Beyond Sex and Gender Difference in Funding and Reporting of Health Research

Background  Understanding sex and gender in health research can improve the quality of scholarship and enhance health outcomes. Funding agencies and academic journals are two key gatekeepers of knowledge production and dissemination, including whether and how sex/gender is incorporated into health research. Though attention has been paid to key issues and practices in accounting for sex/gender in health funding agencies and academic journals, to date, there has been no systematic analysis documenting whether and how agencies and journals require attention to sex/gender, what conceptual explanations and practical guidance are given for such inclusion, and whether existing practices reflect the reality that sex/gender cannot be separated from other axes of inequality. Methods  Our research systematically examines official statements about sex/gender inclusion from 45 national-level funding agencies that fund health research across 36 countries (covering the regions of the EU and associated countries, North America, and Australia) and from ten top-ranking general health (the top five in “science” and the top five in “social science”) and ten sex- and/or gender-related health journals. We explore the extent to which agencies and journals require inclusion of sex/gender considerations and to what extent existing strategies reflect state of the art understandings of sex/gender, including intersectional perspectives. Results  The research highlights the following: (a) there is no consistency in whether sex/gender are mentioned in funding and publishing guidelines; (b) there is wide variation in how sex/gender are conceptualized and how researchers are asked to address the inclusion/exclusion of sex/gender in research; (c) funding agencies tend to prioritize male/female equality in research teams and funding outcomes over considerations of sex/gender in research content and knowledge production; and (d) with very few exceptions, agency and journal criteria fail to recognize the complexity of sex/gender, including the intersection of sex/gender with other key factors that shape health. Conclusions  The conceptualization and integration of sex/gender needs to better capture the interacting and complex factors that shape health—an imperative that can be informed by an intersectional approach. This can strengthen current efforts to advance scientific excellence in the production and reporting of research. We provide recommendations and supporting questions to strengthen consideration of sex/gender in policies and practices of health journals and funding agencies

Beyond a catalogue of differences: A theoretical frame and good practice guidelines for researching sex/gender in human health

Extensive medical, public health, and social science research have focused on cataloguing male–female differences in human health. Unfortunately, much of this research unscientifically and unquestionably attributes these differences to biological causes – as exemplified in the Institute of Medicine’s conclusion that “every cell has a sex.” In this manuscript we theorize the entanglement of sex and gender in human health research and articulate good practice guidelines for assessing the role of biological processes – along with social and biosocial processes – in the production of non-reproductive health differences between and among men and women. There are two basic tenets underlying this project. The first is that sex itself is not a biological mechanism and the second is that “sex” and “gender” are entangled, and analyses should proceed by assuming that measures of sex are not pristine, but include effects of gender. Building from these tenets – and using cardiovascular disease as a consistent example – we articulate a process that scientists and researchers can use to seriously and systematically assess the role of biology and social environment in the production of health among men and women. We hope that this intervention will be one further step toward understanding the complexity and nuance of health outcomes, and that this increased knowledge can be used to improve human health

Independent Review Of Social And Population Variation In Mental Health Could Improve Diagnosis In DSM Revisions

At stake in the May 2013 publication of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), are billions of dollars in insurance payments and government resources, as well as the diagnoses and treatment of millions of patients. We argue that the most recent revision process has missed social determinants of mental health disorders and their diagnosis: environmental factors triggering biological responses that manifest themselves in behavior; differing cultural perceptions about what is normal and what is abnormal behavior; and institutional pressures related to such matters as insurance reimbursements, disability benefits, and pharmaceutical marketing. In addition, the experts charged with revising the DSM lack a systematic. way to take population-level variations in diagnoses into account. To address these problems, we propose the creation of an independent research review body that would monitor variations in diagnostic patterns, inform future DSM revisions, identify needed changes in mental health policy and practice, and recommend new avenues of research. Drawing on the best available knowledge, the review body would make possible more precise and equitable psychiatric diagnoses and interventions

CDE Working Paper No. 2004-26CHILDHOOD PHYSICAL ABUSE AS A FUNDAMENTAL SOCIAL CAUSE OF MID-LIFE PHYSICAL HEALTH: TESTING A MULTI-PATHWAY LIFE COURSE MODEL

This study combines an ecological approach with a life course perspective to examine the multifaceted mediating pathways linking childhood physical abuse with mid-life physical health. Childhood physical abuse has a strong and persistent effect on mid-life physical health net of family background and age, with women more adversely affected than men. Smoking, obesity, mental illness, and self-rated health are consistent mediators whereas social relations and cognition are inconsequential. The importance of particular paths varies by specific disease outcome indicating that childhood physical abuse acts through a variety of proximate causes, including unhealthy coping strategies and decreased immunity to infections. These findings suggest that childhood physical abuse should be viewed as a fundamental social cause of ill health among adults.

Childhood physical abuse and midlife physical health: Testing a multi-pathway life course model

Although prior research has established that childhood abuse adversely affects midlife physical health, it is unclear how abuse continues to harm health decades after the abuse has ended. In this project, I assess four life course pathways (health behaviors, cognition, mental health, and social relation) that plausibly link childhood physical abuse to three midlife physical health outcomes (bronchitis diagnosis, ulcer diagnosis, and general physical health). These three outcomes are etiologically distinct, leading to unique testable hypotheses. Multivariate models controlling for childhood background and early adversity were estimated using data from over 3000 respondents in the Wisconsin Longitudinal Study, USA. The results indicate that midlife social relations and cognition do not function as pathways for any outcome. However, smoking is a crucial pathway connecting childhood abuse with bronchitis; mental health is important for ulcers; and BMI, smoking, and mental health are paramount for general physical health. These findings suggest that abuse survivors' coping mechanisms can lead to an array of midlife health problems. Furthermore, the results validate the use of etiologically distinct outcomes for understanding plausible causal pathways when using cross-sectional data.USA Child abuse Physical abuse Health Pathways Life course