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Introduction
This module considers the degree to which health research can be considered ‘gender-blind’, and the impact this has had on our understanding of how gender impacts the experience of illness, and on women’s and men’s access to equitable medical treatment. Ethical issues relating to gender in medical research are considered, along with a discussion on the continuing bias evident in medical research.
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Objectives
By the end of this module, students should be able to:
• Critically analyse the relationship between the Biomedical Model of Health and traditional models of medical research
• Describe the consequences of a gender imbalance in health research
• Identify the characteristics of social research
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Research and theBiomedical Model of Health
In many ways our contemporary understandings of research ethics have been shaped by the Women’s Health Movement’s critique of the traditional biomedical model of health research. As well as looking forward with vision to new policy objectives, workers in the women’s health movement had to look to the past because, before the resurgence of the feminist movement in the late 1960s, what women thought about their bodies and health was largely circumscribed by images created through a patriarchal and scientifically rational medical model of health care. Within this paradigm women were embodied in terms of their reproductive function. As a consequence, a major task for women’s health workers has been to change limiting views of women’s bodies, and to write a more positive script for women’s views of themselves.
In its development of alternative views, the women’s health movement presented an implicit and explicit challenge to the traditional organisation and practice of medicine in the Western world. To understand the movement fully, it is necessary, therefore, to anchor it in the background from which it emerged. The specific feature of the context of the women’s health movement is scientific rationality; in particular, the manner in which scientific rationality has influenced the rise of the Medical Model of Health.
Historically, the methodology of science came to be the arbiter of truth in the modern world. Experiments, identified as the scientific method par excellence, produced results which showed cause and effect relationships between variables which could be both generalised and replicated. In essence, science came to be understood as value-free and objective. It was the path-breaking work of Kuhn (1962), on the structure of scientific revolutions, which eventually demonstrated the paradigmatic and value-laden nature of scientific endeavour. Feminist writers, including Harding (1987), subsequently extended this critique to an exploration of the patriarchal nature of science. As Hilary Rose (1986) pointed out, the very birth of science was embedded in male metaphor. Francis Bacon, for example, used the imagery of rape “to invoke the process whereby the scientist forced nature and wrested her secrets from her” (Rose, 1986, p. 168). The implication was that nature was female and had to be dominated and exploited.
The most immediate aspect of the scientific context against which the women’s health movement has reacted is the Medical Model of Health (or Biomedical Model of Health), itself shaped by scientific rationality. The Medical Model of Health care is focused on treatment and cure; medical care is interventionist in nature, and individualistic in orientation. Moreover, the model’s construction of “illness as a malfunction of the body’s biological mechanisms” serves to obscure the social origins of ill-health (Germov, 2009, p. 10).
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Gender in Health Research: Exclusion and Exploitation
Historically, medical research has functioned within a Medical Model of Health framework, and has embodied women in terms of their reproductive function, with gynaecology the only ‘women’s’ speciality. This focus on women’s health as reproductive health has not only drawn attention away from the social context of women’s lives, but has also resulted in women being used as little more than medical research ‘guinea pigs’ on occasions. One of the most infamous examples came to be known as the Unfortunate Experiment, in which women were neither given the full information about their condition, nor informed they were part of a research program which involved them being systematically denied appropriate treatment for malignant cervical cancer. As Coney explained:
A disastrous research programme had been carried out at National Women’s Hospital in Auckland and covered up for years. Women with pre-malignant abnormalities in the cells in the neck of the womb had not received conventional treatment for the condition … These women had developed the maiming and potentially fatal invasive cancer at an appalling twenty-five times the rate of women treated conventionally. They had had normal treatment withheld because one doctor … believed that the abnormal cells were harmless. He argued that the pre-malignant disease, called carcinoma in situ or CIS, did not progress to invasive cervical cancer. (cited in Laimputtong& Dwyer, 2003, p. 131)
The Unfortunate Experiment reveals some of the problems in medical research on women. Illuminated are the power of doctors; a hierarchical system of control and authority; the embodiment of women in terms of their reproductive function; lack of informed consent; and scientific, rational research which failed to recognise women’s concerns. Ultimately there was an inquiry into the experiences of women who were unwittingly involved in this experiment, which returned critical findings. The overall conclusion was that the system of medical care was more to blame than individual doctors for, as Coney (1988) concluded, “the real problem was medical power and its exercise. It could easily have been another doctor, another hospital and another city altogether” (p. 273).
The Unfortunate Experiment illustrates the worst of medical research. However, it is important to acknowledge that considerable advances have been made in the treatment of some women’s diseases as a result of medical research. Nevertheless, there continue to be gender biases in both the “content and processes of health research” (Sen et al., 2007, p. 79). Moreover, as the Director of Research at the Jean Hailes Foundation for Women’s Health highlighted:
there are gaps in research and evidence because there are female specific conditions which need to be addressed and also, in many research areas, research has primarily been undertaken in men and it is unclear as to whether the recommendations in men are applicable to women. (Teede, cited in Jean Hailes Foundation for Women’s Health, 2011).
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Men’s Health Research
Men’s health can also be impacted by exclusion from health research. For example, the focus on female reproductive health has seen research into men’s reproductive health in relation to occupational factors (Varga, 2001, Wang, 2000) and mental health (Astbury, 2002)largely ignored.
The Australian National Male Health Policy 2010 recognises the need for additional research focusing on men’s health, including the following as one of the six priority areas for action:
5. Building a strong evidence base of male health – Fund a National Longitudinal Study on Male Health, commission regular statistical bulletins on male health, give priority to research focusing on male health, routinely collect and report data on male health, explore the potential for surveys on male health, and monitor scientific developments relating to male health. (Department of Health and Ageing, 2010, p. 8).
This Policy also recommends particular population groups be targeted for specific men’s health research, including research designed to help support Aboriginal and Torres Strait Islander males in their family roles (Department of Health and Ageing, 2010)
The impact of work roles is also emerging as a leading area of men’s health research in Australia. For example, research into additional stressors and resulting coping strategies for Fly-In-Fly-Out / Drive-In-Drive-Out (FIFO) workers, predominantly male, has recently received much needed funding and attention. To research the impacts of FIFO work on mental health, Lifeline WA funded the Sellenger Centre for Research in Law, Justice and Social Change at Edith Cowan University to conduct research resulting in the ‘FIFO/DIDO Mental health: Research report 2013’ (Henry, Hamilton, Watson, & Macdonald, 2013).For this study, 924 FIFO workers (81.2% male)participated in a quantitative survey, with an additional 3 women and 15 men participating in qualitative interviews.A number of key findings and recommendations were then developed and are available for review in Reading 10 (see below).
A focus on Australian males’ mental health research has also been in response to media and public attention on the issue of male suicide. The AIHW’s 2014 report on suicide and hospitalised self-harm has played a significant role in increasing awareness of concerning trends in suicide and self-harm amongst men. For example, men are 4 times more likely to commit suicide than women, and suicide rates for current generations of young adult males has increased in comparison to previous generations (Harrison & Henley, 2014).
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Readings
Reading 8(available online)
Sen, G., Ostlin, P., & George, A. (2007). Health research. In Unequal, unfair, ineffective and inefficient. Gender inequity in health: Why it exists and how we can change it (pp. 79-85). Women and Gender Equity Knowledge Network. Retrieved from http://www.who.int/social_determinants/resources/csdh_media/wgekn_final_report_07.pdf
Reading 9 (available through Library One Search)
Kim, A.M., Tingen, C.M., Woodruff, T.K. (2010). Sex bias in trials and treatment must end. (2010). Nature, 465(7299), p. 688-689.
http://search.proquest.com.ezproxy.ecu.edu.au/docview/518152868
Reading 10 (available online)
Henry, P., Hamilton, K., Watson, S., & Macdonald, N. (2013) FIFO/DIDO Mental health: Research report 2013(pp. 6-13).Edith Cowan University, Sellenger Centre for Research in Law, Justice and Social Change.Retrieved from
http://www.lifelinewa.org.au/download/FIFO+DIDO+Mental+Health+Res arch+Report+2013.pdf
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Online Activity
Gerathy, S. (Reporter). (2010, June 10). Women left behind in medical research trials. AM. Windows media file retrieved from http://mpegmedia.abc.net.au/news/audio/am/201006/20100610-am-6-biomedical-bias.mp3(NBplease click on this link to listen this audio file)
Activity 1
Complete the readings and online activity above, and then answer the following questions:
1. Provide three (3) examples of gender imbalances in the research process.
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(ii) ______________________________________________________________________________________________________________________
(iii) ______________________________________________________________________________________________________________________
2. Identify some of the consequences of a gender imbalance in health research for women’s and men’s health.
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Social Research: A New Perspective on Health
As these readings have highlighted, health research positioned within a scientific paradigm continues to a large extent to marginalise women’s interests and needs, and also overlook particular aspects of men’s health. The critiques arising from the women’s health movement seek to diminish the emphasis on medical solutions to problems arising from the social context of women’s lives. As noted previously, scientific medical research has focused on matters to do with women’s reproductive health, while ignoring other factors such as their role as carers, the impact of violence and ageing, and the cumulative effect of socioeconomic disadvantage. As a consequence, women’s feelings about personal health issues have largely been ignored or dismissed as too subjective.
In response to this,Social Research has brought a new perspective of health for both men and women. Defined as “the systematic and empirical exploration of human social life” (Loseke, 2013, p. 3), social research can provide validation and additional insights into the more traditional scientific methods of research.
A prime example of social research that focuses on gender-specific issues includes feminist research. This style of research includes subjectivity as an important feature of the research process, thereby extending the range of knowledge of women’s health issues. Note that the introduction of this qualitative research dimension does not diminish the importance of quantitative research on women’s health. Both are useful in providing data to enhance women’s health (Sen, Ostlin, & George, 2007, p. 85).
An example of social research that focuses more on men’s health is Henry et al’s previously mentioned research amongst FIFO employees(2013), which used a combination of qualitative and quantitative techniques to identify major stressors and health implications of this style of work. Participants’ subjective experiences were privileged, and the findingsinformed key recommendations for support, pre-employment services, health literacy, coping skills and changes to current organisational culture.
Integration of both biomedical and social research is considered by many to be a more effective approach to understanding the determinants of health for men and women (Bird &Rieker, 2002; May, 2011; Loseke, 2013). With such complex interactions between gender, biology, and social determinants, Bird andRieker (2002) believe research that considers “clinical, social and public health perspectives” (p. 114) is needed to ensure a better understanding of gender based health issues.
The following reading provides an overview of social research which can provide deeper insights into women’s and men’s experiences, with a particular focus on producing knowledge which will bring about positive individual and social change.
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Reading
Reading 11(available through Library One Search)
Bird, C. E., &Rieker, P. P. (2002). Integrating Social and Biological Research to Improve Men’s and Women’s Health. Women’s Health Issues, 12(3), 113-115.
Activity 2: Reflective Thinking
Reflecting on your learning to date in this and other units, write one well-structured paragraph on the differences between research conducted within the frames of reference ofsocial research and medical research.
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Conclusion
In this module we have considered the degree to which health research reflects a gender imbalance. This has resulted in gaps in our knowledge of conditions which are specific to women, and limited opportunities to develop treatments more appropriate to women. This module has also considered the concept of social research as a means through which the social factors influencing women’s and men’s health and wellbeing may be more clearly identified.
Review Questions
1. What is the Medical Model of Health, and how has it influenced traditional research?
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2. Why is it important to address gender imbalances in the content and processes of health research? Provide examples relevant to men’s and women’s health to demonstrate your understandings.
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3. What are some advantages of using social research to explore women’s and men’s specific health issues?
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