Including Gender in Public Health Research

Diversity in both biological attributes and the external, lived environment gives rise to different susceptibilities, exposures, health outcomes, and longevity. Public policy can modify the effects of external differences, if groups at greatest risk are identified and pathways to excess vulnerability are understood, by rebalancing and redistributing the inputs or social determinants that work their way under the skin to ultimately cause biological disadvantage. In the past three decades, a large volume of research has identified the nature of these social determinants of health—including income, socioeconomic status (SES), income inequality, social connectedness, and social capital—and the pathways by which they undermine or reinforce innate health. Often listed among these, but rarely studied, is gender. Medical research may identify sex differences when they exist; however, the varied social roles, expectations, and constraints experienced by men and women in a given society go well beyond the individual and sex differences and are rarely examined as inputs responsible for variation in health outcomes. As a result, health-affirming policies tend to homogenize groups (e.g., assuming that all women are the same) or target individual behaviors, and do so in a gender-blind fashion rather than addressing structural biases and inequities that undermine those behaviors. This article explores the nature of gender as a determinant of health and describes how the effects of gender inequities can be included in health outcomes research that can then shape health planning and policy.