Although women are the majority of the population, their health and health care are at times treated as a special case or minority issue in terms of research funding and practice. Without sufficient data, attempts to address gender disparities in health care and outcomes are likely to be both inefficient and ineffective (
Krieger, 2003
, Fremont et al., 2007
). Moreover, misinformation and failure to account for evidence on how biological and social differences influence health can impair efforts to close gaps between men's and women's health and health care (Lawrence and Rieder, 2007
, Prins et al., 2007
). For simplicity, we refer to these as gender differences, but note that they may be biological (i.e., sex based) as well as social (i.e., gender based). Although such differences do not always favor men, improving women's health will require systematic assessment of the nature and extent of disparities in men's and women's access, treatments, and outcomes (Rieker and Bird, 2005
, Bird and Rieker, 2008
). Until access, quality, and outcomes of care are tracked by gender, inequity in treatment will remain unmeasured and potential intervention points will remain understudied. Gender-based analysis can lay the groundwork to develop more effective decision tools and interventions, and in turn improve both women's and men's health and health care.Addressing this problem requires leadership and innovation in research policy, practice, and publishing. Many of the challenges in women's health research relate to the lack of requirements for gender-based analyses aimed at determining to what extent specific findings apply differentially to women and men. The U.S. National Institutes of Health (NIH) has an Office for Research on Women's Health and requires that women and minorities be included in all NIH-supported clinical research studies (
Geller et al., 2011
). Yet, at this time neither the NIH, nor the Agency for Healthcare Research and Quality, which funds health services research, requires samples large enough to allow gender-based analyses or mandates gender-stratified analyses when it is feasible to do so. In contrast, since December 2010, the Canadian Institutes of Health Research (CIHR), which funds projects and investigators across the full spectrum of clinical and health services research, has required that all research funding applicants answer mandatory questions on whether and how they will examine gender (with parallel questions on sex), or why they do not plan to do so (Sharman and Johnson, 2012
). This policy is intended to increase applicants' awareness of gender and may encourage them to include large enough samples of women to assess important differences and to conduct such analyses. There is no equivalent standard in the United States, although investigators are required to provide a rationale when proposing single-sex studies. By December 2012, 2 years after implementation, 50% of CIHR operating grant applicants indicated that they were accounting for gender and/or sex (unpublished CIHR data). To enable further integration of gender in research and peer review, CIHR's Institute of Gender and Health, which supports research on the influence of gender and sex on the health of women, men, girls, and boys, is developing training modules for all CIHR peer reviewers and applicants.The CIHR's approach offers a valuable example of an alternative that could help to advance the recognition of gender differences in health and health care and improve women's health. One clear strategy for informing policy and practice in women's health care in the United States would be to begin funding more gender-based analyses in health research. For example, research aimed at better capturing health care utilization data and test results by gender could inform quality improvement efforts by identifying women whose profile of care and test results indicate they may be experiencing undiagnosed disease. Such data could be used to demonstrate the cost and consequences of health care as usual versus the benefits and potential savings in terms of years of life, quality of life, and potential economic savings of changes to women's health care.
A second strategy would be to increase the integration of gender considerations across health services research (
Greyson et al., 2010
). Achieving such integration requires systematic investments in health services research on gender and in the dissemination of those findings. Efforts along these lines have done much to raise awareness of and recognition for racial/ethnic disparities in health and health care and ultimately lead the NIH to elevate the Office of Minority Health to Institute status, with greater funding and influence than it had in the past. Shifting the U.S. model by elevating the Office for Research on Women's Health, which served as a model for CIHR in establishing the Institute of Gender and Health, to become an institute, and elevating the Office for Research on Women's Health and expanding its mandate to encompass how gender influences the health of all people would require a change in the research and policy dialog on women's health and health care. Irrespective of the mechanism, we are calling for a change from the status quo in which women's health issues are viewed as a specialty issue that can be left to a small number of researchers and studies to a central issue in which women's health and the impact of gender on health care needs and outcomes are seen as deserving of serious attention in research, policy, and practice.The question of whether research findings apply equally to women and men carries over into the reporting of research in scientific journals (
Heidari et al., 2012
). Gender-based analysis is usually not required and authors are frequently discouraged from reporting results that do not show statistically significant differences. Consequently, much less is known about whether specific findings apply equally to men and women, and whether analyses were conducted—but not reported—that show strong evidence of similarities or differences that relate to men's and women's health care and outcomes. Raising this issue in journal articles, targeted commentaries, and research reports may help to heighten attention to this issue and help to shift the requirements and standards for reporting medical research (Foulkes, 2011
). We can look abroad for examples of successful policy change. For example, the Gender Policy Committee of the European Association of Science Editors is presently developing a Common Standard for Gender Policies in Scientific Publishing (European Association of Science Editors, 2013
). U.S. journals such as this one might consider adopting this standard, which is expected to be published in January 2014.European Association of Science Editors (2013). Gender Policy Committee. Available at: http://www.ease.org.uk/about-us/organisation-and-administration/gender-policy-committee.
Advancing research on women's health and health disparities related to the leading causes of death and disability, and to other diseases which differently or disproportionately affect women, is both timely and essential to improving women's health care and outcomes. With the implementation of the Affordable Care Act, new tracking systems are being developed and will become routine. Establishing women's health and gender disparities in care and outcomes of care as a priority is critical to improving women's care and, more broadly, to reaping the benefits for all people of the meaningful and appropriate integration of gender in health research and its applications. We have an opportunity to make the case for such tracking now to make gender differences in health care and outcomes visible so they can be addressed.
References
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European Association of Science Editors (2013). Gender Policy Committee. Available at: http://www.ease.org.uk/about-us/organisation-and-administration/gender-policy-committee.
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Biography
Chloe E. Bird, PhD, is a Senior Sociologist at RAND and Professor of Policy Analysis at the Pardee RAND Graduate School. Her current work focuses on assessing and mapping gender differences in quality of care for cardiovascular disease and diabetes.
Biography
Zena Sharman, PhD, is the Assistant Director of the CIHR Institute of Gender and Health. Her primary interests are the domain of interdisciplinary scholarship and teaching on gender, sex, sexuality, and health.
Article info
Publication history
Published online: February 18, 2014
Accepted:
November 21,
2013
Received:
November 20,
2013
Identification
Copyright
© 2014 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.
