Tag Archive for: inequality

Behind the Science: Moving the Microscopic Lens to Marginalized Populations

Interviewee: Emmanuela Ojukwu (RN, PhD), Assistant Professor of Nursing, University of British Columbia. Authors/Editors: Romina Garcia de leon, Shayda Swann (Blog Co-coordinators).

Published: November 18th, 2022

Could you briefly explain your career trajectory from a Registered Nurse to now an Assistant Professor?

Towards the end of obtaining my Bachelor of Science Degree in Nursing, I knew that I wanted to pursue a career in women’s health. As my journey progressed, I would eventually get accepted to a PhD program where I had the opportunity to work with a professor who was internationally recognized, with a track record of success in improving minority women’s health with a focus on social determinants of health. The decision to focus on HIV came during my RN experiences at a Perinatal HIV clinic for vulnerable populations, wherein I observed birthing parents living with HIV, to be lost to follow-up to their own care but continually engaged in their infant’s care, postpartum. Possibly due to maternal instincts, but the focus on their infants and not themselves was very apparent. This spurred the idea for what would eventually become my dissertation. So, I wanted to see what factors deterred them from engaging in their own care or factors that motivated them to go in (for those that did). Also, as a natural empath – sometimes to a fault – I would find myself really vested in their care, particularly, for the marginalized women, e.g, new immigrants/refugees, racialized populations, homeless. Most of the patients who were lost were within these categories, so it was important to note the possible intersections in their marginalized identities, which were causing their suboptimal engagement in treatment and possible impediments to their overall wellbeing. When I applied to UBC, I definitely wanted to continue with HIV research, although, I realize that HIV rates here compared to the US are relatively less, but it’s still present. And, as there is currently no treatment that completely eliminates the virus, the likelihood of transmission and/or increasing morbidity and mortality,is significantly reduced with effective treatment/management. I remain vested in this topic as a researcher, and would describe my work as focusing on health equity and social determinants of health for vulnerable populations, marginalized by race, sex, gender, disabilities such as HIV, and other psychosocial vulnerabilities.

Why did you choose to study marginalized populations and sexual health?

Asides from being such an empath, I think that I’ve had my own lived experiences of discrimination within the healthcare setting, both as a patient and a healthcare provider. I, sometimes, find that there are “sexual and reproductive health stereotypes” that follow “black women” and these often go before them upon their arrival to any hospital/clinical setting. As a patient, I can count times this has been the case for me; and not until I divulge my profession in healthcare do I get treated any differently. As a provider, the discrimination can stem from patients or colleagues with preconceived, underrated expectations of racialized peoples’ performances, and hence a lack of trust in their abilities as providers, and also unequal (or mostly, subdued) access to and opportunities for growth and development within their various units. All of these experiences, and their impacts on wellbeing demonstrate a critical need for research with and for persons on both sides of the table. By doing this work with and for patients who may fit within these identity brackets, especially for topics that could be stigmatizing such as sexually transmitted infections and HIV, I hope to amplify their voices and create an awareness of their situations. I hope that in creating such an awareness of the existing disparities and inequities; and with the development of interventions, put in place by healthcare providers, public health officers, and even the government; that there might be opportunities to rebuild some of the trust which may have seemed lost in the system, by these communities.

How does Women’s Health specifically intersect with your work at the moment?

Women’s health is at the center of everything I do in my research. A lot of my work focuses on the sexual and reproductive health of women. I currently have two ongoing studies; one, examining the impacts of COVID-19 on quality of life for African, Caribbean, and Black women living with HIV in BC; and another exploring the impacts of racism, sexism, and psychosocial vulnerabilities on access to care services for African, Caribbean, and Black women living with HIV. While I have a special interest for racialized women, I do not shy away from work focusing on the psychosocial and sociostructural factors influencing equitable care for all women. Merely existing in a patriarchal world as a woman can interfere with several aspects of wellbeing. The impacts of other layers of marginalization can have very lasting, detrimental effects on the lives of persons who fit within these identity brackets. Examining the impacts of these intersecting, underprivileged identities and unpacking the various layers and layers of vulnerabilities that surface, is at the core of my research. So in essence, the makeup of a woman’s sexual and reproductive health, and how that interferes with and/or allows them to exist inclusively in a very patriarchal system is of importance to me.

What impact do you hope to see with your work years from now?

I’m hoping that knowledge generated from my work can have lasting positive impacts in the way that care is modified/adjusted for the affected populations. Not surprisingly, there isn’t a lot of data on marginalized populations when it comes to women’s reproductive health, whether it’s rates of maternal mortality or anything else, in Canada. I’m hoping that my research can contribute to bridging those gaps and generating these data, so that researchers, community leaders, healthcare providers, the government, and others in positions of power may be alerted to these situations and help to effect change. We know that these issues exist but the paucity of data and research in this area limits the opportunities for interventions that are culturally-sensitive and -safe. I hope that my research in the short run, can be a “call to action” and in the long run can lead to sustainable “actions for change” for enhancing women’s equitable health.

Where can people find your work?

My email, usually, is the best way to contact me, at emmanuela.ojukwu@ubc.ca.

Using the Power of Sex Differences in Research: What a difference 10 years Did Not Make

Authors: Rebecca Rechlin, BSc Behavioural Neuroscience; Tallinn Splinter, BSc Biology, University of British Columbia | Editors: Negin Nia, Romina Garcia de leon  (Blog Coordinators).

Published: August 26th, 2022.

Females have been overlooked in health research for decades, and despite 10 years of advancements and improvements in knowledge, this has still not changed significantly.  Historically, there has been a long-standing bias of using males predominantly in scientific research instead of females, and as male and female health differ, this has led to health disparities for both males and females. Biological differences between females and males exist in diseases, such as in disease progression, symptomatology, and drug efficacy in many neurological and physiological diseases.

The study of these sex differences is essential for the understanding and advancement of disease treatment and precision medicine. For example women have double the risk for adverse drug reactions compared to men, which may in part be due to incorrect dosing (for instance despite both men and women being recommended the same dose for acetaminophen, an active ingredient in Tylenol, women break down the drug 60% slower than men). The biomedical and clinical research community is beginning to make corrections for these inequalities by issuing mandates for including females in clinical trials (such as by the NIH in 1993), and frameworks from funding agencies to address sex and gender in upcoming research (CIHR: Sex and Gender based Analysis (SGBA)) in 2010, and NIH: Sex As a Biological Variable (SABV) in 2016), however, there is still a long way to go to reach equality. Despite these mandates and increased approving attitudes towards these policies, the literature shows very little improvement in the analysis or examination of any potential sex differences.

Our study aimed to investigate whether and how possible sex differences were being investigated in neuroscience and psychiatry research. We looked at over 3,000 neuroscience and psychiatry studies in 2009 and in 2019 to see whether researchers were including both sexes in their studies. We found that only 53% of these studies actually included both males and females, and only 16.5% of these used an equal number of males and females throughout their study. Of the papers that used both sexes only 6% actually analyzed sex as a discovery variable. We found that the majority (60%) of the papers that used both sexes did not do any analysis by sex. This is concerning, as this means that we will lose out on important scientific discoveries if researchers are failing to embrace the power of studying potential sex differences. 

 

Figure 1: An infographic depicting the change in percentages of total papers sampled reporting studies in 2009 and 2019 that used both sexes, a single sex, omitted sex, papers reporting studies that used an optimal design or analyses for the discovery of possible sex differences irrespective of discipline. Reprinted with permission from Rechlin et al. 2022

It is important to note that biology sex and gender are two different things, and neither one is binary. Sex refers to the biological and physiological attributes of females and males, whereas gender is a psychosocial construct that includes one’s gender identity, and the norms and expectations set out by society. In our analysis we focused on studies using males and females (or sex) in rodents, humans and in research using cell lines, but the study of gender differences is also important to study and examine in regards to disease and treatments.

However studying sex differences, while important is not the only path towards equitable findings and discoveries in both men and women’s health research. With that in mind we found that although 27% of all studies in 2019 were conducted in males, only 3% were in females only! That means there were 9x more studies in males than in females! This greater focus on male health likely contributes to the health disparity and contributes to the historical male bias in assuming females and males are the same. Single sex studies are still essential for the discovery of sex-specific diseases/conditions such as prostate cancer in males and cervical conditions in females. Females specific factors, such as pregnancy and menopause, contribute to health outcomes and disease risk. For example, depression has a higher prevalence in women than men, and the risk of depression is largely increased during perimenopause and during the postpartum period.

So what can we do to improve these disparities? For starters, researchers need to actually analyze their data by using sex as a factor (or discovery variable). This essentially means including sex as one of the independent variables of the study (and not just controlling for it), allowing for the discovery of potential sex differences. It is also important for researchers to use a balanced and consistent study design, meaning they need to use both males and females consistently and in relatively equal numbers throughout their study. And even if they don’t find any sex differences, then the paper should make that statement with supporting statistics and a table to show the means and variation of the dependent variables by sex. This information of no sex differences is just as important as the discovery of them.

For funding agencies, one solution is to have funding dedicated specifically for SABV and SGBA proposals and not as a supplement to regular funding. More training modules from funders or scholarly organizations with an SABV focus may help, however, enticing researchers to explore the influence of sex and gender in their data may be a more fruitful approach. If journals, especially those with higher visibility, adopt calls for papers using sex and gender-based analyses this may serve as a catalyst to ensure more researchers consider possible sex differences and further promote the notion that this research is important to publish. Since we published our paper – Nature journals have committed to ensuring sex and gender are considered in their study design, by requiring authors to state how and why sex/gender was considered, or to state why it was not. If implemented as intended, this is a good first step to increase the amount of studies considering sex and gender in their analysis, and may be a great leap towards fixing these health disparities.