Sex and Gender Health Collaborative

Written by Mary K. Rojek, PhD

The Sex and Gender Health Collaborative began as the Women’s Health Working Group of the American Medical Women’s Association in 2008. The group’s goal was to advance women’s health throughout medical education. Even though scientific evidence showed that there were many differences between men and women for many health conditions, this information was not being integrated into medical curricula. In addition, there was a great deal of research taht showed that there were many social and gender related factors that influenced women’s health which should be integrated into medical curricula. The working group determined that it would accomplish this goal by creating a digital resource library. This library would be a collection of curricula and other teaching resources for faculty so that they could integrate this information into their own course materials. The American College of Women’s Health Physicians (ACWHP) provided support for the digital library. 

The working group members decided to organize as a new entity, the Advancing Women’s Health Collaborative. Members had been concerned about whether all faculty members would be comfortable accessing resource materials on a website that focused on women physicians. An initial digital resource library was created. Advancing Women’s Health Collaborative’s technological partner supported the group’s activities, but the website was difficult to access due to user registration requirements. At the same time, there was an increasing awareness among leaders of the Advancing Women’s Health Collaborative that the social factors and gender issues that influenced women’s health also influenced men’s health, and thus should also be integrated into medical curricula. 

In 2012, the Advancing Women’s Health group reorganized once again as a 501c3 and renamed themselves the Sex and Gender Women’s Health Collaborative (SGWHC). The name of the new organization, SGWHC, reflected the initial focus on women’s health which was still inadequately addressed in medical curricula, along with the fact that sex and gender issues were relevant to both men’s and women’s health. While the focus of the collaborative would be on addressing women’s health issues in medical curricula, men’s health would also be addressed. 

SGWHC’s founding partners were the American Medical Women’s Association (AMWA), the Society for Women’s Health Research (SWHR), and the American College of Women’s Health Physicians (ACWHP). At SGWHC’s inception, ACWHP merged into SGWHC. Subsequently, SGWHC also collaborated with and was supported by the Laura W. Bush Institute for Women’s Health at the Texas Tech University Health Sciences Center. Collaborative relationships were established with many other healthcare groups and organizations. 

Although SGWHC was successful in advancing the new science of sex and gender medicine in research and medical education, national progress was slow. SGWHC wanted to continue to offer curricular resource materials to faculty at no cost and in an easily accessible manner, but it did not have the resources to fully develop and market the materials. Board members were once again considering how they could advance the integration of sex and gender content into medical curricula. 

The American Medical Women’s Association offered to partner with SGHWC more formally in order to advance their similar missions. AMWA’s previous commitment to women’s health in medical education had expanded to encompass sex and gender health education. SGWHC board members decided to merge into AMWA so that they could advance their mission by benefiting from AMWA’s institutional infrastructure, support, and form their shared vision. SGWHC merged into AMWA in 2018. Upon merger, SGWHC was renamed the Sex and Gender Health Collaborative (SGHC). This name change reflected growth in the science of sex and gender medicine and the increasing importance of explicitly considering and identifying sex and gender differences between women and men. It was believed that improvements in women’s health would correspond with improvements in men’s health. The new name would also reflect the growth of interprofessional education and increasing need to integrate sex and gender content into all health professions education. While interprofessional education had been a future goal for SGWHC, the founding of SGHC provided an opportunity to bring this goal into the present. SGHC is at the forefront of advancing sex and gender in medical and health professions education, research, and practice in order to improve healthcare for all.r

Written by Mary K. Rojek, PhD, 2015

The emerging field of Sex and Gender Based Health (SGBH) seeks to remedy the invisibility of many women’s health issues and improve healthcare for all. In a broad sense, SGBH refers to the differences in health and illness between men and women, but it also acknowledges intersex and LGBTQIA health issues. SGBH can be a foundation for how to think about and research all social determinants of health that contribute to health disparities because every person has a sex and gender. When applied in the clinical setting, it will improve patient outcomes. 

• Women’s Health as a Precursor to Sex and Gender Health

  • The field of women’s health is the precursor to SGBH. Historically, women were excluded from research studies, which limited our understanding of their health issues. There were many reasons for this exclusion. For example, there were concerns about the teratogenic effects of pharmaceuticals if a woman should become pregnant. It was also argued that women’s bodies were the same as men’s bodies and that findings from research on men applied to women. At the same time, it was argued that women were too difficult to study because of their hormonal fluctuations. Clearly, the claims that women’s bodies are both the same and different from men’s bodies could not be true. The inequity in women’s health research began to be remedied when the 1993 NIH Revitalization Act specified that women and minorities should be included in research studies. Even so, many researchers resisted. When women were included in research studies, the data were often not analyzed based on sex. 

• Discovering Differences in Men’s and Women’s Health

  • When the results of the Women’s Health Initiative began to be published in the late 1990s and early 2000s, it became clear that there were existing medical practices that harmed some women. For example, hormone replacement therapy was discovered to be harmful to some women’s cardiac health. Subsequent research has shown that women frequently have different symptoms of cardiovascular disease than men. More recent research has shown that the symptoms which are more typical in women actually occur in some men. This knowledge may help us in not only improving clinical care for women at risk, but also for men. This example demonstrates one potential benefit for both women and men from research that uses a sex and gender lens. 

• Every Cell Has a Sex

  • A 2001 Institute of Medicine (IOM) report indicated that “every cell has a sex”. In the past, we believed that the sex of most cells was irrelevant after cellular differentiation. According to the IOM report, there can be different mechanisms that make a cells’ sex relevant. For example, having only one copy of certain genes may contribute to men’s greater susceptibility to certain health problems, while having two copies may be protective for women. We are at the early stages of understanding the role of sex chromosomes and hormones in each cell. This situation will improve in the future because the NIH now requires that NIH funded research studies use both male an female cells and laboratory animals. 

• SGBH and Research

  • While researchers might decide to focus solely on biology (sex) or social factors (gender), SGBH encourages the study of the intersection of the social environment with biology via epigenetics. SGBH also provides a basis for intersectional research, i.e., stratifying one’s analysis based on multiple social dimensions. Congress is currently considering a bill to require inclusion of both male and female cells and laboratory animals in all human and pharmaceutical research, and taht data analysis be disaggregated by sex. 

• Translation of Research to Clinical Care

  • We now know that many previous studies which relied on data from one sex have limited generalizability for clinical care. For example, if female lab animals were not included in studies, then the results may not apply to women or many only partially apply to women. As we increasingly have equity throughout the research pipeline, the application of those research findings to curricula will lead to improvements in clinical care for all patients. For example, differences in drug pharmacokinetics and pharmacodynamics have led to more adverse side effects in women, including death. As sex and gender based research improves, clinicians will be more skilled in providing both personalized and precision care for all patients.