Aandacht voor sekse en gender in gezondheidsonderzoek:

waarom nodig en hoe doe ik dat?

Symposium “Every cell is sexed, every person is gendered”

VuMC, 30 oktober 2017 Ineke Klinge, Chair H2020 Advisory Group for Gender

Determinanten van gezondheid en ziekte

• Sekse

• Gender

• Intersecting factors: age, ethnicity, SES, sexualorientation, disability etc.

Definition of sex and gender

• SEX refers to biological attributes of humans and animals including physical features, chromosomes, gene expression, hormones and anatomy. As such, sex is globally understood as the classification of living beings as male and female, and intersexed. Sex differences relevant to the research and innovation should be investigated and addressed.

• GENDER: A socio-cultural process consisting of:- “Gender Norms” (spoken and unspoken cultural rules in the family,

workplace, society, institutional or global culture that influence individual attitudes and behaviors)– “Gender Identity” (how individuals and groups perceive and present

themselves in relation to gender norms)– “Gender Relations” (the power relations between individuals of

different gender identities) • Gender assumptions often go unquestioned and can unconsciously

influence scientific priorities, research questions, and choice of methods.

Why sex and gender matter

• End of the ‘One size fits all’

• Making research and innovation more responsible to the different needs of men and women

• Taking into account factors intersecting with sex and gender such as age, SES, ethnicity, sexual orientation et. al.

• https://www.youtube.com/watch?v=s_fJ45JUzjg

• http://igar-tool.gender-net.eu/en

3 objectives for the promotion of gender equality

Gender balance in decision making

Gender balance in research teams at all

levelsGender dimension in

R&I content

Gendered Innovations

• developed state-of-the-artMethods of sex and gender analysis

• provided Case Studies to illustrate how sex and gender analysis leads to discovery

• http://ec.europa.eu/research/swafs/gendered-innovations/index_en.cfm?pg=home

Methods of sex and gender analysis

1. Rethinking research priorities and outcomes

2. Rethinking concepts and theories

3. Formulating research questions

4. Analyzing sex

5. Analyzing gender

6. Analyzing how sex and gender interact

7. Analyzing factors intersecting with sex and gender

8. Engineering innovation processes

9. Designing health and biomedical research

10. Rethinking standards and reference models

11. Participatory research and design

12. Rethinking language and visual representations

Methods of sex and gender analysis

Gendered Innovations case studies

3 ONLINE TRAINING MODULES

① Biomedical Research

② Primary Data Collection with Human Participants

③ Secondary Data Analysisof Human Participants

Verdere inhoud: methoden, case studies, resources

• Basic research (animal research, stem cells)• Clinical research (heart disease in women, osteo

research in men)• Public health research ( non-communicable

diseases)• Epidemiological research• Implementation research• Reporting (Sager guidelines)• Evaluation the address of sex and gender;

guidance for peer reviewers

Analyzing sex

• http://genderedinnovations.stanford.edu/methods/sex.html

• Case study : stem cellshttp://genderedinnovations.stanford.edu/case-studies/stem_cells.html

• Case study : animal researchhttp://genderedinnovations.stanford.edu/case-studies/animals.html

Percentage of articles reporting sex of cells used in the experiments

Taylor, K., Vallejo-Giraldo, C., Schaible, N., Zakeri, R., & Miller, V. (2011). Reporting of Sex as a Variable in Cardiovascular Studies using Cultured Cells. Biology of Sex Differences, 2 (11), 1-7.

Stem cell research

Animal Research

• http://genderedinnovations.stanford.edu/case-studies/animals.html

• NIH guidelines (2016)sex as a biological variable.

• To read more:Evaluating sex as a biological variable in preclinicalresearch: the devil in the detailsCara Tannenbaum, Jaclyn M. Schwarz, Janine A. Clayton, Geert J. de Vries and Casey SullivanBiology of Sex Differences20167:13DOI: 10.1186/s13293-016-0066-x©

Environment in animal research

More guidance on basic science

• Collins, F. S. & Tabak, L. A. (2014). Policy: NIH Plans to Enhance Reproducibility. Nature 505, 612–613;

• Clayton, J.A. & Collins, F. S. (2014) Policy: NIH to Balance Sex in Cell and Animal Studies. Nature 509, 282-283;

• Clayton J.A. (2015). Studying Both Sexes: A Guiding Principle for Biomedicine. The FASEB Journal 30, 1-6.

Formulating research questions

• Case study heart diseasehttp://genderedinnovations.stanford.edu/case-studies/heart.html

• To read more:Strategies and methods to study female-specific cardiovascular health and disease: a guide for clinical scientistsPamela Ouyang, Nanette K. Wenger, Doris Taylor, Janet W. Rich-Edwards, Meir Steiner, Leslee J. Shaw, Sarah L. Berga, Virginia M. Miller and Noel Bairey MerzBiology of Sex Differences20167:19DOI: 10.1186/s13293-016-0073-y© Ouyang et al. 2016

Heart disease in women

Osteoporosis as female disease?

Osteoporosis as female disease?

Interactie sex and gender

• Case study on risk factors for non-communicable diseases (NCDs):http://genderedinnovations.stanford.edu/case-studies/nutri.html

• Video:http://genderedinnovations.stanford.edu/video_landing.html

Risk factors for NCD’s

Analyzing gender

• http://genderedinnovations.stanford.edu/methods/gender.htmlemphasis on awareness, background assumptions etc

• More on analyzing gender: (possibility of measuring): Developing gender variables for health research (variables related to the levels of gender (Stanford project)

• See also IGH online module 2

Epidemiological research

• Examples of sex/gender sensitivity in epidemiological research: results of anevaluation of original articles published in JECH 2006–2014Ingeborg Jahn, Claudia Börnhorst, Frauke Günther and Tilman BrandHealth Research Policy and Systems201715:11DOI: 10.1186/s12961-017-0174-z

Implementation research

• Why sex and gender matter in implementationresearchCara Tannenbaum, Lorraine Greaves and Ian D. GrahamBMC Medical Research Methodology BMC series – open, inclusive and trusted201616:145DOI: 10.1186/s12874-016-0247-7

Reporting

• Reporting Sex, Gender, or Both in Clinical Research?Janine Austin Clayton, MD; Cara Tannenbaum, MD, MSJAMA. 2016;316(18):1863-1864. doi:10.1001/jama.2016.16405

Guidelines for journal editors

• http://researchintegrityjournal.biomedcentral.com/articles/10.1186/s41073-016-0007-6

Peer review

• Criteria for evaluating the integration of sex and gender in biomedical research:http://www.cihr-irsc.gc.ca/e/documents/biomedical_research_guidelines-bil.pdf

• Criteria for evaluating the integration of sex and gender in research with human participants:http://cihr-irsc.gc.ca/e/documents/clinical_research_guidelines-en.pdf

Horizon 2020 Advisory Group forGender (AGG) II

• Current governance (2016-17): Ineke Klinge, chairMaria Stratigaki, vice-chairSuzanne de Cheveignè, rapporteur

• Tasks: - Input into Strategic programming (June 2016)- Input into specific WP’s 2018-20 (December 2016)- Own activities to improve the weak points of WP 14- 15 and 16-17

• For a better integration of the GD in Horizon 2020 Work Programme 2018-2020

• http://ec.europa.eu/transparency/regexpert/index.cfm?do=groupDetail.groupDetailDoc&id=28824&no=1

Congres gender & gezondheid, 5 oktober 2017

NVG&G

De vereniging is een platform waar onderzoekers hun wetenschappelijke activiteiten kunnen uitwisselen en verdiepen. Bent u academicus met interesse in het thema gender & gezondheid? Word dan lid van de vereniging! Kijk voor meer informatie op de website van de NVG&G www.genderengezondheid.nl

Thank you for your attention

Website Gendered Innovations projecthttp://ec.europa.eu/research/swafs/gendered-innovations/index_en.cfm?pg=home

Report How gender analysis contributes to researchhttp://ec.europa.eu/research/science-society/document_library/pdf_06/gendered_innovations.pdf

Londa Schiebinger & Ineke Klinge (2015) Gendered Innovation in Health and Medicine. In: Gender Journal for Gender, Culture & Society: 7(7) 29-50http://budrich-journals.de/index.php/gender/article/view/19311

IGAR toolshttp://igar-tool.gender-net.eu/en

Annotated bibliography on how to study the impact of sex and gender in medical research: a review of resourcesAlyson J. McGregor, Memoona Hasnain, Kathryn Sandberg, Mary F. Morrison, Michelle Berlin and Justina TrottBiology of Sex Differences 2016,7(Suppl 1):46https://bsd.biomedcentral.com/articles/10.1186/s13293-016-0099-1