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Role of gender in global health research: Q and A with Dr Janine Clayton, Director, NIH Office of Research on Women's Health

September / October 2013 | Volume 12, Issue 5

Headshot of Dr Janine Clayton

Dr. Janine A. Clayton
Director, NIH Office of
Research on Women's
Health (ORWH)

Dr. Janine A. Clayton is Director of NIH's Office of Research on Women's Health (ORWH), which she joined in 2008, and is also Associate Director for NIH Research on Women's Health. Previously, Clayton was deputy clinical director of NIH's National Eye Institute (NEI). Her research focus includes autoimmune ocular diseases and the role of sex and gender in health and disease, and she discovered a novel form of eye disease associated with premature ovarian insufficiency. She earned her medical degree at Howard University and completed her ophthalmology residency at the Medical College of Virginia and her fellowship training at the Johns Hopkins Hospital's Wilmer Eye Institute and NEI.

Why do we still need research on women's health?

The ORWH was first set up in 1990 to ensure that women were included in NIH-funded clinical research studies. Nearly a quarter-century later, and having come a long way in clinical research inclusion for women and minorities, we are doing a lot more. Today, the ORWH is reaching "beyond inclusion," to more fully investigate the role of sex influences in cell and animal experiments, not only in research studies that include humans. We really need to know more about the role of sex - arguably the most basic biological variable - in biochemical and physiological pathways both related and unrelated to reproduction. Deepening this knowledge base should help us understand what drives sex differences in the health of women, and it will undoubtedly help us ask and answer smarter questions in clinical studies.

How does gender factor in global health research?

Globally, women have significant impacts on others - you could say that women are the glue that holds together families and communities. Worldwide, women are most often caregivers, meaning they influence the health of children, men and elders. For decades, women have had a longer life expectancy than men, nationally and internationally, but the extra years are not always good ones. The global epidemic of noncommunicable diseases casts a pall on the well-being of women everywhere, with ischemic heart disease and depression among the leading causes of disability globally among females, with smoking, high blood pressure, and high body mass index as top risk
factors for death.

How does ORWH support global health research?

Through scientific leadership, funding, and co-funding, ORWH contributes to the agency’s strategic investment in global health. Some examples include the Tobacco Control Network among Brazilian women; exploratory studies of gall bladder cancer in Chilean women; studies of the impact of indoor air pollution in developing countries; and human papilloma virus vaccine cancer prevention trials in Costa Rica.

Long-term sustainability is really important in global health investments. We are very excited about work that is being done to capitalize on infrastructure that has been established by the U.S. President's Emergency Plan for AIDS Relief (PEPFAR). Through the Medical Education Partnership Initiative (MEPI), Fogarty, ORWH and colleagues are supporting research in sub-Saharan African countries with PEPFAR support to develop or expand and enhance models of medical education for women and men, toward capacity building for the future. The MEPI network joins regional partners, country health and education ministries, and several U.S. and foreign collaborators.

How do partnerships play a role in this research?

Partnerships and collaboration are central to everything we do. Because the ORWH mission is multifaceted - and because my job also includes helping to set the NIH research agenda related to the influences of sex and gender in biomedical research - I am always looking for ways to work together with colleagues in and out of NIH, as well as here and abroad.

One example of a productive collaboration is the White House Working Group on Gender-Based Violence. This cross-agency effort, led by the U.S. State department, aims to develop prevention and response strategies to gender-based violence internationally through increased coordination among U.S. government agencies, with other governments, international organizations, the private sector and civil society organizations, foundations, community-based and faith-based organizations, and labor unions. The group released a report in August 2012, which outlines its plans for generating toolkits, mobilizing resources and other actions. (Read the White House Fact Sheet on preventing and responding to violence against women and girls globally.)

How do Fogarty Fellows and Scholars further these goals?

I believe strongly that people are the lifeblood of medical progress, and so our investments in human capital in biomedicine are extremely important - for the health of the nation and the world. The Global Health Fogarty Fellows and Scholars program is a great example of how NIH shares knowledge and collaborates to build capacity in other nations - developing countries in particular. ORWH co-funds this important effort, which provides mentorship, research opportunities and a collaborative research environment for early-stage investigators from the United States and low- and middle-income countries.

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