Engendering epidemiology

Short abstract

Contributions from the Spanish Research Network for Health and Gender

Nancy Krieger has remarked in the pages of a sister journal¹ that the term gender was almost non‐existent in biomedical or public health journals before the 1970s. Since then, the scientific production of knowledge on gender related health issues has increased in an almost logarithmic progression. It's not a matter of fashion. The real issue is to fill an unjustifiable, unfair and damaging gap in the history of biomedical and public health research, with a deleterious impact on the history of health of women, more than a half of the world population.

As in relation to many other dimensions of social inequality related to health, the Journal of Epidemiology and Community Health has shown increasing interest in gender inequities.² The aim of this work has been to construct what can be called an engendering epidemiology. Decision makers need sound scientific evidence on which to base decisions about priorities and the actions needed in order to avoid any kind of gender discrimination regarding health promotion, disease prevention and the management of ill people in the population. This emphasis on applied knowledge has for many years been a trademark of the journal.³

According to PubMed, the first time the term “gender” was included in the title of a paper published in the Journal of Epidemiology and Community Health (this is not exactly the same as the first time a paper that was interested in, or including analysis and discussion on, gender related differences in health was published in the Journal of Epidemiology and Community Health) was in 1992.⁴ The same search strategy locates more recently, in 2006, four papers published in the journal specifically focusing on gender differences related to occupational health,⁵ health determinants⁶,⁷ and disease management.⁸ This supplement is intended to reinforce and build on this trend.

The Spanish Research Network for Health and Gender (Red de Investigación en Salud y Género, RISG) provided a unique opportunity to have a panoramic view of available data and research needs related to knowledge of gender differences in public health. As explained in the accompanying editorial in this supplement,⁹ the RISG has its roots in a group of researchers from the Spanish Society of Public Health and Healthcare Administration (Sociedad Española de Salud Pública y Administración Sanitaria, SESPAS). Besides their focus on analysing gender inequities affecting their more immediate environment—that is, their own scientific society SESPAS,¹⁰ and at the more macro level, health policies in Spain,¹¹ the research groups integrated in RISG have been producing internationally relevant evidence on a number of crucial areas related to gender inequalities, from which we have a good selection of examples in this issue.

…to fill an unjustifiable, unfair and damaging gap in the history of biomedical and public health research

Migration is a worldwide phenomenon with clear implications for people's health and wellbeing. In our usual Research reports section, Alicia Llácer et al discuss the importance of addressing this open area of research integrating a gender perspective.¹² Also, although a number of studies have focused on gender differences in disease management in hospitals, mostly related to severe diseases, Maria Teresa Ruiz‐Cantero et al provide interesting data on this same bias in relation to primary health care for respiratory complaints.¹³ In fact, Ruiz‐Cantero co‐authored one of the first papers dealing with gender bias in medicine published in the journal some years ago.¹⁴ On the other hand, Rosanna Peiró et al analyse the presence and results of women applying for research grants in Spain, showing up gender inequities but also reverse trends deserving future attention.¹⁵ Besides, in our gallery, a short reference to the first woman MD in Spain, Doctor Dolors Aleu (Barcelona, 1887–1913) ¹⁶ illustrates some of the obstacles women faced in the past in the development of their careers as health professionals. Some of these obstacles seem to be still active a century later.

In the aphorism of the month the words of Jerilynn C Prior remind us how many biological processes affecting women's physiology are largely unknown ¹⁷ and a recent book by this same author dealing with perimenopause is reviewed a few pages later.¹⁸

Common tools and methods in epidemiological research are not always appropriate to proper examination and analysis of gender differences. The sections “Evidence based public health and policy practice” and “Theory and methods” provide noteworthy insights into some common limitations and challenges in this respect. The experience of the incorporation of a gender perspective in Spanish health surveys could be useful in many other settings, as Izabella Rohlfs et al demonstrate.¹⁹ Methodological issues are also discussed with regard to research and policies on violence against women, by Isabel Ruiz‐Pérez et al,²⁰ informal care, by Maria del Mar García‐Calvente et al,²¹ and on occupational epidemiology and work‐related inequalities, by Lucia Artazcoz et al.²² Finally, Maria Teresa Ruiz‐Cantero et al propose an interesting and challenging reference framework for preventing and discussing systematic gender dependent errors in the design and analysis of epidemiological research, accompanying their presentation with selected and useful examples.²³

As stated before, this is only a sample of some of the research lines developed from the Spanish Research Network for Health and Gender, whose integrating groups, mostly conducted by female researchers working in Spanish public health institutions, have been actively producing scientific evidence on other areas such as reproductive and sexual health, health education, mental health or international cooperation, always from a gender perspective. A good deal of this previous work has been published in the Spanish journal of public health Gaceta Sanitaria, a journal with ongoing emphasis on research related to social determinants of health too, but also in international journals such as the Journal of Epidemiology and Community Health and others. With this supplement, researchers and public institutions from other countries can have good examples of what can be done in order to generate the knowledge to investigate the determinants affecting women's health and the necessary interventions to prevent inequities in this area. The fact that the Spanish Ministry of Health and Consumer's Affairs finances this supplement is also a good example of how rigorous and relevant research can build on the sensitivity of public authorities to their responsibility of caring for the health of all their citizens.