|Two paradigmatic shifts needed to fundamentally improve the quality of sex/gender and health research:|
|1. Sex/gender should not only be recognized, but also understood as intersecting with other axes of inequality such as race, ability, socioeconomic status, geographic location, sexual orientation, and age.|
|2. Gender should be conceptualized as a structural/social determinant of dealth, and should accompany any investigation of “sex” differences—in other words, research should not assume or proceed with the idea that “sex” can be separated from gender.|
|Six questions to help operationalize these paradigmatic shifts:|
|1. Does the study automatically give primacy to sex/gender? Does it move beyond asking whether sex/gender considerations are taken into account to explaining what relevant factors are taken into account to understand a particular illness, disease or health experience?|
|2. How does the study (biomedical, clinical, health systems, or population health focused) identify relevant factors that shape and determine health (e.g., ethnicity/race, sex/gender, age, socio-economic status, geographic location, sexual orientation)? What are the inclusion/exclusion criteriain relation to this question?|
|3. How does the research design (data collection and analysis) capture the relationships and interactions (e.g., using a multi-level analysis linking individual experiences to broader social structures) among pertinent health determinants and factors, including, but not limited to, sex/gender? Is the sample size adequate for capturing diversity between and within groups often treated in homogeneous manner (e.g., women, men)?|
4. Does the study conceptualize and/or model gender as a social/structural determinant of health?|
a. If yes, how?
b. If no, has a strong rationale been provided for how/why a gender conceptualization is not needed—even if the researcher was not able to directly test the gender mechanism?
5. Does the study assert male/female differences in health related to biological mechanisms?|
a. If yes, how are those biological mechanisms specifically explained and/or tested? Also, has it been explicitly described how gender and other intersecting factors are intertwined with these biological mechanisms?
b. If no, does the study specifically state/demonstrate that intersecting social processes can cause the same biological mechanisms leading to male/female differences in health?
|6. Where relevant, does the study contextualize research findings undertaken with human subjects within broader social structures and processes of power?|