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Improving research through inclusive design: sex and gender

Published: 11 December 2023

Professor Lucy Chappell, Chief Executive Officer of the NIHR and Dr Gail Marzetti, Deputy Chief Executive Officer of the NIHR, explain how the NIHR is taking important steps towards reducing long-standing inequalities in health and care research.

Today, we, alongside other organisations* publish our statement of intent which sets out our ambition to work with the research community, to develop policy and practice which sees sex and gender fully accounted for in research.

We know there are considerable gaps in research related to the health and care of women. Women spend significantly longer living with poor health than men, and they often struggle to access the health services they need. 

Significant steps 

Why are we here? Historically, health and care research has disproportionately benefited the health of men. Research which evaluates women’s experiences of health conditions, and health and care services is limited. Similarly, not enough is known about specific health conditions such as menopause and endometriosis.   

At NIHR we know inclusive research is the bedrock for overcoming health inequalities, and so in recent years we have taken significant steps in this area. We have reviewed and developed our portfolio to cover all areas of women's health along with ensuring our prioritisation committees include the voices of women so that we can identify what research is most important to them. We have updated our expectations of researchers so that applications must detail how diverse participants will be included, recruited and monitored in their research. We have also developed the NIHR INCLUDE and Race Equality Framework to support researchers along with an approach to Equality Impact Assessments. Importantly in 2022, we launched our first Research Inclusion Strategy, which cements our commitments, acting as the foundation to further embed inclusion throughout the NIHR. 

Though we have made progress, there is still much to do. Too much UK-funded research does not consider or account for sex and gender in research design, recruitment, data collection, analysis or the reporting of findings. This means the resulting research findings are male-biased, so not applicable to the broader population, which makes them less accurate and robust. Improving the representation of women in research is not only necessary to improve women’s health, but it also results in higher quality, more impactful and cost effective research for all people.

Culture change

Funders in Canada, the United States and European nations, have been implementing sex and gender policies since the 1990s. The success of these policies is exemplified by the fact that today over 90% of health research proposals submitted in Canada include the consideration of sex in their project design. Like these other nations, we need to have standard, unified guidance for researchers about how to adequately consider sex and gender dimensions in our research studies.

This has already been identified as a pressing need in the Women’s Health Strategy for England and we highlighted this as a key action in our Research Inclusion Strategy. That is why NIHR is working closely with the MESSAGE project: a collaborative cross-sector policy initiative that aims to integrate sex and gender considerations into UK biomedical, health and care research. The culture change driven through this whole-system approach will cement future practices that produce rigorous, sustainable science to reduce health inequalities.

This work on sex and gender is an important step on the journey to NIHR becoming an inclusive funder of research. Over the next 12 months, we will develop an implementation plan for this critical work and continue to share progress on our activities.

* Other organisations issuing a statement of intent are:

  • Academy of Medical Sciences
  • Alzheimer’s Research UK
  • Alzheimer’s Society
  • Association of Medical Research Charities (AMRC)
  • Asthma + Lung UK
  • The BMJ
  • BMJ Medicine
  • BMJ Open
  • Breast Cancer Now
  • British Heart Foundation
  • Diabetes UK
  • The Dunhill Medical Trust
  • Elsevier, including The Lancet Group and Cell Press
  • Epilepsy Action
  • Fight for Sight/Vision Foundation
  • Health Research Authority (HRA)
  • Heart Research UK
  • JDRF
  • Mankind Initiative
  • Medical Research Council (MRC)
  • Medical Research Foundation
  • Medical Women’s Federation
  • Men & Boys Coalition
  • Men’s Health Forum
  • National Institute for Health and Care Excellence (NICE)
  • Stroke Association
  • Trans Learning Partnership
  • Wellcome Sanger Institute

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