The Australian National Health and Medical Research Council has released a significant statement urging the routine consideration of sex, gender, variations of sex characteristics, and sexual orientation in health and medical research. This means the council is asking funding applicants to consider if their research includes data from both males and females, whether outcome measures are suitable for different sex and gender groups, and how differences among these groups will be measured and reported. This approach could greatly reduce biases based on sex and gender in medical research if implemented effectively.
Although related, the terms have distinct meanings: sex refers to one’s biological characteristics and legal status, gender involves identity, expression, experiences, and behaviors which are socially constructed, and sexual orientation involves one’s sexual identity and attractions, such as gay, bisexual, heterosexual, or asexual. These attributes significantly influence health outcomes. Differences tied to sex, gender, and sexual orientation affect susceptibility to disease, diagnosis, seriousness, prognosis, and management across various acute and chronic conditions.
Moreover, sex, gender, and sexual orientation impact how individuals experience health services and how professionals interact with them. Historically, health and medical researchers have not routinely incorporated sex, gender, or sexual orientation in research design, analysis, or interpretation. Most pre-clinical research with non-human animals focuses solely on males, and human clinical trials often have higher male participation rates, frequently excluding pregnant or lactating women, or those of reproductive age. These exclusions are due to concerns about fetal safety and the mistaken belief that females are “harder” to study because of hormone fluctuations. Research findings rarely analyze outcomes by specific sex and gender groups, hindering the ability to identify differences in treatment safety and effectiveness.
This oversight has led to documented disparities in healthcare results. Women experience more adverse medication side effects, yet they are deadlier in men. Strokes are more commonly misdiagnosed in women than men because of sex-based symptom differences, delaying critical treatment. This problem affects everyone, especially marginalized groups like women, people with intersex traits, transgender and non-binary individuals, and those with diverse sexual orientations. Ignoring sex, gender, and sexual orientation also impacts cisgender men’s health. Traditional male gender norms can deter seeking help and accessing care for illnesses like cancer and mental health issues.
In the last 20 years, major health and medical research funders in Europe and North America have introduced policies to address sex-and-gender-based biases. These policies usually require research funding applicants to demonstrate how they have considered sex and gender in their study design and analysis. Australia has been slow to implement such policies until now. The NHMRC’s statement is a crucial step towards aligning Australia with international research standards. As a key funder of health and medical research, this move signifies Australia’s commitment to rectifying longstanding sex and gender disparities in taxpayer-supported research. The statement is a pledge to ensure that publicly funded health and medical research considers sex, gender, variations of sex characteristics, and sexual orientation throughout the research process, from planning to execution.
The statement cites the Australian Bureau of Statistics to define sex and gender, acknowledging that definitions can evolve and vary culturally, including among Aboriginal and Torres Strait Islander peoples. Australian researchers now have a robust framework for more inclusive and equitable research practices, although there is not yet a mechanism to assess how well researchers account for these variables during the funding review process. Without enforcement and assessment, the NHMRC cannot track progress in achieving sex and gender equity in health and medicine.
Universities, medical research institutes, ethics boards, medical journals, and health services must align their practices with the NHMRC’s statement and evaluate their implementation. Incentives such as relevant training and prioritized funding could encourage compliance. The NHMRC’s gender equity strategy, aiming to increase gender diversity among grant recipients, may also contribute positively.