When it comes to healthcare, there are clear and stark inequalities between women and men. Marina Politis, Alice Witt, and Kate Womersley explain how, at its root, this gender health gap derives from a research and data gap, and how the MESSAGE project is working to improve accounting of sex and gender dimensions in medical research.
Everyone aspires to receive gold standard treatment when seeking medical care. What if, however, this standard, was only ever set out to be gold for one group of people? Much of our medical evidence base has been based on a male norm, with women underrepresented at all stages of the research pipeline. Subsequently, when a woman suffers an out-of-hospital cardiac arrest, she is less likely to receive bystander CPR than a man. Once in the hospital, she continues to be less likely to receive optimal care than her male counterpart.
The gender health gap in cardiovascular disease – poorer outcomes women experience due to the “male default” in health research and healthcare – is just one of many conditions for which there are disparities between women and men. From dementia to diabetes, and osteoporosis to obesity, sex and gender differences and similarities remain neglected in UK and international research.
Everyone’s problem
Importantly, sex and gender differences are not just a woman’s issue but everyone’s problem. Uncertainty about how people of different sexes and genders experience health and illness has considerable impact on men, for example in increased suicide rates among men in their 40s, or higher incidence of pancreatic cancer in men compared to women. If sex and gender were considered at every stage of the research pipeline, we would know more about the biological and social differences that underpin this differential risk. Furthermore, trans, non-binary and intersex people suffer particular harms as a result of research having rarely paid attention to the specific sex and gender dimensions of these groups.
Policy co-design
The MESSAGE project, hosted by The George Institute for Global Health in collaboration with Imperial College London and funded by the Wellcome Trust, is working to enhance sex and gender equity in UK biomedical, health and care research. A series of MESSAGE Policy Labs have been underway since May 2023 to bring together representatives from across the UK research sector to co-design and plan implementation of a sex and gender policy framework for research funders. MESSAGE’s stakeholders include government funders (NIHR and MRC), charitable funders (such as the Diabetes UK, Breast Cancer Now and the Wellcome Trust among many others), regulatory bodies (such as MHRA and NICE), patient representatives, researchers, publishers (including The Lancet Group and The BMJ), the Department of Health & Social Care and NHS England. The MESSAGE policy framework will ensure researchers think through the sex and gender dimensions of their studies at the point of applying for funding and integrate this thinking at all stages of the research cycle, from study design and data collection to analysis and reporting of findings.
MESSAGE aligns closely with the Department of Health and Social Care’s 2022 Women’s Health Strategy, championed by Imperial’s Professor Lesley Regan, England’s Women’s Health Ambassador. The strategy calls for improved sex-disaggregation of data (distinguishing between findings for different sexes during data analysis) as a key component of wider efforts to improve women’s inferior health outcomes and poor experiences when accessing healthcare. Adoption of the MESSAGE policy framework will also ensure that UK funders keep pace with international best practice set by the longstanding sex and gender policies implemented by the CIHR in Canada, the NIH in the United States and European nations under Horizon Europe.
A paradigm shift
Considering sex and gender dimensions constitutes a paradigm shift in research thinking and practice to ensure that science is more accurate, reproducible, and beneficial to a wider proportion of society. It will support the UK to maintain its status as a world leader in biomedical, health and care research and an attractive location for clinical trials. Achieving this transition will require that we address challenges, including concerns about the cost and complexity of recruiting diverse study samples, misconceptions about the hormonal variability of the oestrous cycle in women as a threat to “clean data”, and fears about including women of childbearing potential. Excluding women from the controlled environment of the laboratory on the grounds of safety concerns, only to expose them in the real world to treatments which have only been rigorously trialled on men, however, undermines key tenets of patient safety.
The first MESSAGE policy lab at Imperial identified that wider culture change and upskilling of the research workforce will be needed to drive forward changes to centre sex and gender considerations as standard practice. The MESSAGE policy framework will be accompanied by educational materials and guidance to support researchers and funders. This will include guidance on defining sex and gender, statistical considerations, and recruiting representative samples, as well as practical information for reviewers on assessing the strengths and weakness of the sex and gender dimensions of funding applications. Efforts will be needed to showcase best practice in this work, and incentives from annual prizes, tailored funding calls and journal special editions will help to maximise the discussion around change. Consensus across the research sector on why and how to account for sex and gender will also be essential as we move forward with integrating sex and gender as standard.
The co-designed MESSAGE policy framework will be ready in early 2024, at which point the research sector will turn their attention to policy implementation. You can learn more about exciting changes over the coming months on the MESSAGE project website.
Read MESSAGE’s Statement of Intent and their accompanying press release.