” There’s no thing as “just anxiety.” Anxiety is a signal from our bodies that something’s wrong. But to come out without the right information and the right care, you’re setting them off on a trajectory that can be catastrophic for their long-term health. That just should not be. We deserve so much better as women.

Schnall: What also struck me in these findings was that women’s health needs change throughout our lives—from reproductive and maternal health to mental health to menopause—yet women’s health is often narrowly defined around pregnancy and reproduction. Do we need to fundamentally broaden the way we think about women’s health so that women are better supported across their entire lifetimes?

French Gates: Absolutely. We need to really look at all the transitions a woman’s body and her health go through across her lifetime and focus on those areas, because those transitions in her life happen at key times—and they can either keep her on the trajectory that she wants to be on or they can be off-ramps for her. Also menopause, for instance, we’re learning, can potentially lead to things like Alzheimer’s, which is a long-term consequence for women, so of course we need to be looking at all those stages and transitions in a woman’s life.

Schnall: The report shows that women’s health issues can have far-reaching impacts on their careers, families and participation in their communities. We often talk about women’s power in terms of equal pay, childcare, workplace policy and representation. But do we need to start thinking about women’s health as fundamental to women’s power and equality too?

French Gates: Absolutely. The issues you mentioned are all very, very important—equal pay, childcare, et cetera—but we have to look at women’s health. This is why I’m making investments there, because I want to make sure women can do anything they want to do in society. But if that’s the goal, you actually have to go all the way back and start with their health, because women have to be well to do well.

The specifics of 40% of women saying they had to step back in some way, we heard women are cutting back their hours, they’re taking off many hours to go deal with the healthcare system, they’re trying to seek the right information and answers. They’re saying, “Look, I didn’t go for that promotion because my health issues were so severe. I cut back on my ambitions.” If their health is poor, that has profound consequences for how they show up in their family, how they can or can’t show up in their community. Also, if they can’t rise to the ambitions that they want, they’re probably not earning what they want to bring back to their family. And I just don’t think that’s what we want for society.

Schnall: The survey also found striking disparities with many of these burdens falling disproportionately on women of color and lower income women, including poorer reported health, greater caregiving barriers to care and greater career impacts. And so much of the burden seems to fall back on women themselves to navigate a system that wasn’t designed around the reality of their lives. How do we build a healthcare system that actually works around women’s needs and make sure that growing attention and investment in women’s health closes these gaps rather than widening them?

French Gates: We can rethink parts of our healthcare system. For instance, one of the clinics I’ve invested in—I went down to see it in person in Alabama last year—what they have done is they’ve redesigned the clinic completely around a woman’s needs. It happens to be in a community of a lot of Black women. And what they do is, the second she walks in the door, they help assess her mental health and where she is. So if they’re seeing a mental health issue, they’re catching it right away, and the services are right there. At the same time, they are helping her with the pregnancy test and the other needs that she has. They’re also saying, “Hey, you can bring your child with you.” Because, as you said, so many of these women are saying, “I don’t have child access to childcare, and yet I need to go take care of my health.” So if we do wraparound services for women, a clinic can serve them better. Then they’re not going to appointment after appointment and getting in their car or on a bus to go to five different places to get their needs met. Put it all in one place. That’s not that hard to do.

Schnall: You’ve now committed more than $600 million to women’s health over the past two years. Why is women’s health an issue that you feel so personally passionate about?

French Gates: Because I know when women can get the right information and the right care at the right time, they can live their full lives and reach their full potential. But conversely, if they don’t get the right information or the right care, it can be these off-ramps in her life—in her family life, her community, her career.

And when I look back in history and I say, “Where has philanthropy made a difference? Where did they shine a light and make a difference in women’s health?,” I go back to the time I was graduating high school in Texas. The Susan G. Komen Foundation started us on the path of breast cancer awareness. Women talked about it, they did walkathons. The Susan G. Komen Foundation put massive amounts of money into breast cancer research, and they also did advocacy so the U.S. government would. Think about breast cancer today: We know to screen ourselves, we know to get a mammogram. Women are finding out earlier when they have it. So we’re able to prevent breast cancer instead of it taking as many lives as it did.

That’s been in my lifetime, in the last 40 years. So I’m saying, as a philanthropist, let’s focus on these issues, crowd in other money, make sure that we advocate to the government so the government puts in more funding and make sure businesses and healthcare professionals all do their part. We can change the system; I know that from history.

Schnall: You wrote a powerful op-ed about your own experience with menopause, and even with access to excellent healthcare and your decades as a women’s health advocate, you found yourself having to raise the issue with your doctor and push for options. What do you think it says about our healthcare system that even well-informed women with good access to care can reach this major life transition feeling so unprepared, and what can we do about it?

French Gates: It’s staggering. If someone who is as privileged as I am—who can find the right doctors, get the right information over time—if I’m struggling, I look at everybody else and how they must be struggling as well. And that just shouldn’t be. We deserve so much better.

Part of what surprised me was I was 37 when my last child, my daughter, was born. And I thought, “Oh, menopause, I’ve heard about that. That’ll happen much later for me.” No, I started into perimenopause in my early 40s. Wow. So we just need to make sure that women have all the right information and that the care is accessible to them. It’s why I’m also making investments in the system, the Menopause Society, for instance, so that not just one third of OBGYNs are trained on menopause, all OB-GYNs are trained, and primary care doctors and mental health professionals. So as soon as a woman touches the medical system, they start getting the right information and the right care.

Schnall: Referring back to the survey finding that six in 10 Americans believe women’s health should be a high priority at the state and federal level, do you see that as an encouraging sign that there is broad support for prioritizing women’s health, even at a time when some aspects of women’s health around reproductive care have become so politically polarized? Do you think the broader issue of women’s health could become one that would unite us across the political spectrum?

French Gates: I absolutely do. That was the encouraging thing to me in the surveys, that 60% of Americans said, “We have to address women’s health.” And it wasn’t just women, it was men too. Men want their wives, their daughters, their mothers to not just survive, but to thrive. So I do think it’s something that we can come together as Americans and say, “We are going to demand better because it’s right for all of our families.” We know that our health and our healthcare should be guided by science, not politics. I think that’s what people are waking up to and are asking for now. Everybody’s seeing it and experiencing it, but we’ve got to make the right investments.

Schnall: If we actually got this right—if women had access to the information, care and support they need throughout their lives—what would become possible for women and society as a whole?

French Gates: If women got the right care at the right time, they could thrive. They could reach their full ambitions for themselves. They’d be more accessible for their children and help make sure that their children can thrive and reach where they want to go. Women can participate more in civil society. They can participate more in business. So, to me, we would lift up society if we make sure women get this care, because the thing that I know from good research across the globe is that if you invest in a woman, she invests in everybody else around her. So I think we want women to thrive, and it would be phenomenal for our society and for our economy.

For more information on the Gallup-Pivotal survey, visit Pivotal.com or Gallup.com , where the full report will be available September 24.

This interview has been edited for clarity and length.