5 Questions For… Sarah Richardson
Sarah Richardson is the Aramont Professor of the History of Science and of Studies of Women, Gender, and Sexuality at Harvard University and directs the Harvard GenderSci Lab. What’s Next Health spoke with Dr. Richardson about her Robert Wood Johnson Foundation-funded project which explores how to integrate gender and social factors into sex-related health equity research.
This interview is part of our 5 Questions For…Series, where we learn about the ways RWJF’s Pioneering Ideas for an Equitable Future grantees are helping us get to a healthier tomorrow by paving the way today.
Q: What do you hope to learn and accomplish through this work?
A: The U.S. has a history of understudying women in biomedicine. To fill this knowledge gap, there has been an increase in research over the last decade that includes both males and females as research subjects. These studies report out any differences in results between male and female research subjects, and in many cases have illuminated long-standing, unresolved sex inequities. For example, we see much higher reported rates of adverse drug events for women compared to men. While this commitment to finding biomedical solutions to health equity challenges is encouraging, it ignores important non-biological reasons behind sex differences in research results.
There is strong evidence that social variables interact with sex to create health inequities. A good example of this is COVID-19. In the early days of the pandemic, men had a much higher mortality rate than women and the immediate response to this by some commentators, particularly within biomedicine, was, “Ah, it must be testosterone,” or, “It must be in the sex chromosomes.” This response overlooked other factors influencing people’s exposure, such as how men were more likely to be working frontline jobs without access to PPE, and therefore at higher risk of contracting the disease.
With our grant, we hope to accelerate the integration of social factors into biological research. We are going to do that by providing three deep case studies demonstrating how a focus just on sex-based biology can mislead science. From these case studies we’ll then generate a new evidential framework for thinking about and approaching sex disparities research so that it includes consideration of demographic and social variables as well as biological variables.
Q: What signals of the future or emerging trends were you noticing that led you to want to do this project?
A: The first trend, which I mentioned earlier, was this gender equity movement that articulated a need to account for sex in biological research. Now, we’re at the cusp of realizing that this research not only may be insufficient to get to our equity aims, but it may actually cause harm by perpetuating biological sex-essentialist ideas about maleness and femaleness.
A second trend is what I call post-genomics. Post-genomics reflects the ending of the genome sequencing era — where our understanding of human health was centered on the gene, genome and the gene sequence — and a shift toward what I would call the “biosocial.” This means an interest in connecting levels of understanding, from the molecular all the way up to the social level.
Finally, we’re seeing a trend among a younger generation of scientists who want to practice science ethically, accountably, and from the standpoint of their own experiences and their communities. They’re refusing to see biological and social factors as the province of separate disciplines, instead viewing research that includes both as core to the kinds of researchers that they want to be.
Q: Looking ahead five, ten, fifteen years from now, how do you see this work helping individuals and communities create healthier, more equitable futures?
A: Scientific claims about sex, gender, and sexuality matter for people’s lives. These claims inform medical, social and political debates about how to address gender inequities in health — from decisions about sex-based medication dosing to protections for gender minorities. We need clinicians, policymakers, and other decision-makers to understand what science knows, what it doesn’t know, what it can know and what it can’t know about sex-related variables in health and human development, and to consider the social context of sex differences as they shape health care, research and policy.
…the question of women’s health and the future of the health of communities is absolutely embedded in social context. It’s at every level: access to services, access to healthy environments, the fine-grained ways in which our bodies are connected to systems of oppression.
Our project is fairly upstream from that, but if we are successful, our work will lead to new concepts and frameworks, institutional infrastructures and arrangements, funding streams, and well-trained interdisciplinary scholars who can translate across these areas of biology and social science and provide the evidence needed to advance gender equity.
Q: What one thing should people read, watch, or listen to that will help them understand more about your ideas?
A: There was an excellent ProPublica series called “Lost Mothers” on the Black maternal mortality rate in the United States. When you read it, you realize that the question of women’s health and the future of the health of communities is absolutely embedded in social context. It’s at every level: access to services, access to healthy environments, the fine-grained ways in which our bodies are connected to systems of oppression. That series is a very compelling entry point.
Additionally, Anne Fausto-Sterling’s book, Sexing the Body, is a touchstone for this field of research. She uses a metaphor of the Möbius Strip to show the relationship between the social and the biological. The Mobius Strip is a mathematical pattern where, if you trace your finger along it, you suddenly find yourself on the inside and then the outside, and you see how the social and the biological factors, instead of being two different buckets, are inseparable.
Q: What didn’t we ask you?
A: Most scientific research proceeds with a strongly binary understanding of sex, and these binary claims about maleness and femaleness move outward from the laboratory into our understandings of what a man is, and what a woman is. And just as with scientific research on other human social groups, like race and ethnicity, we need to take exceptional care in thinking about how these categories are constructed and rigidified through scientific discourse.
At the GenderSci Lab we’re very interested in exploring this relationship between social context and social values, and the knowledge that science produces. Institutions made entirely of white European men have influenced scientific inquiry and distorted what we know. And while we now have more women in science, the theories and the knowledge systems haven’t changed. And so changing any knowledge system has to involve training up a new generation of scholars to think about data and evidence in new ways — including in these biosocial ways.
The views expressed are those of the interviewee(s) and do not necessarily reflect those of the Robert Wood Johnson Foundation.
