Research Agenda
Health research and practice should give priority attention to the 19 conditions with excess burdens for women that this chapter has identified and clustered into four main groups, according to the interplay of sex and gender in their etiology, to improve women's health status worldwide. A number of cost-effective health technologies are available, but women are dying because these technologies are not available and accessible to all. Thus, a priority need is to deploy them more widely in developing countries. The research challenge is also urgent, given the unacceptably high disease burdens for women in developing countries and the rising numbers of older women worldwide. Research on sex and gender factors affecting women's disease burdens should give physicians new information that will increase their options in relation to diagnostic practices and drug approaches, not only for women, but also for men, thereby improving the provision of gender-appropriate health care for all.
Key general items in a research agenda to reduce women's excess disease burdens include the following:
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Expand and sharpen analyses of sex and gender and their interaction in the etiology, onset, progression, prevention, and treatment of diseases that women and men share, but where women face an excess health burden, and in the assessment of cost-effective interventions.
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Increase research to identify the determinants of women's underuse of health services, paying special attention to the accessibility, affordability, and appropriateness of services. Identify and analyze best practices in health service delivery that incorporate gender variables to inform training and human resource development programs for health sector providers in developing countries for both services specific to women and general services.
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Investigate how interactions between sex and gender, race, ethnicity, and poverty affect the etiology, onset, and progression of disease as well as access to and compliance with prevention and treatment. Investigate the effects of stigmatization and discrimination on service quality and use.
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Use demographic accounting methods to project and plan for the demands that women's overall greater longevity imposes on health systems and investigate cost-effective treatment options, effect of gender variables on prevention and treatment, and viable options for increasing older women's access to health and to social insurance and protection mechanisms. Investigate affordable options for family care of elderly patients that take into account the time and the physical and emotional burdens on women, the traditional family caretakers.
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Improve the methodology used for disease classification, and expand data collection efforts to address the largely unreported causes of women's disease burdens, emphasizing conditions specific to women, including FGM and other domestic-, social-, and religious-based violence against women.
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Promote research, health promotion activities, health services, and advocacy efforts that will help women adopt desirable nutrition and physical exercise practices for optimal health. Exercise is a preventive measure that can help reduce women's excess disease burdens throughout the life cycle and has numerous indirect psychological and social benefits, but it will often require changing deeply rooted cultural mores.
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Support research on the costs and effectiveness of treatments for diseases that affect both men and women but affect women disproportionately, especially in developing countries.
Research needs pertaining to specific conditions include the following:
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Carry out further testing of innovative technologies for diagnosing neoplasms specific to women and explore new options for preventing their growth and proliferation. Regarding treatment, the literature describes few best practices and cost-effective measures, especially for breast and ovarian cancer.
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Evaluate the viability of applying the results of cost-effectiveness analysis carried out in developed countries on the prevention and treatment of cancers specific to women in developing countries to help adapt viable procedures.
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Promote and study the cost-effectiveness of approaches to preventing Alzheimer's disease, osteoarthritis, and other chronic conditions related to aging.
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Compare the prevalence of Alzheimer's disease in different populations, including carrying out genetic epidemiology studies to assess the importance of different genetic risks.
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Expand research on the biological and behavioral determinants of depression in women, on screening alternatives, and on cost-effective prevention and treatment options adapted to specific contexts in developing countries. Explore ways to reduce the stigmatization and discrimination associated with depression in developing countries.
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Continue research to document the risks and benefits of common, but unproven, approaches of preventing and treating diseases specific to women, such as the finding that long-term hormone replacement therapy does not reduce cardiovascular disease in postmenopausal women as had long been thought but instead increases risks for cardiovascular disease and breast cancer.
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Establish a research program to document the prevalence and disease burdens associated with FGM, and seek prevention and treatment alternatives.
