Research Paper- CIHR 2000: Sex, Gender and Women's Health
by Lorraine Greaves, PhD
INTRODUCTION
With the opportunity for transforming and integrating health research in Canada
offered by the Canadian Institutes for Health Research (CIHR), an analysis of sex,
gender and women's health and their relationship to health research is both timely
and instructive. The inclusion of sex and gender as variables in health research is
now recognised as good science, and the omission of these variables leads to problems
of validity and generalizability, weaker clinical practice and less appropriate
health care delivery. Further, such an omission will perpetuate the knowledge gaps
with respect to women's health in particular. We reviewed a vast international
literature on gender, sex, health, women's health, development and medicine. In
addition, our team interviewed thirty-two key informants across four countries who
are specialists in aspects of health research.
Why sex and gender?
Sex refers to the biological differences between men and women, while gender refers
to the social and cultural differences experienced by women and men. In the
determination of health status, both sex and gender have profound impacts on
Canadians. Sex can determine differential propensities for certain health conditions
or diseases, different risk factors, or treatment requirements. Gender can determine
different exposures to certain risks, different treatment-seeking patterns, or
differential impacts of social and economic determinants of health. All societies are
divided along the "fault lines" of sex and gender (Papanek, 1984). In health,
biological differences associated with femaleness and maleness create an immediate
classification in treatment along sex lines. It is just as important to classify
health research in its initial stages by sex-linked characteristics, in order to
produce the highest quality of knowledge.
However, most critical for determining health in Canadian women and men is the
interaction between the sex-linked factors and the gender-based factors that combine
to affect health. For example, we are learning that sex-based factors affect the
presentation of symptoms of myocardial infarctions. Gender-related factors affect the
timing of treatment-seeking in women as well as the responses of health practitioners
to women and men presenting with cardiac symptoms. Taken together, the combined
effects of sex and gender affect health status, health systems responses, and
eventual health outcomes.
Underlying this profound and important link is a serious need for more research on
sex, gender and the interaction between the two. Clinical trials, basic laboratory
research, epidemiological studies, surveys and ethnographic investigations have not
always taken sex and gender into account. As a result, inappropriate generalizations
have been made, assuming that research results apply equally to both males and
females and/or are not affected by sex and gender. The lack of inclusion or
misapplication of sex and gender as important and basic scientific concepts (across
disciplines) renders research partial at best, and dangerously incomplete at worst.
Indeed, it can result in continued suffering, illness or even death. The quality of
science suffers from lack of inclusivity, comprehensiveness and limited
generalizablity.
Why women's health?
In research environments where sex and gender are poorly operationalized or ignored
altogether, women's health is particularly at risk. As a result of decades of
androcentric research we are collectively working with an uneven evidence base
pertaining to women's health in particular. Additionally, we have little research
information regarding differences between groups of women (race, ethnicity, age,
ability, social class, etc). Fortunately, the speciality of women's health is
positioned to be an integrated and transformative area of research, clinical
practice, health promotion and health care delivery in that it includes data and
information from all disciplines in determining paths to improving women's health.
Critically, women's health research also utilizes a wide range of mixed methodologies
(i.e. a combination of qualitative and quantitative methodologies) and sources of
data in order to assess the complex interactions between sex, gender and health.
Women's health has long recognised that it is impossible for any single discipline or
type of specialist to have the requisite expertise to identify women's health risks
and needs.
However, the clear development of a focus for women's health research within the
evolving CIHR is needed to correct the unevenness of the evidence base, attract more
researchers to the speciality and encourage a comprehensive set of variables to be
included across the entire field of health research. Most importantly, it will
provide better health outcomes for Canadian women and girls and their families.
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To download a copy of this research paper go to the BC Centre of Excellence for
Women's Health website at:
http://www.bccewh.bc.ca/cihr.htm or email [log in to unmask]  to order a paper copy of
the report.

Celeste Wincapaw
Communications & Networking Strategist
BC Centre of Excellence for Women's Health
Vancouver, British Columbia
http://www.bccewh.bc.ca
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