Chapter 17
For decades—for centuries, even—at dinner tables and in waiting rooms, in whispered conversations around the water cooler, women have been talking to each other about our health, searching for answers.
How many women did I know who’d gone to a doctor with debilitating pain and been told “It’s all in your head” or “It’s just stress”? More than I could count.
This has created gaps in our understanding of conditions that mostly affect women, only affect women, or affect women and men differently, leaving women seeking health care in a medical world largely designed for men’s bodies.
Improving women’s health requires understanding those conditions.
The discoveries we could make would give us insight into all of human biology.
It was one of those moments that happen in life, where you learn something and you can never see the world the same way again.
Suddenly, the problem felt so familiar—because we all know what Maria was talking about.
If you ask any woman in America about her health care, she probably has a story to tell. You know her.
She’s the woman who gets debilitating migraines but doesn’t know why, and can’t find treatment options that work for her.
She’s the woman going through menopause, who visits her doctor and leaves with more questions than answers, even though half the country will go through menopause at some point in their lives.
She’s the woman whose heart attack isn’t recognized because her symptoms don’t look like a man’s, even as heart disease is the leading cause of death among women.
She’s the woman who needs treatments, and affordable and easy-to-use products that help her stay healthy or feel better when health needs arise.
That same night, I asked Joe at dinner what he thought could be done.
He never wasted time to act when a problem was identified.
In a few short months, we launched the first-ever White House Initiative on Women’s Health Research.
Through this effort, we set out to fundamentally change how the United States approaches and funds research on women’s health.
In March 2024, Joe signed the Executive Order on Advancing Women’s Health Research and Innovation to ensure federal agencies strengthened their research and data standards to enhance the study of women’s health across federally funded research.
As a result, for example, the Congressionally Directed Medical Research Programs, run by the Department of Defense (DOD), implemented a policy to ensure researchers use both male and female study subjects unless there’s a good reason not to do so.
His executive order directed agencies to prioritize grantmaking to researchers and entrepreneurs focused on women’s health, including through the Advanced Research Projects Agency for Health (ARPA-H) and the NIH.
It also directed the US secretary of Health and Human Services to address research gaps related to menopause and women’s midlife health, the secretaries of Defense and Veterans Affairs to support the needs of women service members and veterans related to midlife health, and the director of the National Science Foundation to consider how artificial intelligence might be used to the benefit of women’s health research.
Thanks to the executive order, our White House Initiative galvanized nearly $1 billion in funding for women’s health research, through agencies like the NIH, DOD, and ARPA-H.
These investments aimed to advance research to improve prevention, diagnosis, and treatment of diseases and conditions that affect women uniquely, differently, and disproportionately—from menopause to brain disorders to cardiovascular disease.
In his State of the Union, Joe called on Congress to provide $12 billion for women’s health research, to help make up for all the lost time.
While Congress didn’t get that done, I hope a future administration will deliver this needed funding.
ARPA-H is a legacy of Joe’s administration that few people talk about but that will have a massive impact on the health of Americans.
Modeled on the Defense Advanced Research Projects Agency (DARPA), the defense agency that helped bring us once-unimaginable technologies like the internet, satellites, flat-screens, and Siri, ARPA-H pursues the kind of breakthroughs in health that could change everything.
Joe created this agency because he knew we needed faster and better cures—as anyone who has lost a family member to a terrible disease like cancer knows.
When we began our initiative, ARPA-H was one of the first places Joe turned.
Led by the remarkable Dr. Renee Wegrzyn, the agency launched the Sprint for Women’s Health program, investing $113 million in researchers and entrepreneurs working on solutions like noninvasive blood tests for endometriosis, new ovarian treatments to prevent disease in menopause, and a first-of-its-kind at-home test for the early detection of preeclampsia.
These scientists and entrepreneurs should give us all such great hope.
My visits to research labs have opened my eyes to how many brilliant scientists we have working in this country.
One scientist I encountered had isolated the gene that causes some women to have severe nausea during pregnancy.
She found that a hormone produced by the fetus could trigger morning sickness in women who were particularly sensitive to it.
Hearing about the doctor’s work made me feel like I was watching the Tuesday Science section of The New York Times (my favorite read of the week) come to life.
How proud I was that the boom in research and innovation that Joe fostered would result in greater health and wellness for American women, the discovery of new treatments for disease, and new ways for us to live longer and stay stronger.
I spoke at forums on women’s health alongside some of our greatest doctors—and celebrities boldly admitting that they, too, struggled with the physical challenges of midlife.
As my husband said at our White House Conference on Women’s Health Research in December 2024, “The work we’re doing on women’s health research is some of the most important work this administration has ever done.”
I’m biased, but seeing all the momentum in the field today, I agree!
“Well, Jill, then you shouldn’t go to college.”
That’s what my high school guidance counselor told me.
I was crushed. His assessment was that I wasn’t college material.
He said, “If you don’t really know what you want to do next, college just isn’t right for you. You shouldn’t waste your time.”
My whole life, I’d wanted to go to college. And now the person who was supposed to guide me there was saying I couldn’t do it.
Well, I got my college degree—and, at the age of fifty-five, I walked across that graduation stage to receive my doctorate.
People like to tell us what they think we can’t do, don’t they? They say it’s going to be too hard or too complicated. That no one like you has done this before.
In my advocacy for community colleges, I was determined to make attending them free for students who qualified.
This was an effort I started as Second Lady through the College Promise initiative.
This work resulted in thirty-five state-led efforts to make community college free.
When Joe was elected, I wanted this opportunity to be available for all students in all communities.
My policy team worked to add free community college to a bill that was moving through Congress in spring 2021.
These weren’t just associate degrees, either—workforce development programs were also partnering with community colleges.
Students could sign up for certificate programs that ended with them being given a good trade job in, say, carpentry or electrical work, all debt-free.
As a teacher, I’d seen firsthand how community college supported students educationally, vocationally, and personally. I’d also seen how even the low cost of tuition at these schools could be prohibitive for worthy students who wanted to attend.
Senator Mitch McConnell made passing Joe’s bipartisan Investment and Jobs Act all but impossible, though pieces of it looked as though they might survive.
Free community college had support from both sides of the aisle and a real chance of passing—except there were two key votes against it: Arizona Senator Kyrsten Sinema and West Virginia Senator Joe Manchin.
I went to West Virginia for a vaccine-promotion trip with Jennifer Garner, who I’d served with on the board of Save the Children—she grew up in Charleston, West Virginia, and her mom still lives there.
We invited Senator Manchin and his wife, Gayle, to join us.
I took the opportunity to mention that I thought means-tested free community college could make a huge difference to people like my students trying to get an education even against steep odds.
Manchin told me that churches should take care of helping families in need, and that it was his experience that paying for college yourself helps you learn to value it.
He said he knew people who’d failed out when it was being paid for by other people and who’d really appreciated it when they had to foot the bill themselves.
Another time, I lobbied Manchin after a meeting he had with Joe at the White House, telling him my students’ stories, hoping to move him with how much good increasing access for them could do.
I talked about how many more women were getting into building trades and becoming electricians and carpenters.
I’d gotten to know many of the country’s community college presidents, and I offered to put him in touch with them.
He listened, but in the end, the money was going to go to funding either community college or early childhood education. I didn’t want to compete against pre-K. I believe above all else that early childhood education is essential for student success.
I was scheduled to meet Joe’s policy team and senior staff in the Roosevelt Room to discuss the bill.
I received a heads-up that they were going to ask me to pull back on free community college so that the bill could move forward.
So I put on a dark blue suit and a black armband.
It was my own personal protest. When I walked in the room and they saw what I was wearing, we all broke out into laughter. But I did want to make a point.
Losses like that made the victories even more meaningful.
Like a spell, the word “cancer” stills the air around us—frozen in place, we feel the world as we knew it slipping away.
In the span of a breath, a thousand questions fill our minds: What can I do?
How do I tell people? Why did this happen?
And when the hands of the clock begin to move once again, we are not the person we once were, but someone changed.
Cancer touches everyone.
One of our successes was establishing insurance coverage for patient navigators.
Having navigated the medical system following family cancer diagnoses, I know well that when you hear the news, you’re so shell-shocked that you don’t know what to do, what your next step is.
Typically you get out your phone and start googling—and scare the hell out of yourself.
Patient navigation was a solution, and I made advocacy for it a priority when we relaunched the Cancer Moonshot during Joe’s presidency.
In November 2023, the Biden administration announced that Medicare would pay for navigation services. The administration also announced medical billing codes that enable private health insurers to pay for these services as well. This advanced a new era in cancer treatment.
When my class’s writing tutor, Paula, found out she had lymphoma, she was devastated.
It made things just a little bit easier when, with the help of an assigned guide, she was able to figure out a treatment plan that worked for her.
Newly optimistic about her future, she emailed me to say, “My patient navigator just called me, and I thought of you.”
I am proud of my team for working so quickly to make patient navigation a reality for American families.