Empowering Women in the Face of Body Ideals: A Scoping Review of Health Promotion Programs

Affiliations.

  • 1 Massey University, Wellington, New Zealand.
  • 2 Victoria University of Wellington, Wellington, New Zealand.
  • 3 Seattle University, Seattle, WA, USA.
  • 4 Massey University, Albany, New Zealand.
  • 5 University of Tasmania, Hobart, Tasmania, Australia.
  • 6 University of Otago Wellington, Wellington, New Zealand.
  • PMID: 34628972
  • DOI: 10.1177/10901981211050571

Achieving women's health equity and empowerment is a global priority. In a Western context, women are often disempowered by the value society places on body size, shape or weight, which can create a barrier to health. Health promotion programs can exacerbate women's preoccupations with their bodies by focusing outcomes toward achieving an "ideal" body size. Women's health promotion activities should be empowering if the desired outcomes are to improve their health and well-being long-term. This review sought to identify key elements from health promotion programs that aimed to empower women. A search was conducted in PubMed, MEDLINE, Web of Science, Scopus, CINAHL complete, and Academic Search Premiere databases. The search yielded 27 articles that collectively reported on 10 different programs. Through thematic synthesis, each article was analyzed for (1) key program features employed to empower women and (2) how such programs evaluated women's health. Seven themes resulted, of which five describe key empowering features ( active participation , social support , sustainable change , holistic health perspective , strength-based approach ) and two evaluation characteristics ( assessment across multiple health domains and a mixed-method design ). The findings from this review can assist health promoters to design and improve initiatives that aim to empower women.

Keywords: empowerment; health promotion; program; well-being; women.

Publication types

  • Research Support, Non-U.S. Gov't
  • Empowerment
  • Health Promotion*
  • Social Support
  • Women's Health*

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Global Handbook of Health Promotion Research, Vol. 3 pp 93–101 Cite as

The Contribution of Feminist Approaches to Health Promotion Research: Supporting Social Change and Health Improvement for Vulnerable Women in England

  • Louise Warwick-Booth 3 ,
  • Ruth Cross 3 &
  • Susan Coan 3  
  • First Online: 01 March 2023

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The contribution of feminist approaches to health promotion research is discussed throughout this chapter. We start by outlining the principles that underpin feminist research and discussing how such approaches distinguish themselves from more traditional and mainstream study techniques. Drawing out the links between feminist research strategies and their overlap with health promotion research, we reflect upon our own practice as feminist evaluators examining interventions that support social change and health improvement for vulnerable women in England. We highlight examples of the numerous ways in which we have drawn upon feminist principles to do data collection as part of our evaluation work, aiming to give voice to seldom heard women, and to privilege their lived experiences. Continuous reflection on our work has led us to critically analyse the ways in which feminist research remains challenged within a neoliberal context, is affected by researcher positionality and is a form of emotional labour for all involved. These challenges are relevant for other health promotion researchers, engaged in evaluation work and data collection with vulnerable groups.

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  • Co-production
  • Gendered intervention

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Balaam, M. C., & Thomson, G. (2018). Building capacity and wellbeing in vulnerable/marginalised mothers: A qualitative study. Women and Birth, 31 (5), e341–e347.

Article   PubMed   Google Scholar  

Bhavnani, K., Chua, P., & Collins, D. (2020). Critical approaches to qualitative research. In P. Leavy (Ed.), The Oxford handbook of qualitative research (2nd ed., pp. 243–262). Sage.

Chapter   Google Scholar  

Blaikie, N. (2007). Approaches to social enquiry (2nd ed.). Polity.

Google Scholar  

Brown, K. (2014). Questioning the vulnerability zeitgeist: Care and control practices with ‘vulnerable’ young people. Social Policy and Society , 1–17. https://doi.org/10.1017/S1474746423000535

Brown, K., Ecclestone, K., & Emmel, N. (2017). The many faces of vulnerability. Social Policy and Society, 16 (3), 497–510.

Article   Google Scholar  

Cameron, J. J. (2018). Reconsidering radical feminism. Affect and the politics of heterosexuality . UBC Press.

Cross, R. M., & Warwick-Booth, L. (2016). Using storyboards in participatory research. Nurse Researcher, 23 (3), 8–12.

Cross, R. M., & Warwick-Booth, L. (2018). Neoliberal salvation through a gendered intervention: A critical analysis of vulnerable young women’s talk. Alternative Routes, 29 , 118–141.

Delderfield, R. (2018). When the researcher is a ‘wounded storyteller’: Exploring emotional labour and personal impact in research. The personal in the professional. Self & Society, 46 (2), 34–38.

Dixey, R. (2013). Health promotion: Global principles and practice . CABI.

Fine, M. (2012). Troubling calls for evidence: A critical race, class and gender analysis of whose evidence counts. Feminism & Psychology, 22 , 3–17.

Fisher, P. (2016). Co-production: What is it and where do we begin? Journal of Psychiatric and Mental Health Nursing, 23 (6), 345–346.

Article   CAS   PubMed   Google Scholar  

Humphries, B., Mertens, D., & Truman, C. (2000). Arguments for an ‘emancipatory’ research paradigm. In C. Truman, D. Mertens, & B. Humphries (Eds.), Research and inequality (pp. 3–23). Routledge.

Kaur, R., & Nagaich, S. (2019). Understanding feminist research methodology in social sciences. SSRN. https://doi.org/10.2139/ssrn.3392500

Koshy, E., Koshy, V., & Waterman, H. (2010). Chapter 1: What is action research? In E. Koshy, V. Koshy, & H. Waterman (Eds.), Action research in healthcare . Sage. https://doi.org/10.4135/9781446288696

Lazar, M. (2005). Feminist critical discourse analysis . Palgrave Macmillan.

Book   Google Scholar  

Leung, L., Miedema, S., Warner, X., Homan, S., & Fulu, E. (2019). Making feminism count: Integrating feminist research principles in large-scale quantitative research on violence against women and girls. Policy and Practice, 27 , 427. https://doi.org/10.1080/13552074.2019.1668142

Litosseliti, L. (2006). Gender and language: Theory and practice . Hodder Arnold.

Miller, T., & Bolton, M. (2007). Changing constructions of informed consent: Qualitative research and complex social worlds. Social Science & Medicine, 65 , 2199–2211.

National Commission on Domestic Violence and Multiple Disadvantage. (2019). Breaking down the barriers . Agenda, AVA and Lloyds Bank Foundation.

Ryan-Flood, R., & Gill, R. (2010). Secrecy and silence in the research process: Feminist reflections . Routledge.

Stainton-Rogers, W. (2011). Social psychology (2nd ed.). Open University Press.

Ussher, J. (2006). Managing the monstrous feminine: Regulating the reproductive body . Routledge.

Valpied, J., Cini, A., O’Doherty, L., Taket, A., & Hegarty, K. (2016). Sometimes cathartic, sometimes quite raw: Benefit and harm in an intimate partner violence trial. Aggression and Violent Behavior, 16 , 673–685.

Warwick-Booth, L., & Coan, S. (2020a). Breathing space final evaluation report . Leeds Beckett University.

Warwick-Booth, L., & Coan, S. (2020b). The key. Final evaluation report . Leeds Beckett University.

Warwick-Booth, L., & Coan, S. (2020c). Using creative qualitative methods in evaluating gendered health promotion. Sage Research Methods Cases Medicine and Health. Published online January 2020.

Warwick-Booth, L., & Cross, R. (2020). Changing lives, saving lives: Women Centred working – A evidence-based model from the UK. Critical Studies, 15 (1), 7–21.

Wilkinson, S. (2004). Feminist contributions to critical Health Psychology. In M. Murray (Ed.), Critical Health Psychology (pp. 83–100). Palgrave Macmillan.

Woodall, J., Warwick-Booth, L., South, J., et al. (2018a). What makes health promotion distinct? Scandinavian Journal of Public Health, 46 , 118–122.

Woodall, J. R., Cross, R. M., Kinsella, K., & Bunyan, A. (2018b). Using peer research processes to understand strategies to support those with severe, multiple and complex health needs. Health Education Journal, 78 (2), 176–188.

World Health Organization. (1986). The Ottawa charter . World Health Organization.

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Warwick-Booth, L., Cross, R., Coan, S. (2023). The Contribution of Feminist Approaches to Health Promotion Research: Supporting Social Change and Health Improvement for Vulnerable Women in England. In: Jourdan, D., Potvin, L. (eds) Global Handbook of Health Promotion Research, Vol. 3. Springer, Cham. https://doi.org/10.1007/978-3-031-20401-2_9

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EDITORIAL article

Editorial: women in science: public health education and promotion 2023.

\r\nSunjoo Kang

  • 1 Department of Global Health and Disease Control, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea
  • 2 Department of Public Health Medicine, Medical School, University of Pécs, Pécs, Hungary
  • 3 Bethesda Children's Hospital, Budapest, Hungary
  • 4 International Vaccine Institute, SNU Research Park, Seoul, Republic of Korea
  • 5 Faculty of International Education, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam

Editorial on the Research Topic Women in science: public health education and promotion 2023

Academic research dedicated to developing effective educational programs is increasingly intertwining with the pivotal role of health literacy in healthcare policies. The World Health Organization (WHO) emphasizes that tailored health literacy initiatives are fundamental in combating non-communicable diseases and health disparities ( 1 , 2 ). Recent responses to emerging infectious diseases have underscored the urgency of addressing health literacy gaps within marginalized and underserved communities, given the proliferation of misinformation ( 3 ). This urgency is compounded by persistent disparities in ethnic minority vaccine access ( 2 ) and variations in health literacy levels ( 4 , 5 ), necessitating tailored solutions that factor in diverse population characteristics.

On a practical front, there's an immediate and indispensable need to fortify governance structures and foster collaboration among diverse stakeholders within the healthcare sector. This imperative seeks to unearth governance models that can maximize the impact of health policies and education, serving as the bedrock for sustainable progress in public health practices ( 6 , 7 ).

The Research Topic meticulously highlighted the significant contributions of women researchers in Public Health, especially within the realms of Education and Promotion. It not only celebrated the exceptional achievements of female researchers but also underscored the pivotal role played by studies led by women in public health education and promotion. These articles, led by female first or last authors, fostered collaborative efforts between early career researchers and their senior female colleagues. This editorial aims to provide a comprehensive overview of the 2023 Research Topic on Women in Science – Public Health Education and Promotion . The published research articles significantly enrich our understanding of public health dynamics, each presenting a unique facet of public health and collectively advancing knowledge in this field. Furthermore, these research endeavors distinctly underline the invaluable role of women researchers in driving progressive insights and solutions within the public health domain. The authors' work is organized and summarized according to article type below.

Original research

The focus on health literacy interventions sheds light on their impact and offers more profound insights into the broader implications of health education. Understanding the intricate relationship between health literacy and learner motivation is a potential game-changer in enhancing educational outcomes and fostering improved health practices. Moreover, a comprehensive exploration of menstrual health research holds promise in advancing critical aspects of women's health, potentially shaping policy and educational initiatives in this vital public health domain. Bíró et al. investigated health literacy's multifaceted impact on behaviors, vaccination confidence, and healthcare usage. Their comprehensive study uncovered a nuanced relationship between health literacy dimensions and various health aspects. Despite no consistent link found between health literacy and behavior, sporadic effects of digital health literacy (DHL) on healthcare usage surfaced. Interestingly, both general health literacy (GHL) and DHL showed positive correlations with self-perceived health and vaccination confidence. Prioritizing enhancement in both dimensions holds promise in significantly improving self-perception and fostering vaccination confidence, suggesting a vital need for interventions to bolster GHL before fortifying DHL. The implications underscore the importance of elevated health literacy levels in mitigating health disparities, particularly pivotal for future vaccination campaigns.

Research by Malik et al. examined menstrual experiences and attitudes toward menstrual hygiene among women in Pakistan. The study highlighted a stark contrast between high awareness of menstrual hygiene and limited knowledge regarding health conditions associated with abnormal menstrual cycles. Their findings emphasized the need for comprehensive menstrual health education to bridge knowledge gaps. Furthermore, the success of FemPure products illustrated a strong demand for organic, user-friendly menstrual products, underlining the necessity for policy interventions to drive the development and accessibility of suitable menstrual products. The implications point toward an urgent requirement to destigmatize discussions on menstrual health and effectively address societal taboos through education and policy reforms.

Mózes et al. investigated screening attendance disparities among Hungarian-speaking Roma and non-Roma women across Hungary, Romania, and Slovakia, uncovering crucial factors like chronic diseases, smoking, health insurance, and physical inactivity contributing to attendance disparities. These revelations underline the urgent need for targeted screening programs to reduce healthcare discrepancies. The prominence of lacking insurance as a pivotal barrier Accentuates the urgency for comprehensive coverage to ensure equitable healthcare access. The implications resonate with the necessity of tailored screening initiatives, particularly within the Roma community, to enhance preventive healthcare measures and bridge existing healthcare gaps.

Rachubińska et al. examined the intricate role of depression as a mediator between personality traits and work addiction among women in Poland. Their study revealed correlations between neuroticism, extraversion, agreeableness, conscientiousness, and work addiction, mediated by depression, highlighting the significance of addressing depressive symptoms in managing workaholism. These findings stress the immediate need for tailored interventions and robust workplace support systems aimed at effectively mitigating work addiction tendencies. The study strongly advocates the implementation of comprehensive mental health interventions within work settings to foster healthier and more supportive work environments.

Perspectives

Caron et al. highlighted disparities in public health education among U.S. academic institutions, particularly in Historically Black Colleges and Universities (HBCUs). Identifying significant gaps in public health curricula and educational pathways accentuates the urgency for standardizing and expanding public health education. These enhanced curricula aim to equip individuals to effectively address pressing public health challenges, especially in crises like the ongoing COVID-19 pandemic, preparing future generations to manage diverse public health crises with proficiency.

This research showcases the global contributions of women in the field of public health education and promotion. It encompasses general perspectives inspired and initiated by women in a specific research field, articles celebrating outstanding female researchers, and research studies led by women investigating public health education and/or health promotion under the Women in Public Health Education and Promotion, 2023 collection. This collection emphasizes women's contributions and focuses on the significance of women's research and advancements in public health, underscoring their pivotal role in this domain.

Author contributions

SK: Writing – original draft, Writing – review & editing. ZR: Writing – original draft, Writing – review & editing. SP: Writing – original draft, Writing – review & editing. TN: Writing – original draft, Writing – review & editing.

The author(s) declare that no financial support was received for the research, authorship, and/or publication of this article.

Acknowledgments

The authors express gratitude for the contributions received in response to this Research Topic which is focused on celebrating the research of women researchers.

Conflict of interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision.

Publisher's note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

1. Osborne RH, Elmer S, Hawkins M, Cheng CC, Batterham RW, Dias S, et al. Health literacy development is central to the prevention and control of non-communicable diseases. BMJ Glob Health. (2022) 7:e010362. doi: 10.1136/bmjgh-2022-010362

PubMed Abstract | Crossref Full Text | Google Scholar

2. Elekwachi O, Wingate LT, Clarke Tasker V, Aboagye L, Dubale T, Betru D, et al. Review of racial and ethnic disparities in immunizations for elderly adults. J Prim Care Community Health. (2021) 12:21501327211014071. doi: 10.1177/21501327211014071

3. Arigbede OM, Aladeniyi OB, Buxbaum SG, Arigbede OJ. The use of five public health themes in understanding the roles of misinformation and education toward disparities in racial and ethnic distribution of COVID-19. Cureus. (2022) 14:e30008. doi: 10.7759/cureus.30008

4. Kawai K, Kawai AT. Racial/ethnic and socioeconomic disparities in adult vaccination Coverage. Am J Prev Med. (2021) 61:465–73. doi: 10.1016/j.amepre.2021.03.02

5. Perry Caldwell E, Killingsworth E. The health literacy disparity in adolescents with sickle cell disease. J Spec Pediatr Nurs. (2021) 26:e12353. doi: 10.1111/jspn.12353

6. Regmi K, Jones L. A systematic review of the factors - enablers and barriers - affecting e-learning in health sciences education. BMC Med Educ. (2020) 20:91. doi: 10.1186/s12909-020-02007-6

7. Collins SL, Smith TC, Hack G, Moorhouse MD. Exploring public health education's integration of critical race theories: a scoping review. Fronti Public Health. (2023) 11:1148959. doi: 10.3389/fpubh.2023.1148959

Crossref Full Text | Google Scholar

Keywords: women in science, public health, education, health promotion, health literacy, health disparity

Citation: Kang S, Rákosy Z, Park SE and Nguyen TAP (2024) Editorial: Women in science: public health education and promotion 2023. Front. Public Health 12:1368704. doi: 10.3389/fpubh.2024.1368704

Received: 11 January 2024; Accepted: 26 January 2024; Published: 12 February 2024.

Edited and reviewed by: Christiane Stock , Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany

Copyright © 2024 Kang, Rákosy, Park and Nguyen. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Sunjoo Kang, ksj5139@yuhs.ac

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

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Article Contents

Introduction, why should health promotion and disease prevention policies and interventions pay attention to gender, the way forward: multisectoral policy response to gender inequities in health through health promotion and disease prevention, acknowledgements.

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Gender and health promotion: A multisectoral policy approach

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Piroska Östlin, Elizabeth Eckermann, Udaya Shankar Mishra, Mwansa Nkowane, Eva Wallstam, Gender and health promotion: A multisectoral policy approach, Health Promotion International , Volume 21, Issue suppl_1, December 2006, Pages 25–35, https://doi.org/10.1093/heapro/dal048

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Women and men are different as regards their biology, the roles and responsibilities that society assigns to them and their position in the family and community. These factors have a great influence on causes, consequences and management of diseases and ill-health and on the efficacy of health promotion policies and programmes. This is confirmed by evidence on male–female differences in cause-specific mortality and morbidity and exposure to risk factors. Health promoting interventions aimed at ensuring safe and supportive environments, healthy living conditions and lifestyles, community involvement and participation, access to essential facilities and to social and health services need to address these differences between women and men, boys and girls in an equitable manner in order to be effective. The aim of this paper is to (i) demonstrate that health promotion policies that take women's and men's differential biological and social vulnerability to health risks and the unequal power relationships between the sexes into account are more likely to be successful and effective compared to policies that are not concerned with such differences, and (ii) discuss what is required to build a multisectoral policy response to gender inequities in health through health promotion and disease prevention. The requirements discussed in the paper include i) the establishment of joint commitment for policy within society through setting objectives related to gender equality and equity in health as well as health promotion, ii) an assessment and analysis of gender inequalities affecting health and determinants of health, iii) the actions needed to tackle the main determinants of those inequalities and iv) documentation and dissemination of effective and gender sensitive policy interventions to promote health. In the discussion of these key policy elements, we use illustrative examples of good practices from different countries around the world.

In most countries, resources allocated by government to health-promoting activities are very limited compared to investments in medical care ( McGinnis et al. , 2002 ). This imbalance is evident also in the richest countries of the world. For example, in the USA, approximately 95% of the health expenditure goes to direct medical care services, whereas only 5% is allocated to prevention activities ( Centers for Medicare and Medicaid Services, 2000 ). In Canada, the medical care systems absorbs the majority of health sector resources, with less than 3% of health spending allocated towards health promotion ( Hylton, 2003 ). Therefore, it is of utmost importance to invest these limited resources in preventive activities with high potential for success and cost-effectiveness.

In the first section of this paper, we argue that health promotion policies that take women's and men's differential biological and social vulnerability to health risks (as well as their unequal access to power) into account are more likely to be successful and cost-effective compared to policies that are not concerned with such differences. Examples of the lack of gender perspectives in health promotion programmes are provided and discussed in this section.

Illustrated by examples of good practices from different regions of the world, we discuss in the second section what is needed to counteract gender insensitivity in health promotion interventions and what is required to build a strong multisectoral policy response to gender inequities in health through health promotion and disease prevention. We emphasize the need for upstream health promotion actions within the broader social and economic arena (e.g. finance, labour market, education) where the unequal distributions of power, wealth and risks to health between men and women are generated, beyond the reach of the health care sector.

There is overwhelming evidence from all fields of health research that women and men are different as regards their biology (sex differences), their access to and control over resources and their decision-making power in the family and community, as well as the roles and responsibilities that society assigns to them (gender differences). Together gender and sex, often in interaction with socioeconomic circumstances, influence exposure to health risks, access to health information and services, health outcomes and the social and economic consequences of ill-health. Recognizing the root causes of gender inequities in health is crucial therefore when designing health system responses. Health promotion as well as disease prevention needs to address these differences between women and men, boys and girls in an equitable manner in order to be effective (for a more detailed discussion and examples, see Keleher, 2004 ).

Today, there is a growing recognition, among health professionals, researchers and policymakers, of the widespread and profound implications of gender-based inequities in health. There is also emerging evidence that integrating gender considerations into interventions has a positive effect on health outcomes across various domains ( Boerder et al. , 2004 ). Even though knowledge of gender differences in health is increasingly available, it does not always translate easily into realities of health planning and programme implementation. The field of health promotion is no exception: the lack of translation of knowledge about gender inequities in health into health promotion interventions leads to misallocated resources and weakened potential for success. For example, violence against women, arguably the most extreme phenomenon of gender inequality, affects millions of women. Until recently, the magnitude and health consequences of domestic violence against women have been neglected in both research and policy ( Garcia-Moreno, 2002 ). We have now clear evidence ( WHO/WHD, 1996 ; WHO/WPRO, 1998 ; Astbury and Cabral, 2000 ; WHO, 2002 ; ARROW, 2005 ; WHO, 2005 ) that gender-based violence causes physical and psychological harm. In addition, it undermines the social, economic, spiritual and emotional well-being of the survivor, the perpetrator and society as a whole, but it also compromises the trust relationship between men and women. The social, economic, psychological, physical, emotional and relationship harm to individuals from gender-based violence constitutes a major health concern that requires creative and imaginative responses from the plethora of policy-makers and intervention agencies dealing with health promotion and prevention of violence. In particular, lack of attention to the hidden emotional outcome of gender-based violence, loss of trust, loss of dignity and a deeply compromised self-esteem need to be addressed alongside housing, economic support, social welfare and legal issues as part of an integrated health promotion strategy ( Eckermann, 2001 ).

Gender blindness

When planning and implementing health promotion and disease prevention strategies, gender is an issue that is often neglected ( Cristofides, 2001 ; Östlin, 2002 ; Roses Periago, 2004 ). Generally, there seems to be an assumption that interventions will be just as effective for men as for women. Many health promotion programmes are gender blind and based on research where the sex of the study participants is not made explicit. Gender-neutral expressions, such as ‘health care providers’, ‘children’, ‘adolescents’ or ‘employees’, are often used in programme descriptions and reports ( Ekenvall et al. , 1993 ). As a result, collection, analysis and presentation of data are often not sex-disaggregated and no gender analysis is undertaken.

Terminology is crucial in framing gendered responses to health promotion challenges. For example, the WHO (2005 ) Multi-country Study authors recommend using the term ‘gender-based violence’ to replace the commonly used descriptive terms: intimate partner violence (denotes relationship to perpetrator), domestic violence (denotes location of the abuse) and violence against women (denotes the sex of the survivor). This ensures that the cause of the violence is not forgotten. Violence is regularly the product of socialized but mutable gender relationships, and this is written into the term ‘gender-based violence’. Relationship problems take centre stage with risky behaviour, social disadvantage, environmental degradation and germs in the aetiological chain of events that lead to ill-health and compromised well-being (Eckermann, 2006). Health promotion initiatives need to recognize the importance of good gender relationships in promoting health and well-being.

Gender' as a proxy for ‘women’

Health promotion involves the agent of promotion and the beneficiary of it. In this context, the social construction of gender roles come into play as many of the promotional measures are put into action by women being the care guarantor of every individual in the household. Consequently, health promotion messages often target women in their assigned role as caregivers in the family ( Doyal, 2001 ). Since women's ability to make decisions about implementing health promotional measures is often limited in many countries due to their lower status in the household, the positive health effects of the promotional measures may be less than expected. When health promotion campaigns are addressed to the family as a whole and to the relationships between males and females of all ages, health programmes can be considerably improved. In Ghana, for example, information about the importance of child immunization was directed to both fathers and mothers. As a result, men have taken greater responsibility for their children's health, leading to increased vaccination rates and earlier immunization ( Brugha et al. , 1996 ). In Lao PDR, an outreach health promotion programme attached to the Bolikhan District Maternity Waiting Home targeted men in 11 remote Hmong and Lao villages to encourage them to take an active role in reproductive health. Interactive sessions addressed male and female anatomy and function, fertilization, physiology of pregnancy, birth spacing including responsibility of men, sexually transmittal infections and HIV prevention, the importance of antenatal and postnatal care, nutrition and relaxation during pregnancy. Attendance rates were over 80% of the men in each village. Before the programme, only 18% of participants said they had a very good knowledge of reproductive health issues. At the end of the programme, 72% of participants reported very good knowledge. Thus gendered knowledge barriers to health improvement were greatly reduced in all 11 villages ( Eckermann, 2005 ).

Focus on behavioural change

Many health promotion strategies aim at reducing risky behaviours, such as smoking, while ignoring the material, social and psychological conditions within which the targeted behaviours are embedded. For example, in many countries there is a strong association between material hardship, low social status, stressful work or life events and smoking prevalence ( Bobak et al. , 2000 ; Osler et al. , 2001 ). Critics have argued that gender roles and health-related behaviours linked to those roles in many health promotion programmes have led to a focus on behavioural change at the individual level, rather than on policy change at the societal level ( Kabeer, 1994 ; Stronks et al. , 1996 ). For example, prevention strategies to reduce harmful stress among working women often include measures where the onus is put on women to develop their own personal stress coping strategies to balance competing gender roles. Targeted women often feel accused of not being able to cope with multiple pressures arising from their responsibilities as mothers, wives, housekeepers and workers. To avoid this, complementary measures to ease women's burden, such as the universal provision of accessible and affordable day-care centres for children and the introduction of more flexible working hours, should also be introduced.

Similarly, many men may experience extraordinary pressures from unemployment and material hardship, which constrain them to fulfil their assigned gender role as ‘breadwinners’ ( Möller-Leimkühler, 2003 ). Those who try to cope with stresses through behaviours, such as smoking, drinking or drug abuse, are accused of risking their health by their own personal choice. Strategies that aim at changing the lifestyles of these men would probably be more effective if combined with measures to change the social environment in which the health damaging lifestyles are embedded.

According to a study from Thailand, although the nationwide ‘100% condom programme’ to prevent HIV infection has led to a decrease of the infection among men, young women who were engaged in commercial sex have not been protected from the infection to the same degree as men (Kilmarx et al. , 1999 ). Obviously, there is a need for policies that recognize and address the gender differences of status and power that structure sexual relationships and counteract women's lack of assertiveness to insist on condom use. Again the issue of trust in the relationships between men and women is a key factor for health promotion programmes to take into account.

Lack of multisectoral approach

Traditionally, the health field has been predominantly the domain of medical professionals and the health care sector, where the main focus is on individual health and individual risk factors. Therefore, health promotion and disease prevention strategies within the health care sector are often limited to individual health advice, e.g. on smoking cessation. One limitation of this is that certain groups of people, such as the poor who cannot afford user fees or women who cannot without permission from their husbands visit health clinics, will be excluded from health advice and information. Another limitation is that the promotional measures within the health care sector are unable to tackle the root causes of health disparities. Many of the health determinants need to be tackled by policies in sectors where health is created, such as the labour market, social services, education system, housing, environmental protection, water and sanitation, transport, road safety and security. These policies have direct and indirect health impacts, which may differ between men and women (Benzeval et al. , 1996). The understanding that both women's and men's health is dependent on several societal sectors is critical to upstream, multisectoral health promoting policies and interventions. Any such initiative should take into account the involvement of key stakeholders in communities and needs to be acceptable at individual, household as well as societal levels. In many traditional communities, traditional chiefs, or village leaders, act as gatekeepers in all educational and community-based activities, so it is essential to incorporate these key stakeholders in any health promotion policies and interventions designed to reduce gender inequities.

Top-down approach

The traditional public health approach is top-down rather than bottom-up, with experts identifying problems and formulating interventions while the problems and solutions as perceived by those at particular risk rarely constitute the base for action ( Dahlgren, 1996 ). The power of change is then defined primarily in political and professional terms without the possibility of the targeted people to influence and control various determinants of health. Because of power imbalances and because of the low representation of women in decision-making bodies, women can seldom make their voices heard. As a result, health promotion programmes designed in a top-down manner will not necessarily correspond to women's health needs. Health promotion policies and activities are most meaningful when target communities and groups are involved in all aspects of policy and programme development, implementation and evaluation. For example, ‘The Blue Nile Health Project’ in Sudan with the objective to control water associated diseases was perceived as very successful, thanks to the particular emphasis in the programme on gender-related aspects that defined women's role and participation ( A Rahman et al. , 1996 ). The study urges health planners to persuade the subordinated communities of women in many African countries, like Sudan, to play a more active role in the health programmes.

Building on past experience from successful and less successful health promotion strategies from a gender equity perspective, we discuss in the following some minimum requirements for gender-sensitive health promotion and disease prevention policies and programmes.

Joint commitment

Through international agreements, such as the Ottawa Charter for Health Promotion and the WHO Health For All Strategy (World Health Organization, 1981 ), many countries have already committed themselves to health promotion. Likewise, most countries in the world have committed themselves to promote gender equity. These agreements state that all women and men have the right to live without discrimination in all spheres of life, including access to health care, education and equal remuneration for equal work 1 . The recently adopted Bangkok Charter for Health Promotion states that health promotion contributes, among other things, to reducing both health and gender inequities.

Some major achievements in working towards gender equity are evident. For example, the Multi-country Study on Health and Domestic Violence against Women acknowledges the ‘combined efforts of grass-roots and international women's organizations, international experts and committed governments’ in producing ‘a profound transformation of public awareness’ ( WHO, 2005 :1) about gender-based violence. Since the World Conference on Human Rights (1993), the International Conference on Population and Development (1994) and the Fourth World Conference on Women (1995), the perception of gender-based violence as purely a welfare and justice issue has changed significantly to the point where violence against women is ‘now widely recognized as a serious human rights abuse’ as well as ‘an important public health problem that concerns all sectors’ ( WHO, 2005 :1). However, as the 10-year reviews of the ICPD Plan of Action and the Beijing Platform for Action have highlighted ( ARROW, 2005 ; WHO, 2005 ), all countries still have a long way to go to achieve gender equity in all areas of health and well-being.

The internationally agreed Millennium Development Goals (MDGs) identified ‘gender equality and empowerment of women’ as the third of eight goals and a condition for achieving the other seven. Although, these and similar commitments 2 have been ratified by most United Nations Member States, action by governments to bring national laws, policies and practices in line with the provisions of the ratified conventions has lagged behind ( United Nations, 2005 ). Moreover, these commitments have not been pursued in the health sector.

The Beijing Declaration and Platform for Action in 1995 as well as the UN Economic and Social Council in 1997 have clearly established ‘gender mainstreaming’ as the global strategy for promoting, among other things, women's health. In the field of public health, this strategy means the integration of both women's and men's concerns into the formulation, monitoring and analysis of policies, programmes and projects. In relation to health promotion, it entails taking into account gender issues that have implications for individual and community health.

Setting international, national and local objectives for gender equity in health is the first step in establishing a joint commitment. These objectives need to be measurable and translated into policies and actions.

A good example of translating international objectives to promote gender equity and health into national objectives comes from Lao PDR. The Lao Ministries of Health and Education have signed, in response to the need to meet the targets of the MDGs, a memorandum of understanding to collaborate in developing health promotion programmes in Lao primary schools, which address all eight targets including MDG 3 to promote gender equity. In combination with the Lao Women's Union, village health committees, NGOs and international organizations, the Lao government ministries have also developed a multisectoral national development plan to mainstream gender into all areas of health and well-being.

Assessment and analysis of gender inequities in health

In order to maximize efficient use of resources, health promoting strategies and actions, in general, need to be based on an assessment of the size, nature and root causes of gender inequalities in health. More specifically, health promotion relating to certain issues, for example, gender-based violence, HIV/AIDS, malaria, nutrition or smoking, needs to be designed with an understanding of how women and men differ in relation to the issue's causes, manifestations and consequences. Collection, analysis and reporting of data disaggregated by sex, age, socioeconomic status, education, ethnicity and geographic location should be performed systematically by individual research projects or through larger data systems. Attention needs to be paid to the possibility that data may reflect systematic gender biases due to inadequate methodologies that fail to capture women's and men's different realities ( Östlin et al. , 2004 ). The promotion of gender-sensitive research to inform the development, implementation, monitoring and evaluation of health promotion policies and programs is also desirable.

One good example of recording sex-disaggregated, gender-sensitive and gender-specific health data comes from Malaysia. In 2000, the Asian-Pacific Resource and Research Centre for Women (ARROW) published ‘A Framework of Indicators for Action on Women's Health Needs & Rights after Beijing’ ( ARROW, 2000 ). This publication was developed as a tool for all government, non-government and international organizations to use in monitoring implementation of the Beijing Platform for Action. The framework presents selected Beijing recommendations on women's health and rights, sexual and reproductive health, violence against women and gender-sensitive health programmes, which are then operationalized into quantitative and qualitative indicators. These can be measured to assess progress particularly in women's health status; health service provision, use and quality; and national laws, policies and plans. This will be reviewed in a publication to be released in late 2006. Meanwhile, ARROW (2005) has applied a similar framework in its ‘Monitoring Ten Years of ICPD Implementation’. Eight countries in the Asia Pacific region were examined in detail, using indicators derived from the ICPD recommendations, to ‘assess progress in policies, laws and services and changes in women's health, status and lives’ over the past 10 years and to ‘identify the main barriers and facilitating factors in implementing commitments made in the Programme of Action, ICPD’ ( ARROW, 2005 :17). The Report reveals that 10 years after ICPD, ‘women's lives have seen only minimal improvement’ and ‘violence against women is on the rise, as is HIV/AIDS transmission for women and men’ ( ARROW, 2005 :17). The Report argues that ‘one of the best indicators of real change in power relations between men and women is a decrease in domestic violence and rape’ yet ‘only two of the eight countries (Cambodia and Malaysia) had ever had a national prevalence survey on domestic violence’ ( ARROW, 2005 :43) let alone put prevention strategies in place.

The health promotion recommendations that emerge form the 2005 ARROW Report suggest a major rethinking of intervention to deal with key challenges. These challenges include: deeply embedded patriarchy, early marriage and early first parity, declining commitment of service providers, lack of political will and stability, social inequities, religious fundamentalism in some areas, trends to privatization, liberalization and globalization and persistent low levels of literacy among women and girls. Key recommendations for health promotion include niche planning by governments, rather than the use of uniform ‘one size fits all’ health promotion programmes, using NGOs as clearing houses for up-to-date dissemination of data and community-based workshops on a variety of health issues and using traditional authority processes (such as village chief authorization) to run campaigns to promote female literacy and education.

Another good practice in analysing data by gender to inform implementation of a health promotional intervention has taken place in São Paulo in Brazil. The Agita São Paulo Programme to promote physical activity is a multi-level, community-wide intervention. Gender analysis of sex-disaggregated data revealed important differences between adolescent boys and girls concerning patterns of physical activity ( Matsudo et al. , 2002 ). First, girls were more involved in vigorous physical activity than boys, which was a surprise because literature from several developed countries suggested the opposite. Further analysis showed that the main reason behind this was girls' involvement in strenuous housekeeping (42% of girls versus 6% of boys). On the other hand, boys utilized more active transportation to and from school (100% of boys versus 57% of girls). This was a very important source of information for the programme managers for the design of intervention to increase physical activity among girls and boys.

Actions needed to tackle the main social and environmental determinants of gender inequities in health

The prime determinants of gender inequities in health are social and economic disadvantages related to factors such as decision-making power, income, employment, working environment, education, housing, nutrition and individual behaviours. As mentioned previously, women and men are exposed to various risk factors to different degrees due to differences in gender roles and living and working conditions. These differences are crucial to recognize, estimate and monitor when designing interventions, programmes and population-wide risk reduction strategies. Many determinants of gender inequities in health can be influenced by health-promoting measures and risk reduction strategies ranging from micro- to macro-public policy levels ( Dahlgren and Whitehead, 1991 ). Keleher (2004) emphasizes the need for sustainable upstream strategies that address the economic, social and cultural obstacles that prevent women from fulfilling their potential. She argues that such strategies are much more likely to bring about sustainable change than a continual reliance on midstream and downstream strategies.

Actions to strengthen individuals

Many health promoting interventions with a gender perspective have focussed mainly on strengthening women's and girls' capacity to better respond to, and control determinants of, health in the physical and social environment. They include gaining access to economic capital as well as social and cultural capital. The most effective interventions are those with an empowerment focus ( Sen and Batliwala, 2000 ). They aim to help women to: gain knowledge about, and access to, their rights; access micro-credit to start their own businesses; improve their access to essential services; address perceived deficiencies in their knowledge (including literacy and secondary education); acquire personal skills and thereby improve their health. Empowerment initiatives aim to encourage both sexes to challenge gender stereotypes. Such actions can include, for example, training boys and men to reduce gender biases by promoting gender-sensitive behaviour and reducing violence. Another example of such initiatives is raising awareness among young girls and their families about unfair discrimination against girls and thereby promoting the status and a value of the girl child. The Girl Child Project in Pakistan has, for example, made girls aware that unequal food allocation in the family is wrong ( Craft, 1997 ).

Actions to strengthen communities

Strengthening communities can cover a wide spectrum of strategies aimed at strengthening the way deprived communities function collectively for mutual support and benefit. These range from helping to create meeting places and facilities for social interaction to supporting communities' defence against health hazards, such as substance abuse, crime and violence or environmental pollution. For example, several innovative and gender-sensitive community level initiatives have emerged in Africa over the past decade in response to the devastating effects of the AIDS epidemic in the region ( Iwere, 2000 ). One of these initiatives is the Community Life Project in Lagos, Nigeria, which is a unique example of how synergistic partnerships between activists, community and religious organizations, local institutions, involving men, women and children simultaneously, can help to effectively break the silence on sexuality issues ( Ojidoh and Okide, 2002 ). The project is working with 23 community groups to increase and sustain HIV/AIDS awareness in the community; addressing HIV/AIDS within the broader framework of sexual and reproductive health through sexuality education sessions; and increasing community ownership and participation by training representatives of the groups as volunteers and family life educators. Thus, the initiative places sexuality education on the community's agenda, thereby creating a supportive environment for advancing women's reproductive and sexual health.

In the Woorabinda Aboriginal community in rural Queensland, Australia, the community has organized sanctions around the weekend Australian Rules Football match related to gender-based violence. Any player who has been identified as having abused his partner during any week is banned by the team committee from playing in the football match at the weekend. This reinforces community and shared abhorrence of gender-based violence and acts as a public endorsement of good relations between men and women in the community ( ABC, 2000 ; Queensland Government, 2000 ).

Actions to promote gender equity in access to essential facilities and services

In both industrialized and developing countries, improvements in living and working conditions and access to services have been shown to bring substantial health improvements to populations. Public health initiatives influencing living and working conditions include measures to improve access to clean water, adequate nutrition and housing, sanitation, safer workplaces and health and other welfare services. Policies within these areas are normally the responsibility of separate sectors and there is a need for them to cooperate in order to improve the health of the population. Health promotion policies and interventions aimed at improving living and working conditions and access to services need to be particularly gender sensitive due to the fact that women and men face distinct health risks in their living and working environment and have different health needs. For example, many developing countries suffer from weak health services, infrastructures and unaffordable services, a situation that disproportionately affects women as they require more preventive reproductive health services. The inadequacy and lack of affordability of health services is compounded by physical and cultural barriers to care. At the national level, some attempts have been made to tackle cost and affordability barriers in health services to women. For example, South Africa and Sri Lanka provide free maternal and infant health services. In some cultures, women are reluctant to consult male doctors. The lack of female medical personnel is an important barrier to utilization of health services for many women ( Zaidi, 1996 ). To overcome this barrier, the Women's Health Project in Pakistan works with the Ministry of Health to improve the health of women, girls and infants in 20 predominantly rural districts in four provinces through measures, such as the expansion of community-based health care and family planning services through the recruitment and training of thousands of village women as Lady Health Workers, a ‘safe delivery’ campaign, and the promotion of women's health and nutritional needs and family planning ( Asian Development Bank, 2005 ). The project assumes that a female health care provider could better understand the problem of another woman.

Actions to encourage social and economic policy change

Policies at the structural level include economic and social policies spanning sectors such as labour market, trade environment and more general efforts to improve women's status. These policies have a great potential to reduce or exacerbate gender inequality, including inequities in health. Influencing factors affecting social stratification is therefore a key for the improvement of women's social position relative to men. Policies aimed at improving women's education, increasing their possibilities to earn an income within the labour market, giving women access to micro-credit to start small businesses and family welfare policies are all measures for improving women's social status in the family and in the society. Improved social status for women relative to men may improve women's control over household resources and their own lives. For example, development policies in Matlab (Bangladesh) included strategies, such as micro-credit schemes linked to employment and provision of more places in school for daughters of poor families, which successfully increased the status of the poorest women. Equity-oriented policies in a social context in which women had traditional matrilineal rights to property and girls were valued as much as boys have resulted in considerable health gains in Kerala, India. Women could benefit from improvements in health care provision and achieve high levels of literacy. Kerala is the only state in India where the population sex ratio has been favourable to women throughout the 20th century, and it is not plagued by the problem of ‘missing women’ ( Östlin et al. , 2001 ). Increasing the participation of women in political and other decision-making processes—at household, community and national levels—and ensuring that laws and their implementation do not discriminate against women are measures that have a great potential to improve gender equality and health equity.

The examples presented earlier suggest that most successful interventions are those that combine a wide range of intersectoral and upstream approaches as well as downstream interventions to tackle a problem. For example, interventions at the individual level to empower women to deal with the threats to their mental and physical health from violence are important. However, interventions are also needed at the structural level, where governments have a central role in policy and legislation and in mandating organizational change to ensure that women are in the position to be empowered. The establishment of societal freedoms from discrimination and violence must sit alongside other efforts to increase women's access to economic resources and social inclusion. These economic, legal, social and cultural assets are fundamental to generating and maintaining women's health and well-being but they also benefit men.

Documenting and disseminating effective and gender-sensitive policy interventions to promote health

There is a paucity of information on cost-effective and gender-sensitive health promoting strategies and interventions that have successfully addressed social determinants of health, and little concrete guidance is available to policymakers. Developing an international reporting system to collect such information in order to increase the accessibility for policy-makers to relevant information needs to be encouraged. Monitoring and evaluation of strategies and interventions are also important for informing future processes and track progress towards gender equality.

Indicators and methods should be developed urgently for systematic integration of gender dimensions in health impact assessments that assess not only a policy's impact at an aggregate level, but on different population groups, including the marginalized and vulnerable; such an assessment should be applicable not only to health systems policy, but also to policy in other sectors ( Lehto and Ritsatakis, 1999 ; Whitehead et al. , 2000 ).

Recognizing gender inequalities is crucial when designing health promotion strategies. Without such a perspective, their effectiveness may be jeopardized, and inequities in health between men and women are likely to increase. Although the dynamics of gender inequalities are of profound importance, gender biases in health research, policy and programming and institutions continue to create a vicious circle that downgrades and neglects gender perspectives in health.

In some countries, such as Canada ( Status of Women Canada, 2001 ) and a number of European countries ( Pollack and Hafner-Burton, 2000 ), considerable work is underway to integrate gender perspectives in policy and practice. The country case study examples presented in this paper suggest that it is feasible and beneficial to integrate gender in health promotion policies. However, greater efforts are needed to sensitize stakeholders including health professionals—policymakers and researchers alike—to its importance. Many lessons have been learnt, which can be used as building blocks for adaptation to ensure that health promotion policies are contextual in nature taking into account gender specific factors that can impinge on the promotion of health among a given community. Effective health promotion policies and programmes are those centred on joint commitment and a multisectoral approach and which are based on evidence gathered with gender dimensions in mind.

We would like to thank the staff of the Gender, Women and Health Department and the Department of Chronic Diseases and Health Promotion at WHO in Geneva, for valuable comments. We would also like to thank the participants of the Sixth Global Health Promotion Conference in Bangkok, August 2005, and the anonymous reviewer of the manuscript for their comments.

The United Nations International Covenant on Economic, Social and Cultural Rights, Article 12 and the United Nations International Covenant on Civil and Political Rights, Article 2.1 and Article 3. The United Nations Economic, Social and Cultural Rights, Article 2.2, Article 3, Article 7(a)(i), Article 12.2(d) and Article 13.

For example, Article 25 of the Universal Declaration of Human Rights in 1948; the Convention on the Elimination of All Forms of Discrimination against Women (CEDAW) in 1973, the Declaration on the Elimination of Violence against Women of 1993, the Programme of Action of the International Conference on Population and Development (ICPD) in Cairo in 1994, the World Summit for Social Development in Copenhagen and The Beijing Declaration and Platform for Action in 1995; the Declaration of Commitment on HIV/AIDS adopted at the UN General Assembly Special Session on HIV/AIDS (UNGASS) in 2001.

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  • Open access
  • Published: 16 October 2021

Health promotion focusing on migrant women through a community based participatory research approach

  • Cecilia Lindsjö 1 ,
  • Katarina Sjögren Forss 1 ,
  • Christine Kumlien 1 &
  • Margareta Rämgård 1  

BMC Women's Health volume  21 , Article number:  365 ( 2021 ) Cite this article

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Metrics details

Migrants are often more vulnerable to health issues compared to host populations, and particularly the women. Therefore, migrant women’s health is important in promoting health equity in society. Participation and empowerment are central concepts in health promotion and in community-based participatory research aimed at enhancing health. The aim of this study was to identify conditions for health promotion together with women migrants through a community-based participatory research approach.

A community-based participatory research approach was applied in the programme Collaborative Innovations for Health Promotion in a socially disadvantaged area in Malmö, Sweden, where this study was conducted. Residents in the area were invited to participate in the research process on health promotion. Health promoters were recruited to the programme to encourage participation and a group of 21 migrant women participating in the programme were included in this study. A qualitative method was used for the data collection, namely, the story-dialogue method, where a process involving issue, reflections and actions guided the dialogues. The material was partly analysed together with the women, inspired by the second-level synthesis.

Two main health issues, mental health and long-term pain, were reflected upon during the dialogues, and two main themes were elaborated in the process of analysis: Prioritising spare time to promote mental health and Collaboration to address healthcare dissatisfaction related to long-term pain. The women shared that they wanted to learn more about the healthcare system, and how to complain about it, and they also saw the togetherness as a strategy along the way. A decision was made to start a health circle in the community to continue collaboration on health promotion.

Conclusions

The community-based participatory research approach and the story dialogues constituted an essential foundation for the empowerment process. The health circle provides a forum for further work on conditions for health promotion, as a tool to support migrant women’s health.

Peer Review reports

Migrants are at higher risk, compared to populations of host countries, of acquiring diseases [ 1 ]. Health vulnerability is thus greater among migrants, particularly among women, and may consequently entail specific healthcare needs [ 2 ]. Mental issues, such as anxiety and depression, have been shown to be more common in a migrant population compared to the host population [ 3 ]. Furthermore, research among Syrian migrants living in Sweden revealed that mental health problems were more common in Syrian women than in their male counterparts [ 4 ]. Similarly, another study on self-rated health among Iraqi migrants in Sweden, showed that Iraqi migrants, and in particular Iraqi women, tended to rate their health poorer than the native Swedish population [ 5 ]. In addition, women from Iraq had a lower belief in their ability to promote their own health compared to Swedish women and engaged less in physical activity [ 5 ]. Health interventions intended to help the general patient population, such as physical activity on prescription, may not be compatible with the situation of migrant women [ 6 ]. In summary, the health situation of migrant women can be compared neither with that of migrant men nor with that of women of host countries. Therefore, according to previous research, one could argue that migrant women’s health is important to consider when promoting health equity in society.

Health inequity is linked to social determinants of health, which should be kept in focus when working for health equity [ 7 ]. The Swedish Commission for Equity in Health and the Malmö Commission have emphasised the importance of participation and empowerment in enhancing health [ 8 , 9 ]. Thus, the reports of the commissions can be said to be in line with the central concepts of health promotion, i.e., empowerment, participation, holism, cross-sectoral collaboration, equality, sustainability and multi-strategy [ 10 , 11 ].

According to the World Health Organization (WHO), health promotion is ‘ the process of enabling people to increase control over, and to improve, their health ’ [ 12 ]. It includes a broad range of measures regarding how to influence individuals’ health behaviour as well as focusing on social structures [ 10 , 11 ]. Thus, health changes can be conducted on different levels, individual, community or public, as well as on several levels simultaneously, often with even more impact [ 13 ]. Moreover, the interplay between levels is important, connecting individuals to their context [ 11 ]. Worldwide, no commonly accepted theory of health promotion exists, despite numerous theoretical frameworks, but the central concepts referred to above are a foundation [ 10 ]. Previous studies focusing on health promotion among migrant women have shown positive results. For example, a study on the cultural adaptation of a health-promotive intervention showed perceived improved health [ 14 ], and another study, on a salutogenic health-promotion programme, showed trends pointing to better self-esteem and reduced stress [ 15 ].

The central concepts of health promotion are fundamental in the programme Collaborative Innovations for Health Promotion, wherein this study is situated, and the approach of Community-Based Participatory Research (CBPR) was applied in the programme [ 16 ]. Wallerstein et al . have defined CBPR as: ‘collaborative efforts among community, academic, and other stakeholders who gather and use research and data to build on the strengths and priorities of the community for multilevel strategies to improve health and social equity’ [ 17 ]. In a CBPR project the community members are part of the research process as partners compared to community-placed research where the researchers conduct the research in a community without involving community member in the research [ 17 ]. One of the primary objectives of CBPR programs is to reduce health inequity through community empowerment. Favourable conditions for participation will substantially affect the outcomes of projects aiming to reduce health inequity through community empowerment [ 17 ]. CBPR is about addressing structural inequalities and social injustice, together with the community members who are struggling with these issues [ 18 ]. Through social changes, inequalities in health can be reduced [ 19 ]. Engagement in the community is therefore essential to achieve empowerment and take action [ 18 ]. CBPR is one way of doing participatory action research and the approach has been developed from and inspired by the participatory action research paradigm [ 19 , 20 ], where a cyclic process is applied, moving from problem to reflection to action [ 21 ]. The participatory research approach has commonly been used in research regarding marginalised groups as a defiance to oppression and a questioning of power relations of knowledge [ 20 ]. In the process of democratisation and the act of change, Paulo Freire, among others, emphasises the importance of, and has developed the teaching of, critical thinking, which initiates the empowerment process [ 20 , 22 ]. To enable critical thinking and empowerment, participation is essential [ 22 ]. The CBPR approach can bring together research, theory and practice and is suitable for marginalised populations lacking involvement in the community [ 23 ]. The CBPR approach is often used in the context of health inequalities when a subpopulation is differently affected by health conditions and poorly understood compared to the general population [ 24 ].

The programme within which this study was included takes as its point of departure the community members’ own perception of their needs of health promotion, initiating a focus on migrant women’s health. CBPR for community health promotion has been previously used in health interventions focusing on physical activity and nutrition to prevent chronic diseases, among migrant women in the USA [ 25 ]. Congolese migrant women in the USA have also, together with researchers, used the CBPR approach for health promotion, resulting in photo and story sharing on themes such as healthcare system issues, social support, and daily experiences of health [ 26 ]. Furthermore, review studies have concluded that community work for migrant women can include the initiation of dialogue and collaboration to increase community social support, which can prevent isolation as well as improving mental health and access to healthcare [ 27 ]. Many stressors, such as housing or work, may affect health among migrant women, and social support may work as a resilience strategy in handling various situations [ 28 ].

Promoting health among women is important from a societal perspective in order to reduce health inequality [ 29 ]. Moreover, women should be involved in the construction of the knowledge needed to promote their health, especially women with different needs than the majority [ 29 ]. Migration is a global phenomenon, and, while acknowledging previous research, studies using the CBPR approach are needed to understand the conditions for health promotion in a North European context. The above-mentioned studies with a CBPR approach have been conducted in the USA [ 25 , 26 ], a context that might differ from the North European one. For example, in the USA, women migrants were concerned about access to health insurance and consequently access to healthcare, whereas in Sweden migrants are entitled to healthcare when they get a residence permit and an address in Sweden [ 26 , 30 ]. Therefore, the aim of this study was to identify conditions for health promotion together with women migrants in a Swedish context through a CBPR approach.

Design and setting

This study was part of the programme Collaborative Innovations for Health Promotion. The CBPR approach was applied, which was suitable since the programme was conducted in a socially deprived area of Malmö, Sweden, where parts of the population may be marginalised. This area is classified as a socially vulnerable area. According to the Swedish police authority, a socially vulnerable area is defined as an area with a population with low socioeconomic status and widespread criminality that affects the local society [ 31 ].

Initiatives for researching issues regarding health equity in this area were taken by researchers at Malmö University, and a further description of those initiatives is presented elsewhere [ 16 ]. In brief, residents were invited to so-called Future workshops in 2016–2017 and together with researchers and other actors they developed an action plan, recognising obstacles to the promotion of residents’ health. Using a multisectoral approach, solutions for health promotion activities were elaborated [ 16 ]. A co-creative lab focusing on women’s health, and included in the programme, was initiated by women migrants, primarily from countries of the Middle East, though the group was open to women with any ethnic origin. Activities mainly focusing on social inclusion, started for women within the community.

To facilitate participation, lay health promoters from the community were recruited into the programme. Their role implies (a) a similar migration background as the community being served, (b) knowledge and understanding of the society and the systems of health and social services in the new country as well as in the one they have migrated from, and (c) the ability to use that knowledge and understanding to help the community participants [ 32 ]. Community health workers have previously been researched as an option for engaging in health promotion among women migrants, and their role also enables addressing social determinants of health [ 32 ]. In this study, the role of the health promoter was to initiate actions with regard to health-promoting issues according to the action plan. The health promoter could translate language-wise but also culturally, explaining behaviours to both researchers and participants. Moreover, the health promoter kept up the contact between participants and researchers, reached out to and recruited new participants, and informed about activities. The health promoters contact with participants, both in groups and individually, was kept up by using social network applications, short message service (SMS) and phone calls. To have more personal contact besides general messages is inevitably demanding for the health promoter, while creating a safe atmosphere for the participants.

Issues that had been identified in the Future workshops had led to actions with and for the women in the co-creative labs. In the spring of 2018, regular meetings were held during a trust-building phase until October 2018 and after this a new cycle in the research process was to begin.

Study participants and data collection

Data was collected using the story-dialogue method. The story-dialogue method, which was developed by Labonte, Feather and Hills, is a technique that can be used to explore and acknowledge a person’s stories and experiences, in a structured way that makes them useful for health promotion [ 33 ]. Reflection is in focus in the method with the purpose to reach a shared understanding between participants and practitioner/researcher [ 33 ]. The story-dialogue method has previously been used among migrants [ 34 ]. The use of stories for knowledge development has been emphasised as suitable for reaching poor communities where traditional research methods can be suboptimal, for example, within populations where little research is compiled and researchers do not know which questions to ask, or when aiming for consciousness-raising among women [ 33 ]. Using participants’ own stories can help them find their own voice, thus forming the basis for opposing social structures [ 35 , 36 ], and sharing one’s own story is part of the empowerment process [ 33 ]. Stories engage emotions which can impact the motivation for action [ 20 ]. In addition, the structure of the story-dialogue method offers the opportunity to move from the issue to actions, through reflection, together with participants [ 33 ], which is consistent with the action research process [ 21 ]. The exchange of perspectives is essential to develop each person, since one person’s understanding does not fully overlap with other persons’ understanding and is formed according to experiences [ 20 ]. It is therefore essential to create a forum for dialogue within participatory practice [ 37 ].

The study took place in social meeting places in the community that the women were familiar with. To create a comfortable atmosphere the researchers visited the women´s area and the place where the study was conducted on several occasions before starting the research to build trust. Women from the community health program was invited to take part of the research and could communicate in their own language. Local health promotors distributed written invitations to women in the co-creative lab. The women were then invited to meet the researchers to receive oral information, translated by the health promoters, about the research study and had opportunity to ask questions about the research. The study population from the co-creative lab can be seen as a natural group that can be useful to maximise interaction between participants in reflection [ 38 ], also due to the heterogeneity in the group since women from different middle eastern countries differ in culture.

The women who wanted to participate were divided into three groups and the dialogues took place in October 2018. Thus, three story dialogues were conducted with 5–8 women in each group, in total 21 women. Two of the women wanted to stay anonymous and did not want to share details about themselves. The women originated from countries of the Middle East, such as Iraq, Lebanon, Palestine, Yemen, Syria and Jordan, and from African countries, such as Morocco and Sudan. They had been living in Sweden between 1 and 34 years (median 15 years) and the age of the women was between 26 and 75 years (median 46 years). There was a wide variation in the source of income, including income from work, study grant, pension or social security benefits. The educational background also varied, from 5 to 16 years of education (median 9 years).

The dialogues took place in a closed room in a community space, familiar to the participants. The health promoter assisted in translating from Arabic into Swedish and vice versa, since the researchers did not speak Arabic and many of the participants spoke limited Swedish. All dialogues were audio recorded and two or three of the authors were present during the dialogues, one observing and taking notes and one or two facilitating the dialogue.

Before each dialogue, one participant in each group prepared a story on the topic of a health issue encountered in daily life. The method follows a circular structure to deepen a story that is told. The first part consists of listening to a story, and this is followed by a reflection circle and a structured dialogue. The reflection circle gives the participants opportunity to reflect and share with the group one by one how the story that has been told connects to themselves [ 33 ]. The structured dialogue includes questions encouraging the participants to further describe, explain and, finally, synthesise and come up with possible actions [ 33 ]. This is followed by a review of notes taken during the dialogue, and it ends with the creation of insight cards, that is, statements based on the significant notes from the dialogue [ 33 ]. The process of the story-dialogue method is expected to lead to actions which can later be evaluated [ 33 ].

The method was modified to be suitable to and accepted by the study population. Others who have previously used the method have also modified it according to their needs [ 39 ]. For example, in this study, due to the participants’ limited time, each dialogue included only one story. Additionally, because of language barriers, the insight cards and themes were written by the researchers when none of the participants volunteered.

Second-level synthesis was used as inspiration for the analysis [ 33 ]. This method consists of moving from individual stories of experiences to a more general material, thus developing the knowledge [ 33 ]. The analysis was conducted together with the participants and primary themes and sub-themes were identified. Then, all data relevant to the purpose of the study were extracted and transcribed by the researchers, and the material was subsequently analysed to find new themes and sub-themes that had not been identified by the participants. The analysis was structured according to the phases of action research, look-reflect-act [ 21 ], which fits well with the process of the story-dialogue method [ 33 ]. The ‘look’ phase includes the description, the reflection phase includes explaining and synthesising and, finally, the act phase includes the actions identified in the dialogues. Themes identified by the participants framed the analysis of all the material, and some themes from the three story dialogues overlapped. NVivo qualitative data analysis software (version 12) was used as a tool to keep the texts and codes in order [ 40 ].

Two main health issues, mental health, and long-term pain were reflected upon during the dialogues, and the process of action research, including the phases look, reflect and act, was followed (Table 1 ). Based on this, two main themes were identified in the process of analysis: Prioritising spare time to promote mental health and Collaboration to address healthcare dissatisfaction related to long-term pain.

Prioritising spare time to promote mental health

The sub-themes within this theme were labelled as follows: Mental health issues were considered to be a trajectory to other health problems, Migration and household work were thought to be associated to mental health issues, and Moving forward through prioritising self and teaching children about gender equality (Table 1 ).

Mental health issues were considered to be a trajectory to other health problems

In the ‘look’ phase, the women defined mental health issues. Their stories of mental health issues were frequently about stress or depression, phenomena associated with their daily lives and struggles to adapt to a new country and to the unstable situation of migration. Several women found that they had similar experiences and talking about this made them feel sad. The women also associated mental health issues to both weight loss and weight gain which led to other, physical, health issues, such as pain, breathing problems, sleep deprivation and decreased ability to move.

Stress affects the whole body. Mental health affects physical health. It causes pain. (Story dialogue 3)

Migration and household work were thought to be associated to mental health

The main reasons for the women’s mental health issues were identified, thus constituting the phase of reflections. When the women reflected with each other in the group, they considered the reasons for their health issues to be outside of their control.

The first reason the women reflected upon was the situation of migration. Both physical and mental symptoms experienced during the process of transfer from one country to another and after arrival in the new country, were described. The physical symptoms could be breathing problems, tension, pain and headache, but were thought to be related to the depression. The women also reflected on specific issues in the migration situation which they thought influenced their mental health. One woman talked about the change in climate when she had moved from a warmer country to a cold one. Another woman described how the cold made her feel tired and depressed. Furthermore, unstable housing and the change of housing when migrating were highlighted.

We used to live in big houses with a bottom floor [quadrangles], but here we must live in apartments in high-rise buildings. (Story dialogue 3)

The uncertain migration status, that is, not knowing whether they would get permission to stay or not, brought about a stressful situation that led to pain and mental health issues. It was highlighted that the society from where they came was completely different from the Swedish society, and fear of the new culture as well as difficulty to integrate were issues encountered. One woman argued that the relationship with their husbands was one reason for women not being able to integrate in the new society. The men had the power to forbid the woman to meet with other people or go out of the home, and this had an impact on their mental health. But some others in the group argued that not all men were alike and that it takes some time to familiarise yourself with the equality in a new system.

I think that my husband has influenced my life negatively. He wants to live here in Sweden, and he knows it’s a completely different culture, but he doesn’t try to balance between the two cultures. I think it’s normal when you move to another society that you try to adjust to the new society. (Story dialogue 3)

The other reason for mental health issues was associated to the responsibility women have in the household, with little support from the husbands. One woman said that before the marriage the women hope to share responsibility for household duties with their husband. However, husbands sometimes work away from the home many hours per day, with little possibility to accomplish household work. This is necessary due to the family’s economic situation, leaving those husbands that want to help with household duties with no option. Additionally, the women argued that as migrant women they are alone here in the new country with no support from relatives. Therefore, the women must handle the children and the household, as well as completing their own education.

I think that women have a lot of responsibility at home and they need to take care of their children. /… / And a lot of women actually suffered depression after giving birth. (Story dialogue 1)

The role of a woman was described as being a leader of the family and hence they felt that they needed to be strong, so as not to rock the boat. The many commitments led to an untenable position, and not completing the household work perfectly was associated with guilt. With the responsibility for the household resting solely on them, the women had little energy remaining for themselves and did not prioritise themselves.

In most cases women think mostly of their children, to take care of them in a correct way. It takes a lot of energy from the woman and then sometimes she forgets herself to give them [the children] a lot of time. (Story dialogue 1)

Moving forward through prioritising self and teaching children about gender equality

After the reflections, a phase with thoughts of actions followed. A successful change described by one woman was given credit by other women and inspired them. One of the women described how she had changed her situation of ill health. She had found motivation in considering the risk of secondary health issues, and in previous experiences of health issues in the family.

When I hear her story, I want to do the same because I also have family and children. I also have [over]weight. Therefore, when I listen to her, I think a lot about myself because I want to get better for myself too. (Story dialogue 1)

They reasoned that to take care of their children they first had to help themselves to health. To bring about change, accountability to oneself and a change of mindset were necessary. Additionally, to maintain changes, the support of a belief, for example, in God, was important.

The women reflected on actions aimed at teaching their children about gender equality to accomplish change for the next generation. They wanted both to make their daughters strong and to equip their sons for the future to take care of their own home. Therefore, it was important not to make a difference between sons and daughters when assigning household duties.

Must teach them about gender equality. /…/ Must treat the two of them equally at home. (Story dialogue 1)

However, this could be difficult, since some sons refused to help in the household, thinking it was the women’s duties, the women argued. To adapt to a behaviour of shared responsibility, maybe smaller children could be asked to help, but older children needed male role models, they said. But one woman had told her sons that the division of duties was an old thinking. Furthermore, it was mentioned that it was important to find a balance between work away from home and household work.

To benefit themselves, the women decided to try to find time for themselves to cope with their stressful situation, time that could be used to engage in physical activities.

I want to have special time for myself. For example, one hour a day or two hours a day to start gymnastics, to do something. (Story dialogue 1)

A women’s group was suggested by the researchers and adopted by the women. To make time for such a group, the women reasoned, they had a responsibility to themselves to let go, for example, by allowing the fathers to take responsibility. Some were eager to try this idea, while others did not have any chance to do so.

Additionally, the women wanted to meet with a psychologist to advise them on how to act. It was also mentioned that maybe the men need a supporting group when arriving in a new country, such groups being normally for women.

Collaboration to address health care dissatisfaction related to long-term pain

The sub-themes within this theme were labelled as follows: Challenges of long-term pain entails other health issues, Household work as the root to pain and dissatisfaction with the healthcare, and Working together in order to make a change, if not for oneself then for someone else (Table 1 ).

Challenges of long-term pain entails other health issues

Within the ‘look’ phase, long-term pain was identified as a health problem the women encountered in daily life. Many participants could relate to the situation since they had experienced similar pain or had close relatives who had. Long-term pain often led to other problems, such as sleep deprivation and decreased ability to move, as well as being psychologically challenging and sometimes leading to depression. The pain did not just affect the women but also their families, though pain was concealed in front of the children to calm them.

I don’t want to show my children that I’m sick, or weak. I don’t want to show them because they are sensitive. Therefore, I always say to them that I’m very well. Because that makes them a bit calmer as well. (Story dialogue 2)

Household work as the root to pain and dissatisfaction with the healthcare

In this phase, the women reflected on reasons for pain, and reflections on the healthcare were shared. The women talked about the effect household work had on the pain they perceived. Many Arabic women have pain and the reason for this, they said, was that Arabic women are responsible for the household. One woman reflected that women do not work outside the home, only in the household with cleaning and cooking. They do not engage in any physical activity and have not done so while they were young, and now with age this shows.

I know her (referred to the storyteller), pain. All Arabic women [suffer from] pain. Why? Not working, no gym, only working in the home. (Story dialogue 2)

One participant had heard from a physiotherapist that she was weak because she did not exercise. The importance of physical activity and food was highlighted by the women in relation to pain and decreased ability to move. Memories of relatives’ situations had made them realise how important physical activity is.

Self-determination was thought by the women to help them out of the situations they were in. One woman explained that she had done everything she could to prevent herself from ending up in a wheelchair and to avoid operation. Another woman said that it was important for her to continue to teach to prevent depression. She could not work as before, due to her long-term pain, but instead worked on a voluntary basis, and in this way, she helped herself. It was said that one must help oneself and not wait for the doctor to help.

Okay, I like to continue to work as an Arabic teacher. That’s what I want, and I feel happy and proud to work. /…/ I continue to work on a voluntary basis. To feel good and not get depressed because of not being able to handle my life and my job. I need to think how I will help myself. (Story dialogue 3)

Thus, they described how they followed recommendations from the healthcare to help themselves. Weight loss, new shoes, physiotherapy, water aerobics and pain relief treatment were some of the recommendations they had followed, and some had helped. One of the women said she got good help from the doctor she had met and wanted to continue with a follow-up since she was not fully recovered, but, disappointingly, the doctor refused.

Moreover, the women reflected upon difficulties they had encountered within the healthcare in relation to the pain they perceived. Many had the same problem and thought that they had not got proper help from the healthcare. This, one of the women explained, led to a feeling of hopelessness. Another woman said that it brought a feeling of being imprisoned and others went on to say that it brought about mental health issues and physical consequences. They identified some of the difficulties they had encountered. Some of the women highlighted diagnostic difficulties, which were said to lead to a poor medical treatment of their issues. Long waiting times, together with ambiguity regarding the responsibility for one’s care, led to a dissatisfied and uncertain perception of the healthcare. The ambiguity regarding responsibility was thought to be due to both high staff turnover and the fact that physicians did not take into account decisions made by another physician. Too few and inexperienced physicians, especially specialised physicians, were seen as reasons for the difficulties within the healthcare. The women also reasoned that the system was to blame for the difficulties, not the single physicians, as they were required to follow the rules and think economically according to their organisation. Access to Arabic-speaking physicians had shown that the language barrier could not entirely explain the difficulties the women perceived within the healthcare. Instead, the bureaucracy made the women feel that the physicians did not care genuinely about them as patients.

I’ve had enough, they don’t work from the heart, they work to get paid. A physician doesn’t work because he’s a physician and wants to help. (Story dialogue 2)

The difficulties the women encountered within the healthcare, in association with their long-term pain, made them compare the Swedish healthcare to the healthcare in their home countries. This caused them to question and wonder at the long waiting times in emergency care or for results of a simple blood test. However, they also said that in their home countries only those with money were entitled to healthcare; the rest died.

Working together in order to make a change, if not for oneself then for someone else

In the ‘act’ phase, the dialogues stressed the importance of acting within the healthcare system. Many suggestions about what should be done were put forward: the doctors need more experience, access to specialists should be easier, healthcare centres need to be more serious about helping their patients, the government needs to invest more in healthcare centres, and more time is needed to meet with doctors. In relation to this, the women arrived at the conclusion that they themselves needed to understand the system better. It was mentioned that politicians should be addressed, but it was also said that members of the community could help each other.

The women wanted to protest about the healthcare but did not have the resources to do so. To accomplish change, they decided to write something together. Different opinions about this were shared, involving a feeling of hopelessness and a lack of trust that it would lead to a change, but also a feeling that maybe things can get better for someone else.

If one thinks that if one had complained, it might get better for other people. Sometimes one must think like that, why not complain to make them improve. So that what happened to me will not happen to someone else. (Story dialogue 2)

They decided to accept an initiative from the researchers regarding a health circle, to continue to work with the ideas that had been brought up during the dialogues. The attitudes of the participants differed, in that some of them wondered if the health circle would be helpful, while others welcomed the idea.

The findings identified several important conditions for health promotion among migrant women. Through their stories the women recognised health issues of concern. In the dialogues, the women reflected on reasons for and consequences of those health issues. The stories and reflections were also closely linked to social determinants of health, such as gender roles, housing and the accessibility of the healthcare system. Suggestions on actions emerged from the reflections. Thus, the CBPR approach and the story dialogues offered the women a forum for reflection and a common plan to continue the process of health promotion.

The women in our study reasoned that they must rely on themselves to change their own health. The women felt let down by the healthcare; hence, a need to understand the healthcare system better was emphasised. In previous literature, migrants also acknowledge the need of more information about the healthcare system in host countries [ 41 , 42 ]. Moreover, health literacy has been shown to be low among migrants, that is, they often have less knowledge about health information, how to access it and how to apply it [ 43 ]. Additionally, the social gradient influences health literacy, in that it is lower in groups with lower education and social status and less financial resources, and therefore the social gradient is important for health-promotive work [ 44 ]. Thus, it is not merely the migrant status that decides the level of health literacy, which implies that migrants need to be treated as a heterogenous group [ 43 ]. Having said that, in this study, the median years of education among the women were 9 years, but ranging from 5 to 16 years, and it was common to depend on social security, but other sources of income also occurred. However, some consensus was apparent in the group regarding not having resources to complain about the healthcare. Consequently, migrant women’s voices may not be heard in the healthcare system, thus not contributing to policy changes. Based on our work, one could argue that in a population of migrant women, changes in health literacy are closely connected to the social determinants of health. Policy changes in healthcare are needed, as well as a more culture-sensitive behaviour from professionals in healthcare. Policy changes can be related to a higher extent of health literacy, which is also connected to the ability to change social determinants of health [ 45 ]. In the acting phase of this study, the suggestion of a health circle, where health issues could be discussed and health-related information brought forward, was adopted by the women. Health literacy may increase among migrants by integrating recommendations such as adapting information, assuming that health literacy may vary, and distributing information relevant to the group [ 42 ]. Following such recommendations, a dialogue with the people concerned would be appropriate, as in this study, where the women were invited to frame health promotion for themselves.

According to the women in our study, household work was a reason for health issues and an obstacle to promoting one’s own health, since it leaves the women with too little time to prioritise themselves. Migrant women have previously described a lack of time to promote their own health, due to household work [ 46 ]. In this study, the women reasoned that they have a responsibility to change their behaviour to make room for spare time, also expressing that they were inspired by each other when hearing about successful health changes. In addition, when reflecting on possible actions, a suggestion to help each other within the community was brought up. Social support has been used as a strategy among migrant women to stay balanced in stressful situations [ 28 ]. Among migrants, social participation can protect against poor mental health when exposed to discrimination, although over 80% of women migrants participate to a low extent socially [ 47 ]. This study provided an opportunity to develop social support. The group also included a health promoter that can be regarded as a peer supporter. Community peer support can have a positive effect on health literacy, if following recommendations, such as the health promoter/s being similar to the target group and making the target group participate in social networks [ 48 ]. A previous study has described the role of a lay health worker from a migrant population as a participatory researcher and this person’s involvement in research was said to empower the community [ 49 ]. Also, Diaz et al . recommend that participants are involved in the research process for health interventions intended for migrants [ 50 ]. Thus, the migrant women’s actions to support each other and to start the health circle are in line with previous research to promote health.

The women perceived that they did not get proper help from the healthcare and were not listened to, which is why they expressed a will to learn to protest and address politicians. The language barrier can be a reason for migrants not seeking healthcare as much as the general population [ 51 ]. Nonetheless, in this group, Arabic-speaking doctors could be available, and some women knew a little Swedish. Further, access to healthcare can be dissimilar for different populations due to racial prejudices but also due to healthcare planning based on the majority of the population [ 52 ]. For example, activities for physical activity on prescription were developed for the general population and may not be compatible with a minority population such as migrant women [ 6 ]. The construction of gender is acknowledged in most cultures [ 53 ] and stereotypical characteristics can cause gender biases [ 54 ]. This situation might be troublesome to healthcare personnel to navigate, and gender differences in treatment have occurred [ 54 ]. Further, life opportunities might vary between groups due to, for example, gender, class, ethnicity or age [ 53 ], and these potentially subordinated social categories might intersect [ 55 ]. Consequently, women of colour might be marginalised due to both gender and ethnicity [ 55 ], which is why a definition and an analysis of the power relations of social categories are important [ 56 ]. Of course this needs to be done with caution in order not to generalise groups within social categories as oppressed [ 57 ]. Thus, the mechanisms of the social categories can be important when finding various tools for health promotion adapted to diverse populations [ 58 ].

It was apparent that the women who participated in this study already had critical consciousness, but also that they lacked resources to express opposition. Learning to complain about healthcare and making their voices heard, might enable migrant women to impact policy changes. Thus, the dialogues served as a forum to start a process of empowerment and defiance to oppression. This is in line with previous literature, in that health-promotive activities for migrants should focus on supporting them in becoming part of, and being active residents within, the new society [ 11 ].

The women identified factors related to health issues that can be considered to be outside of their control, such as the migration process or the imposed sole responsibility for the household. They also felt that they lacked control, being unable to affect their situation, when not getting support from the healthcare as expected. According to Wallerstein and Bernstein, low control leads to ill health, while increased control will lead to better health [ 22 ]. Nonetheless, the women considered solutions implying that they are moving towards empowerment. They want to learn about the health system, they want to support each other, and they want to learn how to complain when their healthcare needs are unmet, and they do this through dialogue and the health circle. Empowerment has been described by Wallerstein and Bernstein as: ‘a social action process that promotes participation of people, organizations, and communities in gaining control over their lives in their community and larger society’ [ 22 ]. The provision of a forum for dialogue was essential, as well as the role of the health promoter, in creating social inclusion for the process of health promotion. Nikkhah and Redzuan claim that a bottom-up approach to community development will lead to better community empowerment compared to a top-down approach, while a medium level of empowerment could be achieved through the approach of partnership [ 59 ]. Of these three approaches, the partnership can best describe the relationship between the community and the other actors in the programme that this study is part of. The participants were the ones to set the agenda in the Future workshops in 2016, where health issues among migrant women were identified. The idea of the health circle came from the researchers, however, and aimed at continuing the dialogue around the issues raised. Knowledge among the participants regarding resources for actions may not have been clear at the time. Thus, the power in a partnership approach may vary during the time of development [ 59 ]. Another strategy could have included a second dialogue to explore ideas on actions. Such a strategy might have increased participation and empowerment even more.

Limitations

The study sample was in the first phase of the programme determined by the community interviews. There is a risk that this method of sampling doesn’t generate a representative sample, although this is a method suitable in hard-to-reach populations [ 38 ] and was therefore chosen to be used in this study.

To strengthen generalisability, in the sense of usefulness in other contexts, it is recommended to include more than one story in a story dialogue [ 33 ]. However, in this study only one story per group was included, due to time limitation among the participants. The dialogue therefore emerged from that one story, something which might have impacted the richness of the dialogue. Nevertheless, the use of one story led to several important reflections. In this study, we can only conclude that the experiences reported are contextual, with a narrow selection, and have been conducted in a limited community. Still, since there are not very many studies in this group of women, the results may contribute an important perspective, that could be transferred to other groups of migrant women.

The participants and the health promoter were only involved in the first phase of the second-level synthesis, which means that the participatory approach was not possible when merging the three dialogues together, something which could be a limitation. However, different levels of participation are possible in the participatory research process and a lower level of participation should not be an argument for not conducting the research. One could also argue that the first part of the analysis, in which the participants did participate, was the frame for the rest of the analysis.

Several conditions for health promotion were identified by the participating migrant women through the story dialogues. With the help of the CBPR approach and the health promoters, the participants were involved in the research process from the start and could reflect on what resources they have to promote their own health. The knowledge transfer and learning among the group of women made them want to find strategies to cope with their situation and empowered them as a group to want to learn more about how to change the healthcare system by complaining and acting. The use of the CBPR approach and the story-dialogue method can, together with participation and dialogue, function as an essential foundation for the empowerment process. The health circle can possibly provide a forum for working with these matters and constitute a tool to support migrant health, following recommendations by previous studies.

Availability of data and materials

The data generated and/or analysed during the current study are not publicly available due to GDPR and secrecy but are available from the corresponding author on reasonable request.

Abbreviations

World Health Organization

Community-based participatory research

Short message service

World Health Organization. Report on the health of refugees and migrants in the WHO European Region. Copenhagen: World Health Organization; 2018. https://apps.who.int/iris/bitstream/handle/10665/311347/9789289053846-eng.pdf?sequence=1&isAllowed=y .

Thomas SL, Thomas SD. Displacement and health. Br Med Bull. 2004;69:115–27.

Article   PubMed   Google Scholar  

Siddiqui F, Lindblad U, Bennet L. Physical inactivity is strongly associated with anxiety and depression in Iraqi immigrants to Sweden: a cross-sectional study. BMC Public Health. 2014;14:502.

Article   PubMed   PubMed Central   Google Scholar  

Röda Korset. Nyanlända och asylsökande i Sverige: En studie av psykisk ohälsa, trauma och levnadsvillkor. Stockholm: Röda Korset; 2016. https://www.redcross.se/globalassets/press-och-opinion/rapporter/studie_nyanlanda-och-asylsokande-i-sverige_web.pdf .

Bennet L, Lindstrom M. Self-rated health and social capital in Iraqi immigrants to Sweden: the MEDIM population-based study. Scand J Public Health. 2018;46(2):194–203.

Jörgensdotter Wegnelius C, Petersson EL. Cultural background and societal influence on coping strategies for physical activity among immigrant women. J Transcult Nurs. 2018;29(1):54–63.

World Health Organization. Closing the gap in a generation: Health Equity through action on the social determinants of Health. Final Report of the Commission on Social Determinants of Health. Geneva: The World Health Organization; 2008 [cited 2019 28th June]. https://apps.who.int/iris/bitstream/handle/10665/43943/9789241563703_eng.pdf .

Statens offentliga utredningar. Nästa steg på vägen mot en mer jämlik hälsa-Förslag för ett långsiktigt arbete för en god och jämlik hälsa. Stockholm; 2017.

Stigendal M, Östergren P-O. Malmös väg mot en hållbar framtid-hälsa, välfärd och rättvisa. Malmö: Kommission för ett socialt hållbart Malmö. Malmö stad; 2014 [cited 2019 28th June]. https://malmo.se/download/18.3108a6ec1445513e589b90/1491298327791/malmo%CC%88kommissionen_slutrapport_2014.pdf .

Korp P. Vad är hälsopromotion? Lund: Studentlitteratur; 2016.

Bringsén Å, Lindström PN. Hälsopromotion i teori och praktik: olika arenor och målgrupper. Liber; 2019.

World Health Organization. Ottawa charter for health promotion. Health Promot. 1986;1:iii–v.

Google Scholar  

Nutbeam D, Harris E. Theory in a nutshell: a practical guide to health promotion theories. 2nd ed. New York: McGraw-Hill; 2004.

Ekblad S, Persson-Valenzuela UB. Lifestyle course as an investment in perceived improved health among newly arrived women from countries outside Europe. Int J Environ Res Public Health. 2014;11(10):10622–40.

Bonmatí-Tomas A, Malagón-Aguilera MC, Gelabert-Vilella S, Bosch-Farré C, Vaandrager L, García-Gil MM, et al. Salutogenic health promotion program for migrant women at risk of social exclusion. Int J Equity Health. 2019;18(1):139.

Sjögren Forss K, Kottorp A, Rämgård M. Collaborating in a penta-helix structure within a community based participatory research programme: “Wrestling with hierarchies and getting caught in isolated downpipes.” Arch Public Health. 2021;79(1):27.

Wallerstein N, Duran B, Oetzel JG, Minkler M. Community-based participatory research for health: advancing social and health equity. Hoboken: Wiley; 2017.

Abma TA, Cook T, Rämgård M, Kleba E, Harris J, Wallerstein N. Social impact of participatory health research: collaborative non-linear processes of knowledge mobilization. Educ Action Res. 2017;25(4):489–505.

Wallerstein NB, Duran B. Using community-based participatory research to address health disparities. Health Promot Pract. 2006;7(3):312–23.

Abma T, Banks S, Cook T, Dias S, Madsen W, Springett J, et al. Participatory research for health and social well-being. Cham: Springer; 2019.

Book   Google Scholar  

Stringer E. Action research. 4th ed. Los Angeles: SAGE Publications; 2014.

Wallerstein N, Bernstein E. Empowerment education: Freire’s ideas adapted to health education. Health Educ Q. 1988;15(4):379–94.

Article   PubMed   CAS   Google Scholar  

Israel BA, Schulz AJ, Parker EA, Becker AB. Review of community-based research: assessing partnership approaches to improve public health. Annu Rev Public Health. 1998;19:173–202.

Bordeaux BC, Wiley C, Tandon SD, Horowitz CR, Brown PB, Bass EB. Guidelines for writing manuscripts about community-based participatory research for peer-reviewed journals. Prog Commun Health Partnersh Res Educ Action. 2007;1(3):281–8.

Article   Google Scholar  

Wieland ML, Weis JA, Palmer T, Goodson M, Loth S, Omer F, et al. Physical activity and nutrition among immigrant and refugee women: a community-based participatory research approach. Womens Health Issues. 2012;22(2):e225–32.

McMorrow S, Saksena J. Voices and views of congolese refugee women: a qualitative exploration to inform health promotion and reduce inequities. Health Educ Behav. 2017;44(5):769–80.

Hawkins MM, Schmitt ME, Adebayo CT, Weitzel J, Olukotun O, Christensen AM, et al. Promoting the health of refugee women: a scoping literature review incorporating the social ecological model. Int J Equity Health. 2021;20(1):45.

Shishehgar S, Gholizadeh L, DiGiacomo M, Green A, Davidson PM. Health and socio-cultural experiences of refugee women: an integrative review. J Immigr Minor Health. 2017;19(4):959–73.

Judd JA, Griffiths K, Bainbridge R, Ireland S, Fredericks B. Equity, gender and health: a cross road for health promotion. Health Promot J Austr. 2020;31(3):336–9.

Kunskapscentrum Migration och hälsa. Jämlik hälso- och sjukvård ur ett migrationsperspektiv-Rapport om möjliga indikatorer för kvalitetsuppföljning i Region Skåne. Malmö: Region Skåne; 2018.

Nationella operativa avdelningen. Utsatta områden-social ordning, kriminell struktur och utmaningar för polisen: Nationella operativa avdelningen, underrättelseenheten; 2017. https://polisen.se/siteassets/dokument/ovriga_rapporter/utsatta-omraden-social-ordning-kriminell-struktur-och-utmaningar-for-polisen-2017.pdf .

Torres S, Spitzer DL, Labonte R, Amaratunga C, Andrew C. Community health workers in Canada: innovative approaches to health promotion outreach and community development among immigrant and refugee populations. J Ambul Care Manag. 2013;36(4):305–18.

Labonte R, Feather J, Hills M. A story/dialogue method for health promotion knowledge development and evaluation. Health Educ Res. 1999;14(1):39–50.

Abrahamsson A, Andersson J, Springett J. Building bridges or negotiating tensions? Experiences from a project aimed at enabling migrant access to health and social care in Sweden. Divers Health Social Care. 2009;6(2):85–95.

Williams L, Labonte R, O’Brien M. Empowering social action through narratives of identity and culture. Health Promot Int. 2003;18(1):33–40.

Freire P, Macedo D. Literacy: reading the word and the world. Routledge & Kegan Paul; 1987.

Ledwith M, Springett J. Participatory practice: community-based action for transformative change. Bristol: Policy Press; 2010.

Green J, Thorogood N. Qualitative methods for health research. London: SAGE Publications Ltd; 2009.

Poland BD, Cohen R. Adaptation of a structured story-dialogue method for action research with social movement activists. Action Res. 2020;18(3):353–71.

QSR International. NVivo qualitative data analysis software. Doncaster: QSR International Pty Ltd.; 2018.

Mangrio E, Sjögren FK. Refugees’ experiences of healthcare in the host country: a scoping review. BMC Health Serv Res. 2017;17(1):814.

Mårtensson L, Lytsy P, Westerling R, Wångdahl J. Experiences and needs concerning health related information for newly arrived refugees in Sweden. BMC Public Health. 2020;20(1):1044.

Wangdahl J, Lytsy P, Martensson L, Westerling R. Health literacy among refugees in Sweden: a cross-sectional study. BMC Public Health. 2014;14:1030.

Sorensen K, Pelikan JM, Rothlin F, Ganahl K, Slonska Z, Doyle G, et al. Health literacy in Europe: comparative results of the European health literacy survey (HLS-EU). Eur J Public Health. 2015;25(6):1053–8.

Nutbeam D. Health literacy as a public health goal: a challenge for contemporary health education and communication strategies into the 21st century. Health Promot Int. 2000;15(3):259–67.

Wieland ML, Tiedje K, Meiers SJ, Mohamed AA, Formea CM, Ridgeway JL, et al. Perspectives on physical activity among immigrants and refugees to a small urban community in Minnesota. J Immigr Minor Health. 2015;17(1):263–75.

Lecerof SS, Stafström M, Westerling R, Östergren PO. Does social capital protect mental health among migrants in Sweden? Health Promot Int. 2016;31(3):644–52.

Harris J, Springett J, Croot L, Booth A, Campbell F, Thompson J, et al. Can community-based peer support promote health literacy and reduce inequalities? A realist review. Southampton (UK); 2015.

Meyer MC, Torres S, Cermeño N, MacLean L, Monzón R. Immigrant women implementing participatory research in health promotion. West J Nurs Res. 2003;25(7):815–34.

Diaz E, Ortiz-Barreda G, Ben-Shlomo Y, Holdsworth M, Salami B, Rammohan A, et al. Interventions to improve immigrant health. A scoping review. Eur J Public Health. 2017;27(3):433–9.

Mangrio E, Carlson E, Zdravkovic S. Understanding experiences of the Swedish health care system from the perspective of newly arrived refugees. BMC Res Notes. 2018;11(1):616.

Bhopal R. Ethnicity, race, and health in multicultural societies: foundations for better epidemiology, public health and health care. Oxford: Oxford University Pres; 2007.

Harding SG. The science question in feminism. Ithaca: Cornell University Press; 1986.

Hovelius B, Johansson E. Kropp och genus i medicinen. Lund: Studentlitteratur; 2004.

Crenshaw K. Mapping the margins: intersectionality, identity politics and violence against women of color. Stan L Rev. 1991;43(6):1241–99.

Öhman A. Genusperspektiv på vårdvetenskap. Stockholm: Högskoleverket i samarbete med Nationella sekretariatet för genusforskning; 2009. https://www.uka.se/sok.html?query=Genusperspektiv+p%C3%A5+v%C3%A5rdvetenskap .

Mohanty C. Under western eyes: feminist scholarship and colonial discourses. Fem Rev. 1984;12(3):333–58.

Bowleg L. The problem with the phrase women and minorities: intersectionality-an important theoretical framework for public health. Am J Public Health. 2012;102(7):1267–73.

Nikkhah HA, Redzuan M. Participation as a medium of empowerment in community development. Eur J Soc Sci. 2009;11(1):170–6.

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Acknowledgements

Thanks to Noha Aldahdouli for her extensive work and efforts for this study. In addition, the authors want to thank the participants in the study for contributing their knowledge and time.

Open access funding provided by Malmö University. The programme where this study was included was funded by VINNOVA (Reg. no. 2016-00421, 2017-01272), primarily for the establishment of the health-promoting platform (and not for research conducted within this platform).

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Lindsjö, C., Sjögren Forss, K., Kumlien, C. et al. Health promotion focusing on migrant women through a community based participatory research approach. BMC Women's Health 21 , 365 (2021). https://doi.org/10.1186/s12905-021-01506-y

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  • Story-dialogue method
  • Health promoter
  • Empowerment
  • Health literacy
  • Social determinants of health

BMC Women's Health

ISSN: 1472-6874

research on women's health promotion

National Academies Press: OpenBook

Women's Health Research: Progress, Pitfalls, and Promise (2010)

Chapter: summary.

Women make up just over half the US population and should not be considered a special, minority population, but rather an equal gender whose health needs require equal research efforts as those for men. Historically, however, the health needs of women, apart from reproductive concerns, have lagged in medical research. In 1985, the Public Health Service Task Force on Women’s Health Issues concluded that “the historical lack of research focus on women’s health concerns has compromised the quality of health information available to women as well as the health care they receive.” Since the publication of that report, there has been a transformation in women’s health research—including changes in government support of research, in policies, in regulations, and in organization—that has resulted in the generation of new scientific knowledge about women’s health. Offices on women’s health have been established in a number of government agencies. 1 Government reports and reports from other organizations, including the Institute of Medicine (IOM), have highlighted the need for, and tracked the progress of, the inclusion of women in health research. A number of nongovern-

ment organizations have also provided leadership in research in women’s health. And women as advocates, research subjects, researchers, clinicians, administrators, and US representatives and senators have played a major role in building a women’s health movement.

CHARGE TO THE COMMITTEE

Given the research activities occurring in women’s health over the last 2 decades, in the Consolidated Appropriations Act of 2008 (Public Law 110-161) Congress provided the Department of Health and Human Services Office on Women’s Health (OWH) with funds for the IOM “to conduct a comprehensive review of the status of women’s health research, summarize what has been learned about how diseases specifically affect women, and report to the Congress on suggestions for the direction of future research.” In response, the OWH requested that the IOM conduct a study of women’s health research; the charge to the committee for the project is presented in Box S-1 .

In response to that request, the IOM convened a committee of 18 members who had a wide variety of expertise, including expertise in biomedical research, research translation, research communication, disabilities, epidemiology, healthcare services, behavioral and social determinants of health, health disparities, nutrition, public health, women’s health, clinical decision making, and such other medical specialties as cardiovascular disease (CVD), mental health, endocrinology, geriatrics, and immunology.

THE COMMITTEE’S APPROACH TO ITS CHARGE

The committee met six times, including two open information-gathering sessions at which the members heard from stakeholders and researchers, and conducted extensive literature searches of publications from the last 15–20 years. The committee approached women’s health as a concept that has expanded beyond a narrow focus on the female reproductive system to encompass other conditions

that create a significant burden in women’s lives. The committee focused on health conditions that are specific to women, are more common or more serious in women, have distinct causes or manifestations in women, have different outcomes or treatments in women, or have high morbidity or mortality in women. Numerous conditions could be included in such a list. The committee could not review all such conditions and, therefore, highlights a number of such conditions as examples that are specific to women; that have differences in prevalence, severity, preferred treatment, or understanding for women; or that the condition is prominent in women or there is a research need regarding women, whether or not there are sex-differences. Searches included research on factors that are determinants of health (biologic, psychologic, environmental, and sociocultural factors), especially factors that might affect women disproportionately or uniquely, and on the translation of research findings into practice and the communication of research findings to the public.

When considering health end points, the committee did not present a comprehensive review of findings of all research on all diseases, disorders, and conditions that are women’s health issues. The committee identified a number of conditions that have a large impact on women, reviewed the literature related to them, and categorized them as conditions in relation to which there has been major, some, or little improvement in women’s health.

The committee developed a series of questions to focus deliberations and ensure appropriate response to the charge. Those questions and the committee’s responses to them are presented below.

IS WOMEN’S HEALTH RESEARCH STUDYING THE MOST APPROPRIATE AND RELEVANT DETERMINANTS OF HEALTH?

Determinants can range from a woman’s genetic makeup to her behaviors to the social, cultural, and environmental context in which genetic vulnerabilities and individual traits and behaviors are developed and expressed. Over the last 20 years, much has been learned about what the determinants of women’s health are.

The committee found that many behavioral determinants (such as smoking, eating habits, and lack of physical activity) are risk factors for most of the conditions under consideration. Those behavioral factors, in turn, are shaped by cultural, social, and societal contexts. Marked differences in the prevalence of and mortality from various conditions in women who experience social disadvantage due to race and ethnicity, lack of education, low income, and other factors have been documented. The differences stem from a variety of social determinants, including differential exposure to stressors and violence, which are more common in more disadvantaged communities. Such exposures are related to wide-ranging outcomes, including injury and trauma, depression, arthritis, asthma, heart disease, human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), and other sexually transmitted infections.

The underlying determinants of health and their relative power may differ by sex and gender, and tailored interventions might be more effective than generic treatments. As discussed in Chapter 2 , few studies have tested ways to modify behavioral determinants in women, and even less research has been conducted on the effects of social and community factors in specific groups of women.

IS WOMEN’S HEALTH RESEARCH FOCUSED ON THE MOST APPROPRIATE AND RELEVANT HEALTH CONDITIONS?

The committee discussed the research of a number of conditions as examples of conditions that greatly affect women. It categorized those conditions as having major, some, or little progress (see Table S-1 ).

Conditions on Which Research Has Contributed to Major Progress

The committee identified breast cancer, CVD, and cervical cancer as the conditions on which major progress has been made.

Mortality from breast cancer has decreased in the last 20 years. Consumer demand and involvement and increased funding have spurred breast-cancer research at the molecular, cellular, and animal levels as well as clinical trials and

TABLE S-1 Conditions Discussed by Committee, Categorized by Extent of Progress

observational studies in women. That research has led to the development of more sensitive detection methods, biomarkers of risk and of more aggressive tumors, identification of risk factors, and treatment options that improve survival and posttreatment quality of life. The finding in the Women’s Health Initiative (WHI) of increased risk of breast cancer from hormone therapy led to changes in practice, and a substantial drop in the incidence of breast cancer has been attributed to those changes in practice. Progress has not been seen to the same extent in all groups of women, however; for example, black women have higher mortality from breast cancer than white women despite a lower incidence.

CVD is the leading cause of death of both women and men. As in men, age-adjusted mortality from coronary heart disease was reduced by half in women from 1980 to 2000. About half the decline is attributable to changes in behavioral factors, including a drop in smoking; the other half is attributable to new clinical treatments that emerged from research. Studies led to recognition of CVD in women and, subsequently, extension of diagnosis and treatments for CVD to women. Awareness of CVD among women has increased, in part because of educational campaigns. However, the history of years of the study of CVD only in men has delayed greater progress.

Reductions in the incidence of and mortality from cervical cancer began as early as the 1960s and continued over the last 20 years as diagnosis and screening have improved further. In addition, during the last few years a vaccine that is effective in preventing infection by human papillomavirus, the virus that causes most cervical cancer, was developed. The vaccine was developed and brought into clinical practice through research on the basic biology of the virus and its relationship to cervical cancer in human cells and animals and through epidemiologic studies of cervical cancer’s etiology. Although overall gains have been seen in mortality from cervical cancer, rates remain higher in black and Hispanic women than in white and Asian women.

Conditions on Which Research Has Contributed to Some Progress

The committee identified depression, HIV/AIDS, and osteoporosis as conditions on which some progress has been made as a result of women’s health research.

The incidence and consequences (such as effects on educational attainment) of depression are higher in women than in men. Advances have been made in the treatment of depression in the last 20 years, although their impact has not been maximized, because of inadequate translation particularly in relation to primary providers. There have been rapid and major advances in the treatment of HIV/AIDS in the last 20 years, mostly through research in men. The rapid development of treatments has benefited women despite the focus of the research on men; however, the predominance of male-focused studies has limited some of the benefits for women. For example, issues with the toxicity of HIV/AIDS treat-

ments in women (for example, increased risk of anemia and acute pancreatitis as compared to men) are only now being identified through women-based research. Over the last 20 years there have been advances in the knowledge of the basic science underlying osteoporosis and in the diagnosis and treatment of osteoporosis. That includes the identification of genes whose expression affects the risk of osteoporosis. Recent trends show a decrease in the incidence of hip factures. Osteoporosis remains, however, a condition that greatly impacts the quality of life of a large number of women, particularly as they age.

Conditions on Which Little Progress Has Been Made

The committee identified a number of conditions on which little progress has been made in reducing incidence or mortality, including unintended pregnancy 2 and autoimmune disease. The risk factors for unintended pregnancy are known, and effective contraceptives are available to prevent pregnancy. The fact that unintended pregnancies continue to occur at a high rate points to the need for research on the use of contraceptive regimens, the need for development of new contraceptives, including non-hormonal contraceptives, that are more acceptable to groups of women in which unintended pregnancies occur with greater frequency, and the need for social and community-level interventions to decrease unintended pregnancies. Autoimmune diseases constitute about 50 diseases, most of which are more common in women. As a group, they are the leading cause of morbidity in women, and they affect women’s quality of life greatly. Despite their prevalence and morbidity, little progress has been made toward a better understanding of those conditions, identifying risk factors, or developing a cure.

Looking at the set of conditions on which little progress has been made—including unintended pregnancy; autoimmune disease; alcohol-addiction and drug-addiction disorders; lung, ovarian, endometrial, and colorectal cancer; non-malignant gynecologic disorders; and Alzheimer’s disease—the committee tried to identify characteristics or explanations for the lack of progress. The committee could not determine specifically why progress was seen for some conditions and not others, but it considered a number of potential reasons, including degree of attention and subsequent research funding from government agencies, consumer advocacy groups, and Congress; availability of interested researchers trained in a given field; adequacy of understanding of the underlying pathophysiology of a condition; availability of sensitive and specific diagnostic tests and screening programs to identify persons who are at risk for or who have a condition; mor-

bidity, rather than mortality, as the outcome of a disease; and barriers associated with political or social concerns.

IS WOMEN’S HEALTH RESEARCH STUDYING THE MOST RELEVANT GROUPS OF WOMEN?

Many of the conditions that the committee reviewed are more common or have poorer outcomes in women who are socially disadvantaged than in women who are not. They include the three diseases on which there has been major progress—breast cancer, CVD, and cervical cancer. The fact that subgroups of women are not benefiting from the progress that has been made could indicate that the most relevant groups, the groups that have the greatest burden of disease, are not being adequately studied and research results are not being translated into practice and policies.

ARE THE MOST APPROPRIATE RESEARCH METHODS BEING USED TO STUDY WOMEN’S HEALTH?

The women’s health research reviewed includes basic research (studies in animals and at the molecular and cellular levels), epidemiologic or clinical research (research conducted or observed in human subjects), and studies of health systems. All those study types have contributed to progress in women’s health, and all yielded important findings on the conditions on which there has been major progress—breast cancer, CVD, and cervical cancer.

The committee identified a number of issues specific to the studies reviewed or to women’s health. Large observational studies—such as the observational arm of the WHI, the Nurses’ Health Study, and the Study of Women’s Health Across the Nation (SWAN)—were coordinated among multiple research centers to accrue large and diverse samples and were especially useful for generating hypotheses for further testing. The postmenopausal hormone therapy and the calcium and vitamin D components of the WHI were randomized clinical trials that were based on the findings from such observational research. In addition, the observational studies led to animal and in vitro studies aimed at elucidating the pathophysiology of conditions and identifying potential treatments.

Different study types have different limits, and results from diverse study designs can combine to provide extremely useful information that is directly relevant to the health of women and some have led to clear improvements in women’s health. The committee recognizes that there are drawbacks to different study types. For example, observational studies and clinical trials can be expensive, can have subject attrition, can be of long duration, and, in the case of observational studies, can have difficulty in finding appropriate comparison populations and in controlling for potential confounders. Large human studies, such as the WHI, are further hindered by complex study designs and associated pitfalls.

Despite those drawbacks, the committee concluded that information from large, complex observational and clinical studies could not be obtained with other study designs and are integral to progress in women’s health. New study designs that yield similar levels of certainty would be valuable. Smaller studies, in contrast, provide different information and can often be better controlled, potentially faster (depending on the end points studied), and less expensive. Internal validity (for example, the ability to establish causal relationships) is generally stronger in such studies, but this may be at the cost of external validity (that is, generalizability). Smaller studies are important to provide information on which to base large studies and to test specific hypotheses.

Although women are now routinely included in clinical research, the initial design often is not optimal for obtaining data on women, including problems in the inclusion criteria and selection of end points that do not apply to women. Sample size and the ability to recruit adequate numbers of women in studies to allow appropriate analyses can be challenging. Sex- and gender-specific analyses must be published and used for drug development or clinical guidelines. Even when sex-specific analyses are conducted by researchers, the analyses are not always included in publications, because of page limitations or journal restrictions.

Studies often use incidence and 5-year survival rates as end points; fewer studies look at morbidity or quality of life after treatment and survival. Given that women tend to report worse overall health than do men and tend to emphasize quality of life when considering their health, the lack of assessment of quality of life in studies of women’s health is problematic.

ARE THE RESEARCH FINDINGS BEING TRANSLATED IN A WAY THAT AFFECTS PRACTICE?

It can take 15–20 years for research findings to be incorporated into practice. Barriers to translation of findings on women’s health include barriers that impede translation of science to practice more generally, such as the iterative nature of research in which inconsistent or contradictory results often are published before a clear picture emerges; social and cultural opposition to some new treatments or approaches; entrenched financial or other interests that favor the status quo or a specific approach; and lack of reimbursement for new treatments or practices. Patients themselves faced with a multitude of research findings and complex decisions can have difficulty in weighing new options for their health.

Other barriers, however, differentially affect the translation of research into better care for women. They are derived from the fragmentation of care that results when women see multiple providers for different health concerns, failure of performance measures to include many conditions that are specific to women, and failure to analyze sex-based differences in care, which undermines the use of incentives to implement research findings in women’s health care.

ARE THE RESEARCH FINDINGS BEING COMMUNICATED EFFECTIVELY TO WOMEN?

Complex and sometimes inconsistent or contradictory results present challenges to the communication of research findings, including those relevant to women. Often, the implications of a given finding are complex, so it is difficult to give a clear, concise message. The emergence of the Internet and the World Wide Web has increased the amount of and access to health-related information for the general public, but it has also added to the confusion about the findings and to concerns about the validity of the available information. Communication is complicated by competing forces, for example, when health messages compete with the marketing forces of industries.

GAPS IN WOMEN’S HEALTH RESEARCH

Relatively few studies have been published on a number of conditions important to women, including ovarian and endometrial cancer, pre-eclampsia (a major cause of maternal morbidity and mortality), and conditions that affect elderly women, including frailty. There is little information on many autoimmune diseases, such as lupus. Research on prevention of and treatment for Alzheimer’s disease, obesity, and diabetes has rarely examined sex differences. Despite the prevalence of co-occurring conditions and the need to evaluate risk–benefit tradeoffs across multiple outcomes, such issues are rarely incorporated into studies of specific conditions. More information on how the physical and social environment affect health is needed, including an understanding of how they may result in health disparities in disadvantaged groups. In some cases, particularly reproductive health, strong data supporting the safety and efficacy of treatments may be insufficient to fuel their use if there is social or political opposition on nonmedical grounds. Advances in women’s health may require attention to such obstacles in addition to those inherent in the research.

COMMITTEE’S KEY FINDINGS AND RECOMMENDATIONS

Substantial progress has been made since the expansion of investment in women’s health research. Research findings have changed the practice of medicine and public-health recommendations in several prominent contexts, including changes in standards of care for women. There have also been decreases in mortality in women from breast cancer, heart disease, and cervical cancer. In other contexts, however, there has been less progress, including research on other conditions that affect women and identification of ways to reduce disparities among subpopulations of women.

Several barriers to further progress in improving the health status of women were identified. For example, there has been inadequate attention to the social

and environmental factors that, along with biologic risk factors, influence health. There also has been inadequate enforcement of requirements that representative numbers of women be included in clinical trials and that women’s results be reported. A lack of taking account of sex and gender differences in the design and analysis of studies, and a lack of reporting on sex and gender differences, has hindered identification of potentially important sex differences and slowed progress in women’s health research and its translation to clinical practice. The committee recommends that all published scientific reports that receive federal funding and all medical product evaluations by the Food and Drug Administration present efficacy and safety data separately for men and women.

Poor communication of the results of women’s health research has in many cases led to substantial confusion and may affect the care of women adversely. Research findings will have a greater impact if they are coupled with a well thought-out plan for communication and dissemination. Development of a plan for communication and dissemination should be a standard component of federally sponsored women’s health research and the clinical recommendations that are made on the basis of that research.

The committee’s specific findings and recommendations follow.

Investment in women’s health research has afforded substantial progress and led to improvements in women’s health with respect to such important conditions as some cancers and heart disease. Greater progress in women’s health has occurred in conditions characterized by multipronged research involving molecular, animal, and cellular data; in observational studies to identify effects in the overall population; and in clinical trials or intervention studies from which evidence-based conclusions on treatment effectiveness can be drawn.

Recommendation 1

US government agencies and other relevant organizations should sustain and strengthen their focus on women’s health, including the spectrum of research that includes genetic, behavioral, and social determinants of health and how they change during one’s life. In addition to conducting women-only research as appropriate, a goal should be to integrate women’s health research into all health research—that is, to mainstream women’s health research—in such a way that differences between men and women and differences between subgroups of men and women are routinely assessed in all health research. Relevant US government agencies include the Department of Health and Human Services and its institutes and agencies—especially the National Institutes of Health, the Centers for Disease Control and Prevention, the Food and Drug Administration, the Agency for Healthcare Research and Quality, and the Substance Abuse and Mental Health Services Administration—and

such others as the Department of Veterans Affairs, the Department of Defense, and the Environmental Protection Agency.

Women who experience social disadvantage as a result of race or ethnicity, low income, or low educational level suffer disproportionate disease burdens, adverse health outcomes, and barriers to care but have not been well represented in studies of behavior and health.

Recommendation 2

The National Institutes of Health, the Agency for Healthcare Research and Quality, and the Centers for Disease Control and Prevention should develop targeted initiatives to increase research on the populations of women that have the highest risks and burdens of disease.

The incidence, prevalence, morbidity, or mortality associated with a number of conditions—for example, unintended pregnancy, maternal mortality and morbidity, nonmalignant gynecologic disorders, alcohol- and drug-addiction disorders, autoimmune diseases, and lung, ovarian, and endometrial cancer—have not improved. Most of those conditions substantially affect the quality of life of those who experience them. The major focus of health research has been on reducing mortality; a singular focus on mortality, however, can divert attention from other health outcomes despite the high value that women place on quality of life.

Recommendation 3

Research should include the promotion of wellness and quality of life in women. Research on conditions that have high morbidity and affect quality of life should be increased. Research should include the development of better measures or metrics to compare effects of health conditions, interventions, and treatments on quality of life. The end points examined in studies should include quality-of-life outcomes (for example, functional status or functionality, mobility, and pain) in addition to mortality.

Social factors and health-related behaviors and their interactions with genetic and cellular factors contribute to the onset and progression of multiple diseases; they act as pathways that are common to multiple outcomes. Considerable progress has been made in understanding the behavioral determinants of women’s health,

but less is known about how to change them and about the broader determinants of women’s health that involve social, community, and societal factors.

Recommendation 4

Cross-institute initiatives in the National Institutes of Health—such as those in the Division of Program Coordination, Planning, and Strategic Initiatives—should support research on common determinants and risk factors that underlie multiple diseases and on interventions on those determinants that will decrease the occurrence or progression of diseases in women. The National Institutes of Health’s Office of Research on Women’s Health should increase collaborations with the Office of Behavioral and Social Sciences Research to design and oversee such research initiatives.

Limitations in the design, analysis, and scientific reporting of health research have slowed progress in women’s health. Inadequate enforcement of recruitment of women and of reporting data by sex has fostered suboptimal analysis and reporting of data on women from clinical trials and other research. That failure has limited possibilities for identifying potentially important sex or gender differences. New methods and approaches are needed to maximize advances in promoting women’s health.

Recommendation 5

Government and other funding agencies should ensure adequate participation of women, analysis of data by sex, and reporting of sex-stratified analyses in health research. One possible mechanism would be expansion of the role of data safety monitoring boards to monitor participation, efficacy, and adverse outcomes by sex.

Given the practical limitations in the size of research studies, research designs and statistical techniques should be explored that facilitate analysis of data on sociodemographic subgroups without substantially increasing the overall size of a study population. Conferences or meetings with a specific goal of developing consensus guidelines or recommendations for such study methods (for example, the use of Bayesian statistics and the pooling of data across study groups) should be convened by the National Institutes of Health, other federal agencies, and relevant professional organizations.

To gain knowledge from existing studies that individually do not have sufficient numbers of female subjects for separate analysis, the director of the Office of the National Coordinator for Health Information Technology in the Department of Health and Human Services should support the development and application of mechanisms for the pooling of patient

and subject data to answer research questions that are not definitively answered by single studies.

For medical products (drugs, devices, and biologics) that are coming to market, the Food and Drug Administration should enforce compliance with the requirement for sex-stratified analyses of efficacy and safety and should take those analyses into account in regulatory decisions.

The International Committee of Medical Journal Editors and other editors of relevant journals should adopt a guideline that all papers reporting the outcomes of clinical trials report on men and women separately unless a trial is of a sex-specific condition (such as endometrial or prostatic cancer). The National Institutes of Health should sponsor a meeting to facilitate establishment of the guidelines.

The translation of research findings into practice can be delayed or precluded by various barriers—the complexity of science and research and challenges in communicating understandable and actionable messages, social or political opposition to advances for nonmedical reasons, fragmentation of health-care delivery, health-care policies and reimbursement, consumer confusion and apprehension, and so on. Many of those barriers are seen in connection with translation of research in general, but some have aspects that are peculiar to women, and few studies have been conducted to examine how to increase the speed or extent of the translation of findings related specifically to women’s health into clinical practice. Methods of translation that have been used and that warrant evaluation for translating research findings in women include clinical-practice guidelines, mandatory standards, reimbursement practices, laws (including public-health laws), health-professions school curricula, and continuing education.

Recommendation 6

Research should be conducted on how to translate research findings on women’s health into clinical practice and public-health policies rapidly. Research findings should be incorporated at the practitioner level and at the overall public-health systems level through, for example, the use of education programs targeted to practitioners and the development of guidelines. As programs and guidelines are developed and implemented, they should be evaluated to ensure effectiveness.

The public is confused by conflicting findings and opposing recommendations that emerge from health research, including women’s health research. Conflicting results and work to resolve disagreements are part of the scientific process, but

that iterative aspect of scientific discovery is not clearly conveyed to, or understood by, the public. The resulting uncertainty and distrust of research may affect women’s care adversely. Relevant knowledge from studies of communication often is not used by researchers, funders, providers, and public-health professionals to target health messages and information to women.

Recommendation 7

The Department of Health and Human Services should appoint a task force to develop evidence-based strategies to communicate and market health messages that are based on research results to women. In addition to content experts in relevant departments and agencies, the task force should include mass-media and targeted-messaging and marketing experts. The strategies should be designed to communicate to the diverse audience of women; to increase awareness of women’s health issues and treatments, including preventive and intervention strategies; and to decrease confusion regarding complex and sometimes conflicting findings. The goals of the task force should be to facilitate and improve the communication of research findings by researchers to women. Strategies for the task force to consider or explore might include

requiring a plan for the communication and dissemination of findings of federally funded studies to the public, providers, and policy makers; and

establishing a national media advisory panel of experts in women’s health that would be readily available to provide context to reporters, scientists, clinicians, and policy makers at the time of release of new research reports.

Even though slightly over half of the U.S. population is female, medical research historically has neglected the health needs of women. However, over the past two decades, there have been major changes in government support of women's health research—in policies, regulations, and the organization of research efforts. To assess the impact of these changes, Congress directed the Department of Health and Human Services (HHS) to ask the IOM to examine what has been learned from that research and how well it has been put into practice as well as communicated to both providers and women.

Women's Health Research finds that women's health research has contributed to significant progress over the past 20 years in lessening the burden of disease and reducing deaths from some conditions, while other conditions have seen only moderate change or even little or no change. Gaps remain, both in research areas and in the application of results to benefit women in general and across multiple population groups. Given the many and significant roles women play in our society, maintaining support for women's health research and enhancing its impact are not only in the interest of women, they are in the interest of us all.

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Goal: Promote health and well-being for women.

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Women experience many unique health issues — for example, pregnancy, childbirth, and menopause. And some health issues that affect both men and women pose unique challenges for women. Healthy People 2030 focuses on addressing these specific needs in order to improve women’s health and safety throughout their lives.

Both pregnancy and childbirth can lead to serious long-term health problems for women. Strategies to decrease unplanned pregnancies and make sure women get high-quality health care before, during, and after pregnancy can help reduce serious health problems and deaths.

Women are also at risk for diseases like breast and cervical cancer. Screening for these diseases and health issues that disproportionately affect women is key to identifying problems and making sure women get the treatment they need.

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Women — General

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Women's Health Research Roadmap

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OWH research roadmap

On this page: About the roadmap | Research priority areas | Related links  

Download the Research Roadmap (PDF, 9.20 MB)

About the Women’s Health Research Roadmap

A strategy for science and innovation to improve the health of women  

Since its inception, the FDA Office of Women’s Health (OWH) has worked closely with FDA’s centers to expand existing research projects and foster new collaborations related to advancing the science of women’s health. OWH has also worked with other government agencies, academia, women’s research organizations, and other stakeholders to foster and facilitate research projects and scientific forums. These combined efforts have helped to advance our understanding of women’s health issues. They have furthered the development of new tools and approaches for informing FDA decisions about the harm or the safety and effectiveness of FDA-regulated products that are used not only by women, but by all Americans.

The Women’s Health Research Roadmap builds on knowledge gained from previously funded research and is intended to assist OWH in coordinating future research activities with other FDA research programs and with external partners. The Roadmap outlines priority areas where new or enhanced research is needed. Although many critical women’s health issues may warrant further examination, future OWH-funded research should focus on areas where advancements will be directly relevant to FDA as it makes regulatory decisions. The Roadmap creates strategic direction for OWH to help maximize the impact of OWH initiatives and ultimately promote optimal health for women.  

Research priority areas

  • Advance safety and efficacy : Advance the safety and efficacy and reduce the toxicity of FDA-regulated products used by women
  • Improve clinical study design and analyses : Improve clinical study design and conduct to better identify and evaluate possible sex differences related to FDA-regulated products
  • Novel modeling and simulation approaches : Evaluate and promote the adoption of novel modeling and simulation approaches that can aid in regulatory evaluation of FDA-regulated products
  • Advances in biomarker science : Develop tools and methods that can help identify, evaluate, and qualify predictive or prognostic clinical and non-clinical biomarkers and surrogate endpoints
  • Expand data sources and analysis : Identify, develop, and evaluate data sources and efficient techniques for data mining, data linkage, and large data set analysis that can be used to assess the postmarket toxicity or the safety and effectiveness of FDA-regulated products
  • Improve health communications : Develop, evaluate, and use tools and methods to foster the creation and easy availability of clear and useful information about FDA-regulated products used by women to help women and their health care professionals make informed health-related decisions
  • Emerging technologies : Support the identification of sex differences related to the use of emerging technologies

Related links

  • OWH information on BAA funding
  • Extramural Research - Women's Health (including funding information)

The gender health gap: It's more than a women’s issue. Here’s why

research on women's health promotion

Gender health gap ... closing it could potentially boost the global economy by $1 trillion. Image:  Unsplash/National Cancer Institute

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Stay up to date:, health and healthcare.

  • Millions of women of all ages have no access to healthcare, treatment and support they need.
  • Closing this 'gender health gap' would enable more women to join the workforce, potentially boosting the global economy by $1 trillion.
  • A new World Economic Forum and McKinsey Health Institute report highlights the vital need to strive for gender parity in health.

The gender health gap affects everyone: our families, communities, workplaces, societies. Yet around the world, millions of women at all stages of life are unable to access the healthcare, treatment and support they need.

Resolving this issue was the focus of our discussions at the World Economic Forum in Davos, where we joined a session called Closing the Gender Health Gap .

Davos AM24 session 'Closing the Gender Gap in Health'.

Have you read?

Why the women’s health gap exists – and how to close it – according to experts at davos, over a million women around the world were asked 'what do you want most for your health and well-being' here's what they said , 3 conditions that highlight the women’s health gap.

Davos saw the launch of a new report from the Forum and the McKinsey Health Institute, called Closing the Women’s Health Gap: A $1 Trillion Opportunity to Improve Lives and Economies .

With just 1% of global healthcare research and development dedicated to female-specific conditions , this research highlights the vital need for action to close the gender health gap and strive for gender health parity.

Diagnosing the gender health gap

Despite living longer than men on average, women spend 25% more of their lives in poor health, according to the report.

Healthcare research and innovation in female-specific conditions

Poor sanitation takes 1.4 million lives annually, with women and girls bearing a disproportionate burden , according to the World Health Organization. Meanwhile, conditions such as premenstrual syndrome, depression and gynaecological diseases are among the leading conditions that restrict female contributions to GDP growth.

In India, lack of access to water and sanitation has been a threat to women and girls, in terms of their health and their physical security. In response, the Indian government has built 110 million toilets and provided 130 million potable water connections to address the problem.

In addition, wellness centres and health insurance schemes offer support to almost 146 million women in the country. The focus on preventative care has resulted in 168 million breast screenings and 113 million cervical-cancer screenings. Such measures also encourage women to become part of a healthy workforce, which empowers them economically.

Moreover, the Indian national nutrition mission, Poshan Abhiyaan, has provided support to more than 25 million pregnant women and lactating mothers.

Programmes like these help to break down some of the societal stigmas surrounding women's healthcare and encourage women to seek medical treatment and other social services.

The global health burden is not only carried by the women it impacts, but is also felt throughout broader society. As the Closing the Women's Health Gap report outlines: "The disparities in women’s health affect not only women’s quality of life but also their economic participation and ability to earn a living for themselves and their families. Health is intricately linked to economic productivity, prospects for prosperity and contribution to economic output."

Closing the gender health gap could not only avoid many years of life lost every year due to poor health or early death, but it would also enable women to participate more actively in the workforce and contribute to growth.

We need to stop looking at this challenge as solving an issue for women. We are solving this issue for the whole population.

The Global Health and Strategic Outlook 2023 highlighted that there will be an estimated shortage of 10 million healthcare workers worldwide by 2030.

The World Economic Forum’s Centre for Health and Healthcare works with governments and businesses to build more resilient, efficient and equitable healthcare systems that embrace new technologies.

Learn more about our impact:

  • Global vaccine delivery: Our contribution to COVAX resulted in the delivery of over 1 billion COVID-19 vaccines and our efforts in launching Gavi, the Vaccine Alliance, has helped save more than 13 million lives over the past 20 years .
  • Davos Alzheimer's Collaborative: Through this collaborative initiative, we are working to accelerate progress in the discovery, testing and delivery of interventions for Alzheimer's – building a cohort of 1 million people living with the disease who provide real-world data to researchers worldwide.
  • Mental health policy: In partnership with Deloitte, we developed a comprehensive toolkit to assist lawmakers in crafting effective policies related to technology for mental health .
  • Global Coalition for Value in Healthcare: We are fostering a sustainable and equitable healthcare industry by launching innovative healthcare hubs to address ineffective spending on global health . In the Netherlands, for example, it has provided care for more than 3,000 patients with type 1 diabetes and enrolled 69 healthcare providers who supported 50,000 mothers in Sub-Saharan Africa.
  • UHC2030 Private Sector Constituency : This collaboration with 30 diverse stakeholders plays a crucial role in advocating for universal health coverage and emphasizing the private sector's potential to contribute to achieving this ambitious goal.

Want to know more about our centre’s impact or get involved? Contact us .

Treating the symptoms

The challenge to improve female healthcare is not restricted to doing more research or providing more treatments, drugs or infrastructure, it's also about policy and perception. We need to change public perception of society and, in turn, policy and decision-making about female-specific healthcare.

Initiatives like the World Economic Forum’s Global Alliance for Women's Health , which was launched at Davos in collaboration with the Bill & Melinda Gates Foundation and other partners, encourage stakeholders from across the medical world to join forces, build trust and encourage investment in women’s health.

The Alliance aims to provide impetus to public-private partnerships that are essential to unlocking the finance and innovation needed to transform healthcare systems and make them more responsive to women’s health needs.

This can help health officials promote more strategic approaches to preventive healthcare for women in many ways, including raising global awareness of female-specific healthcare issues in different geographies and identifying common red flags.

Collaboration can also bring together rich sources of data from the global health system that may not otherwise be available, which can then inform future plans and procedures.

And, most importantly, it combines areas of expertise needed to address specific medical challenges from a gender perspective, with a focus on how they can be delivered.

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Women in the healthcare industry: An update

Our most recent analysis of women in healthcare is based on data gathered for the Women in the Workplace 2022 report published by McKinsey and LeanIn.Org. 1 Women in the Workplace 2022 , a joint report from McKinsey and LeanIn.org, October 18, 2022. In this article, we examine female representation, attrition, promotion rates, and external hiring; the barriers to advancement for women of color; and threats to recent gains (see sidebar, “About the research”).

Representation

Healthcare continues to outpace other industries in the representation of women; however, women (especially women of color) remain underrepresented at senior levels in healthcare organizations (Exhibit 1).

About the research

This article is based on data collected for the Women in the Workplace 2022 report, published by McKinsey in partnership with LeanIn.Org. The data behind this report are based on a survey of 333 companies across the United States and Canada. The analysis builds on similar research that McKinsey and LeanIn.Org have conducted annually since 2015, as well as on 2012 research from McKinsey.

For the 2022 report, data about pipeline representation were collected from year-end 2021. These data reflect not only the representation of women and men as of December 31, 2021, but also personnel changes (for example, those resulting from promotion, hiring, and attrition) during 2021. HR leaders and professionals provided information on policies, programs, and priorities at their companies. These data sets, representing point-in-time snapshots, reflect the responses of companies and the experiences of employees when the survey was conducted. 1 Submitted data were checked for consistency, and inconsistent data were excluded as needed during the rigorous quality control process. A minimum of five organizations are required to create an industry benchmark. If this minimum is not met, there will be an N/A for that benchmark metric.

Visit womenintheworkplace.com to see the healthcare organizations that have agreed to publicly share that they have participated in the healthcare benchmark.

Increased representation. Women’s representation in healthcare has increased across all levels compared with last year, with the most marked advancement in senior vice president positions (an increase of up to ten percentage points). At all levels, women’s representation in healthcare remains higher than in corporate America overall. The representation of women of color in healthcare is the same or higher at all levels (except for C-suite roles) compared with corporate America.

Lack of representation in senior levels. Women’s representation in healthcare remains high early in the pipeline, including in entry-level (75 percent), manager (70 percent), and senior manager or director (61 percent) roles, and has risen substantially compared with years past. But the representation of women drops in each successive career level to a low of 32 percent at the C-suite level. For example, although 70 percent of managers are women, just 45 percent of vice presidents (two levels higher) are women—a drop-off of 25 percentage points. Similar to last year, promotion rates, retention, and external hiring have not kept pace to improve representation at more senior management levels.

Lack of diversity, particularly in senior levels. Women in senior-level roles in healthcare are predominantly White. For example, only 4 percent of C-suite healthcare executives are women of color. Similarly, 32 percent of healthcare board members are women; of those, only 8 percent are women of color. Women of color experience the steepest drop in representation throughout the pipeline. Representation of women of color drops steadily—and more sharply than overall industry averages—at each successive career step, from entry level (26 percent) to C-suite roles (4 percent).

Higher rates of attrition. Our 2022 data show that women in healthcare are leaving their jobs at higher rates on average than in previous years. Attrition was especially acute at the entry and C-suite levels (Exhibit 2). The female attrition rate at the C-suite level more than doubled from the previous year, rising from 6.4 percent to 16.6 percent. It was also about five percentage points higher than for C-suite men and C-suite women across all industries.

Lower promotion rates. Internal promotion rates for women in healthcare are lower than the average for women in all industries at every level. Men were promoted at higher rates than women into manager, vice president, and senior vice president roles, while women were promoted at higher rates than men into senior manager or director and C-suite roles (Exhibit 3). Promotion rates for women (and men) decreased at year-end 2021 through the vice president level, compared with the prior two years. Notably, women were promoted at higher rates to the senior vice president and C-suite levels compared with year-end 2020, although this is still a decrease from the promotion rate for women to C-suite roles at year-end 2019.

In healthcare, a broken rung persists at the manager level: only 2.0 percent of men and 1.4 percent of women are promoted to manager roles, compared with 8.3 percent of men and 7.2 percent of women across all other industries.

External hiring

Increased external hiring. At junior levels, more than half of all external hires in healthcare are women (75 percent of entry-level workers, 66 percent of managers, and 58 percent of senior managers or directors) (Exhibit 4). Healthcare companies can keep a critical eye on the ratio of women’s representation at a given level and the share of women hired into that level. When the share of externally hired women is lower than the share of women currently in that level, as is the case at the manager through SVP levels in the healthcare industry, this runs the risk of being dilutive to women’s representation over time.

At senior levels, women make up less than half of external hires in healthcare (42 percent of vice presidents and 41 percent of senior vice presidents). As with the more junior levels, these hires also run the risk of being dilutive to women’s representation at those levels over time (assuming all other representation flows stay constant).

Women continue to have higher levels of representation, hiring, and advancement in healthcare than in corporate America overall. Even so, the latest data show that the industry has plenty of room for improvement.

April 8, 2022

The healthcare sector is examining how to better hire and promote women to the highest levels..

Women have long found a path toward advancement in healthcare and life sciences—from Virginia Apgar, who developed a standard in the 1950s to assess newborn health, to Tu Youyou, who earned the Nobel Prize in medicine in 2015 for her discovery of a treatment for malaria. 2 Women have been awarded Nobel Prizes 59 times: 18 in peace, 16 in literature, 12 in physiology or medicine, seven in chemistry, four in physics, and two in economic sciences. Women currently account for more than half of all entry-level employees in the sector and have made progress in advancing to management, according to our previous analysis of women in healthcare .

This article is based on data collected for the Women in the Workplace 2021 report, published by McKinsey in partnership with LeanIn.Org. The data behind this report are based on a study of 423 companies across Canada and the United States. 1 The healthcare companies in the study included four payers, 26 providers, and 21 biotech or pharmaceutical- or medical-products companies. The analysis built on similar research that McKinsey and LeanIn.Org have conducted annually since 2015, as well as on 2012 research from McKinsey.

Separately and in addition, more than 65,000 employees from 88 companies were surveyed on their workplace experiences. In this 2021 Employee Experience Survey, 5,994 respondents worked in the healthcare sector (including providers, payers, and life sciences companies). Within this group, we interviewed women of different races and ethnicities, LGBTQ+ women, and women with disabilities at all levels of their organizations, working either remotely or on-site.

For the 2021 report, data about pipeline representation were collected from March to August 2021. These data reflect not only the representation of women and men as of December 31, 2020, but also personnel changes (for example, those resulting from promotion, hiring, and attrition) during 2020.

From June to August 2021, human-resources leaders and professionals provided information on policies, programs, and priorities at their companies. In addition, from May to July 2021, employees were surveyed on their workplace experiences. These data sets, representing point-in-time snapshots, reflect the responses of companies and the experiences of employees when the survey was conducted.

The nursing survey was in the field from February to March 2021 and again from November to December 2021. A representative sample of frontline registered nurses was recruited and verified by Dynata using proprietary data from professional organizations and state licensure records. Frontline nurses were screened to ensure that they spent at least 70 percent of their working hours delivering direct patient care and that they had at least one year of work experience. The 396 survey responses collected from February to March 2021 and the 710 responses collected from November to December 2021 were weighted by the respondent’s primary work setting to align with the actual distribution of the nursing workforce (from the US Bureau of Labor Statistics).

However, the COVID-19 pandemic has created a seismic shift in the workforce, with a specific impact on women . Millions of Americans have resigned  from their jobs, and many have cited unmanageable workloads or a need to care for family as important factors in their decision. The healthcare sector is no exception. 3 On subsequent references, “healthcare sector” reflects employees at payers, providers, and life sciences companies. Our most recent analysis  is based on the seventh annual Women in the Workplace data (for 2021), by McKinsey and LeanIn.Org. That research looks at drop-offs in female representation, promotion rates, and external hiring at the highest levels in healthcare; at the barriers to advancement for women of color; 4 In this article, “women of color” may include respondents who identified themselves as American Indian or Alaskan Native, Asian, Black or African American, Hispanic or Latino/Latina/Latinx, Middle Eastern or North African, and Native Hawaiian or Other Pacific Islander, as well as those who identified themselves as of mixed race. and at threats to recent gains (see sidebar, “About the research”). In many cases, these outcomes are correlated with the effects of the COVID-19 pandemic, including reports of increased responsibilities at home and higher levels of burnout. 5 Employees surveyed were asked to identify the frequency of burnout (a combination of emotional and physical fatigue, compounded by a sense of a lack of accomplishment or fulfillment in one’s healthcare role), as well as how often they felt exhaustion, job negativity, stress, and impact on work efficacy because they were juggling responsibilities. Parents in particular struggle  with both of these problems. For example, our analysis shows that women in healthcare are twice as likely as men to cite parenthood and increased home responsibilities as reasons for missing out on opportunities for promotion.

In previous work, we have discussed how COVID-19 could reshape the broader healthcare workforce and the potential impact of that shift on women . In this article, we start with the good news: in 2021, women in healthcare had higher representation at the managerial level and lower rates of attrition than they did in previous years. We also focus on the looming challenge of retention and on the risk that women of color will miss out on advancement opportunities. Finally, we offer strategies for improving retention and representation, as well as a goal to prepare for the shift to the next normal in an era of endemic COVID-19.

Women in healthcare are twice as likely as men to cite parenthood and increased home responsibilities as reasons for missing out on opportunities for promotion.

Reasons to celebrate

As a whole, healthcare continues to outperform other sectors in the representation of women, who make up more than two-thirds of entry-level employees in healthcare organizations (Exhibit 1). We identified three important shifts in 2021: increased representation of women at specific managerial levels, lower rates of attrition among women in healthcare than in other sectors, and increased external hiring of women at specific levels of the pipeline.

Increased representation

In healthcare, the representation of women at the senior-manager or director level improved by four percentage points on average, to 53 percent, in 2021. That is 18 percentage points higher than the average across all sectors. The gap in female representation in healthcare between managers and senior managers or directors was smaller than it had been in 2019.

Lower rates of attrition

On average, in 2021 women left jobs in healthcare at lower rates than women in other sectors, men in healthcare, and women in healthcare in previous years. In particular, the female attrition rate at the C-suite level was approximately half of what it was in 2019 (Exhibit 2). While many factors probably contributed to this outcome, our employee sentiment survey indicates two possible reasons: more women than men reported being somewhat or very happy with their companies, and more women than men would recommend their companies as great places to work. In addition, fewer women of color in healthcare management roles had left by the beginning of 2021 than had in 2019.

Increased external hiring

Hiring from outside an organization can be one strategy to increase representation. In 2021, external hiring of women at the manager through vice-president (VP) levels increased in healthcare from 2019. These numbers compare favorably with the averages across all sectors, in which women account for 34 to 47 percent of external hires.

Critical challenges

Despite the reasons to celebrate women’s success in healthcare, critical challenges remain. The ongoing stress of the COVID-19 pandemic threatens to undo progress in promotion and attrition rates, potentially setting female representation and advancement in healthcare back by several years. If women leave the workforce, miss out on promotions, or both, that will hinder efforts to reach gender parity in the C-suite.

We examine three crucial areas: drop-offs in representation at specific levels of the pipeline, in promotion rates, and in external hiring; barriers to advancement for women of color; and potential threats to recent gains in female representation, including increased home responsibilities and levels of burnout, correlated with the COVID-19 pandemic.

Drop-offs in representation at specific levels of the pipeline

The representation of women declines at each successive step, from the entry level (67 percent) to the C-suite (29 percent). Representation drops particularly sharply—by eight to 11 percentage points—at each level from manager to senior vice president (SVP). Clearly, promotion rates, retention, and external hiring have not kept pace to improve representation at more senior management levels.

While promotion rates for women in healthcare were on average on par with or slightly lower than those for men through the SVP level, the gap between men and women was larger in the C-suite (Exhibit 3). Previously, women had been promoted at higher rates to the SVP and C-suite levels: an 8.3 percent promotion rate for women to the C-Suite in 2019, compared with 0.8 percent in 2021. This effect can compound over time, resulting in lower representation for women at the highest levels.

External hiring is one of the quickest strategies to increase the representation of women at the top. There is room for improvement here: external hiring of women in healthcare is on par with the share of women already in healthcare organizations, and men account for a larger share of external hires than women from the VP level through the C-suite (Exhibit 4). External hiring of women in C-suite positions in particular decreased to 33 percent in 2021, from 42 percent in 2019. Across all sectors, women make up 36 percent of external hires. As a result, current external-hiring trends are likely to further widen the gaps in female representation, especially in senior levels.

Barriers to advancement for women of color

In healthcare, women of color make up almost a fourth of entry-level positions but occupy only 5 percent of C-suite ones. The attrition rates for women of color at the level of manager (28 percent) and senior manager or director (17 percent) are particularly alarming. Attrition among women of color at the entry levels will probably hurt representation at more senior levels in future years. 6 By comparison, men of color have remained, on average, between 10 and 12 percent representation across all levels and years. Compared with White women, White men, or men of color, proportionally more women of color reported spending time on diversity, equity, and inclusion (DEI) efforts, but they are the least likely to say that these efforts are well resourced at their companies. They also are the least likely to report that their managers consistently created an environment where people can discuss challenging topics.

Respondents to our survey said that they frequently do not feel supported in their DEI work—in fact, 16 percent of women reported that when they spoke out against bias, they experienced retaliation. A larger share of women than of men reported taking on DEI work. Fifty-one percent of women said that they carved out time to learn about the experiences of women of color by reading, listening to podcasts, or attending events. Only 35 percent of men did.

Pandemic fallout

In the COVID-19 era, employed women have faced increasing pressures and challenges, according to results from our employee experience survey. Women across all sectors have shouldered more household responsibilities, and more women reported feelings of burnout.

The problems are seemingly more acute for women in healthcare, who have fewer opportunities to work remotely, report feeling greater pressure to prioritize work over family, and seem to be “pushing through” burnout and missing fewer workdays than women in other sectors. Although this may have been celebrated in moments of crisis, executives and organizations can evaluate how to encourage women in healthcare to recharge. Otherwise, they may find that the pandemic’s headwinds are correlated with, if not causing, a more challenging path for women to become top executives in healthcare (Exhibit 5).

The employee experience survey indicates that women in healthcare feel burned out at work more frequently than men do and have missed more days of work as a result (Exhibits 6 and 7). The recent increase of burnout levels in healthcare may raise attrition in the future. In 2021, levels of burnout for women in healthcare resembled those of women in other sectors: across all levels, the same proportion of women (42 percent) in healthcare and all other sectors reported “often/almost always” feeling burned out at work. However, women in healthcare appear to be pushing through this burnout: six percentage points fewer women in healthcare than in all other sectors reported that they had missed one or more days of work as a result of burnout, stress, or mental-health issues. Over time, women who do not take time off to address their mental health may leave.

In addition, our 2021 employee experience survey found that 53 percent of women and 47 percent of men in healthcare reported feeling stressed at work in the past few months. 7 The survey was in the field during July and August 2020, n = 5,425. Thirty percent of women in healthcare reported feeling “pressured to work more” in the past few months, compared with 25 percent of men in healthcare. As the pandemic continues, these challenges may be worsening, especially for nurses . McKinsey’s survey of nurses, conducted in February 2021 and in November 2021, reflected the strain. 8 The number of respondents was 396 in the February survey and 708 in the November one. The November 2021 results indicated that more than 32 percent of surveyed nurses may leave their current positions  providing direct patient care within the year—a substantial increase over 22 percent in the spring. Of nurses reporting an intention to leave , 60 percent said that they had become more likely to do so after the start of the COVID-19 pandemic. Since the pandemic began, a higher proportion of female than male nurses have said that they are likely to leave.

This finding is consistent with a recent McKinsey survey  conducted across employees in healthcare and social assistance: in mid-2021, 36 percent of the respondents said that they were at least somewhat likely to leave their current jobs within the next three to six months. Forty-two percent of the healthcare and social-assistance workers who had already quit did so without having new jobs.

The experience survey data paint an unprecedented picture: women are nearing a tipping point, and their professional advancement is being affected. If these challenges are not addressed, they could jeopardize the progress that women in healthcare have made in recent years.

Actions to take

Employers can consider three specific actions to retain and promote women in healthcare: mitigate attrition; use open positions to advance DEI goals, with external hiring and equitable promotions as mechanisms for change; and maintain a deliberate focus on opportunities for women of color.

Mitigate attrition

Employers can take several steps to mitigate attrition: for example, they can ensure reasonable workloads, encourage clear boundaries for availability, and provide greater flexibility at work (such as flexible working hours, options to transition to part-time work or to a more time-flexible role, or remote-work options). Women said that these factors could dissuade them from reducing their hours or leaving the workforce.

In addition, people-focused managers can be trained to recognize and acknowledge the additional burdens of the pandemic period and to connect team members with relevant support resources. Appropriate steps might include communicating consistently about mental-health counseling benefits and stress management programs. In healthcare particularly, employees may feel pressure to be available 24/7. Thirty percent of women (and 23 percent of men) said that helping employees to set boundaries for availability would be a meaningful action for employers to take.

This is, of course, in addition to best standard-practice elements of a superior employee experience. These include social experience (people and relationships, teamwork, and social climate), organization experience (purpose, technology, and the physical environment), and the work experience (work organization, work control and flexibility, and growth and rewards)—as described in our previous work .

Use open positions to advance DEI goals

If your company faces rising attrition rates, look at the potential opportunities: stability is a goal, but open positions can be a chance to evaluate ways of making promotions and external hiring more equitable.

As we show in our previous work on women in healthcare , helpful actions include bias training, objective criteria for evaluation and promotion, diverse slates for promotions, and greater transparency and reporting. Requesting a diverse selection of candidates for open roles can be a powerful driver for change at every level. When two or more women are put forward for consideration, the odds that a woman will be promoted rise dramatically. 9 Cynthia DuBois, “The impact of ‘soft’ affirmative action policies on minority hiring in executive leadership: The case of the NFL’s Rooney Rule,” American Law and Economics Review , Spring 2016, Volume 18, Number 1; Elsa T. Chan, David R. Hekman, and Stefanie K. Johnson, “If there’s only one woman in your candidate pool, there’s statistically no chance she’ll be hired,” Harvard Business Review , April 26, 2016; Jean Martin, “A fairer way to make hiring and promotion decisions,” Harvard Business Review , August 13, 2013. It is equally important to ensure that women and people of color within the organization are ready now or ready soon to fill these openings. In addition to preparing internal succession candidates, companies may want to reexamine external hiring, including whether it is an adequate component of specific recruitment efforts.

If multiple leadership roles in an organization or team are open, it is especially important to take a holistic perspective. In these situations, think about building the best leadership team as a whole—with leaders whose perspectives, experiences, and backgrounds complement one another and reflect the broader employee, customer, or patient populations—rather than making a series of independent hiring decisions. These senior placements are a visible signal of organizational priorities to the rest of the workforce.

Maintain deliberate focus on opportunities for women of color in healthcare

Companies may consider comprehensively examining their evaluation and promotion processes, when biases and barriers often disproportionately affect women of color. In addition, they may pay careful attention to retaining critical talent and to addressing the reasons that women—particularly women of color at the manager, senior manager/director level—cite for reducing their workloads or for leaving.

If healthcare companies truly wish to improve the representation of women of color, they may choose to hold managers and senior leaders more accountable by making the diversity of their organizations more transparent or making diversity goals a component of performance reviews (for example, sponsorship of lower-tenured colleagues from underrepresented groups).

No matter their gender, race, or career dreams, healthcare workers join the sector with a desire to help people recover from illness and to live healthy lives. Yet the past two years have taken a toll on employees, and in particular those on the front lines of the pandemic. Gender parity and proportionate representation of women of color in healthcare at the top levels remains aspirational. Although there are reasons to celebrate, healthcare stakeholders may consider what they can do to rebalance the scales. While we cautiously watch the experience of women in healthcare during the ongoing pandemic, we feel optimistic about the healthcare sector’s potential to remain a leader in the representation and experience of diverse leaders.

Gretchen Berlin, RN , is a senior partner in McKinsey’s Washington, DC, office; Nicole Robinson is an associate partner in the San Francisco office; and Mayra Sharma is a consultant in the Austin office.

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Promoting Health for Adults

woman sitting at counter

  • Helping People Who Smoke Quit
  • Increasing Access to Healthy Foods and Physical Activity

Preventing Excessive Alcohol Use

  • Promoting Lifestyle Change and Disease Management

Promoting Women’s Reproductive Health

Promoting clinical preventive services, promoting community water fluoridation, promoting mental health and emotional well-being, promoting better sleep.

Chronic diseases—such as heart disease, cancer, and diabetes—are the leading causes of death and disability in the United States. They are also leading drivers of the nation’s $3.8 trillion in annual health care costs.

Many chronic diseases are caused by a short list of risk behaviors: tobacco use, poor nutrition, physical inactivity, and excessive alcohol use. CDC’s National Center for Chronic Disease Prevention and Health Promotion  (NCCDPHP) works to improve health for all adults.

In the United States:

Candle

1 IN 3 DEATHS

each year is from heart disease, stroke, or other cardiovascular diseases.

30.8 million adult smokers

30.8  MILLION ADULTS

smoke cigarettes.

person standing on scale

74% OF ADULTS

are overweight or have obesity.

Clipboard with A1C 5.7-6.4

96 MILLION ADULTS

have prediabetes.

CDC’s Approach

Helping people who smoke quit and supporting comprehensive programs.

Tobacco use is the leading cause of preventable disease, disability, and death in the United States. As of 2018, about 34 million US adults smoke cigarettes, and every day, about 1,600 young people under 18 try their first cigarette. In addition, 58 million people who don’t smoke are exposed to secondhand smoke every year.

CDC’s Office on Smoking and Health  focuses on motivating US adults who smoke to try to quit through its  Tips From Former Smokers ®  ( Tips ® ) campaign.  Tips  features real people who are living with serious health conditions caused by smoking and secondhand smoke exposure. The newest Tips series adds compelling stories from family members who take care of loved ones affected by a smoking-related disease or disability.

Tips connects people who smoke with resources to help them quit, including 1-800-QUIT-NOW, which directs people to free services from their state quitlines.

CDC also funds comprehensive tobacco control activities nationwide through the National Tobacco Control Program  to:

  • Prevent young people from starting to use tobacco.
  • Promote quitting among adults and young people.
  • Reduce people’s exposure to secondhand smoke.
  • Advance health equity by identifying and eliminating tobacco-related disparities.

Increasing Access to Healthy Foods and Physical Activity Opportunities

man holding basket of vegitables

A healthy diet and regular physical activity can help prevent weight gain, heart disease, stroke, type 2 diabetes, and some kinds of cancer. However, only about 1 in 10 US adults eats enough fruits or vegetables. Nine in 10 Americans consume more than the recommended amount of sodium. In addition, only 54% of adults get enough aerobic physical activity, and nearly 74% have overweight or obesity.

CDC’s Division of Nutrition, Physical Activity, and Obesity  develops and shares proven approaches that make healthy living easier for everyone. CDC works with states, communities, and national partners to help increase healthy food options where people live, learn, work, and play. CDC also partners with states and communities to promote improvements in equitable community design that make physical activity safe and convenient for all persons.

Promoting Lifestyle Change and Disease Management Programs

CDC’s  National Diabetes Prevention Program  (National DPP), for example, is a public-private partnership working to build a nationwide system to deliver an affordable, evidence-based lifestyle change program proven to prevent or delay type 2 diabetes. Participants in the lifestyle change program learn to make healthy food choices, be more physically active, and find ways to cope with problems and stress. These lifestyle changes can cut their risk of developing type 2 diabetes by as much as 58% (71% for those over 60). The program is delivered in person, online, by distance learning, and through a combination of these formats.

Excessive alcohol use contributes to more than 140,000 deaths in the United States each year, shortening the lives of those who die by an average of 26 years. Excessive drinking is associated with 1 in 10 deaths  among working-age adults and cost the United States $249 billion in 2010.

CDC’s Alcohol Program  works with states and communities to:

  • Improve public health surveillance on excessive alcohol use, especially binge and underage drinking, and related health outcomes.
  • Share effective population strategies to prevent excessive alcohol use and related outcomes.
  • Expand state and local public health epidemiology to prevent excessive alcohol use.

Chronic conditions such as high blood pressure, diabetes, heart disease, and obesity compromise women’s health and can put them at higher risk of pregnancy complications and infertility.

Pregnant woman at the doctor's office

CDC’s Division of Reproductive Health  works with partners to improve preconception health, pregnancy care, and infant health by monitoring outcomes, promoting quality clinical services, and conducting research. Health care providers and women can work together to prevent and control chronic conditions both before and during pregnancy, which may improve a woman’s chances of having a healthy pregnancy and delivery.

CDC also tracks the experiences of women before, during, and after pregnancy and collects information on pregnancy-related deaths, through surveillance systems such as the Pregnancy Risk Assessment Monitoring System and the Pregnancy Mortality Surveillance System . Data collected are used to improve all aspects of pregnancy.

Getting good medical care that finds problems early and treats them effectively is an essential part of staying healthy. CDC works with public health partners and health care systems to improve the delivery of clinical preventive services, such as using electronic health records to monitor patient care and adding community health workers to health care teams.

CDC’s Division for Heart Disease and Stroke Prevention supports programs across the country to help millions of Americans control their high blood pressure and reduce other cardiovascular disease risk factors. For example, the WISEWOMAN  (Well-Integrated Screening and Evaluation for WOMen Across the Nation) program works to reduce heart disease and stroke risk factors for women aged 40 to 64 with low incomes and little or no health insurance.

Participants receive preventive health services such as blood pressure, cholesterol, and diabetes screenings. They are counseled about their risk of heart disease and stroke and referred to lifestyle change programs and other community resources that can help them control their blood pressure, eat a healthier diet, be physically active, and quit smoking.

CDC’s Division of Cancer Prevention and Control  works with national organizations and state and local health agencies to help people lower their cancer risk by increasing the use of effective cancer prevention strategies and screening tests. Screening tests can help detect pre-cancerous colorectal and cervical conditions that if treated can prevent cancers from developing and find colorectal, cervical, breast, and lung cancers early, when treatment works best.

CDC’s Colorectal Cancer Control Program  funds 20 states, 8 universities, 2 tribal organizations, and 5 other organizations to increase colon cancer screening rates among men and women aged 45 and older.

CDC’s National Breast and Cervical Cancer Early Detection Program  funds programs in all 50 states, the District of Columbia, 6 US territories, and 13 American Indian/Alaska Native tribes or tribal organizations to provide access to breast and cervical cancer screening for women with low incomes and little or no health insurance.

A woman pouring herself a glass of water from faucet.

The independent, nonfederal Community Preventive Services Task Force recommends water fluoridation as an effective intervention for reducing cavities for entire communities. Even with the widespread use of products with added fluoride, like toothpaste, studies have found that people living in communities with water fluoridation have 25% fewer cavities than those without fluoridation.

CDC’s Division of Oral Health  works with state and national partners to improve water fluoridation quality by training drinking water, oral health and other public health staff. State officials and residents can access water fluoridation information through several online tools .

NCCDPHP promotes mental health and emotional well-being , social connectedness, and resilience through research-based health promotion and prevention programs.

To support people with mental health challenges, CDC offers a comprehensive Mental Health  website and the award-winning How Right Now / Qué Hacer Ahora campaign. How Right Now is an evidence-based, culturally informed communications campaign that provides tailored mental health resources to strengthen the emotional well-being and resilience of people with chronic stress, grief, and loss related to the COVID-19 pandemic and beyond.

Adults should get at least 7 hours a night of sleep, but one-third of US adults report that they usually get less. Not getting enough sleep is linked with many chronic diseases and conditions, including type 2 diabetes, heart disease, obesity, and depression. Not getting enough sleep can also lead to motor vehicle crashes and mistakes at work.

CDC’s Sleep and Sleep Disorders Program in the Division of Population Health  works to increase awareness about the need for good sleep and how to get enough.

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Practice Full Report

Promoting health and well-being in healthy people 2030, associated data.

Supplemental Digital Content is Available in the Text.

Healthy People 2030 describes a vision and offers benchmarks that can be used to track progress toward the goal of all people in the United States achieving their full potential for health and well-being across the life span. This vision can be realized through evidence-based interventions and policies that address the economic, physical, and social environments in which people live, learn, work, and play. Securing health and well-being for all will benefit society as a whole. Gaining such benefits requires eliminating health disparities, achieving health equity, attaining health literacy, and strengthening the physical, social, and economic environments. Implementation of Healthy People 2030 will by strengthened by engaging users from many sectors and ensuring the effective use and alignment of resources. Promoting the nation's health and well-being is a shared responsibility—at the national, state, territorial, tribal, and community levels. It requires involving the public, private, and not-for-profit sectors.

Healthy People provides science-based national objectives with 10-year targets for improving the health of the nation. Healthy People 2030—the fifth edition of the Healthy People initiative—describes a vision and offers benchmarks that can be used to track progress toward the goal of helping all people in the United States achieve their full potential for health and well-being across the life span. Healthy People 2030 expresses an expanded focus on health and well-being and an understanding that health and well-being for all people is a shared responsibility. This vision can be achieved through evidence-based interventions and policies that address the economic, physical, and social environments in which people are born, live, learn, work, play, worship, and age. High-quality data that are accurate, timely, and accessible are required to record and report on progress 1 over the course of the decade and to direct interventions to populations that are most likely to benefit from them.

Healthy People sets the federal agenda for the nation's health, guides its direction and allocation of resources, informs federal data collection and programmatic activities, and provides a model for promoting health and well-being at the state and local levels. The initiative's emphasis on promoting health and well-being signals to the nation that it is time to work across sectors to achieve health equity. This decade Healthy People 2030 is a resource for all sectors.

As part of the development of Healthy People 2030, the US Department of Health and Human Services (HHS) sought guidance from the Secretary's Advisory Committee on National Health Promotion and Disease Prevention Objectives for 2030 (Secretary's Advisory Committee), a federal advisory committee composed of nonfederal, independent subject matter experts. The Secretary's Advisory Committee presented recommendations to the HHS Secretary for developing and implementing the objectives for 2030. The Secretary's Advisory Committee convened regularly between December 2016 and September 2019, with meetings open to the public.

Health promotion has been a cornerstone of the Healthy People initiative since its inception in 1979. The Secretary's Advisory Committee recommended that the focus of Healthy People 2030 expand beyond health promotion to the broader purpose of promoting “health and well-being.” The process that has been called health promotion no longer focuses on health alone, but now leads to health and well-being for individuals in addition to society as a whole. This offers a chance to balance the needs of individuals and society. Society is defined as “a voluntary association of individuals for common ends.” 2 Health and well-being are elements among the common ends that motivate us, as individuals, to act for the good of all. In return for participating in society, individuals expect fair and just opportunities to be as healthy and well as possible. This article provides insights into defining health and well-being, promoting health and well-being, fostering user collaboration to improve health and well-being, and measuring health and well-being, in addition to implications for policy and practice.

The Secretary's Advisory Committee produced 2 detailed briefs that offered guidance for promoting health and well-being. Secretary's Advisory Committee members, joined by additional subject matter experts, developed these 2 briefs. The original documents are available on the HealthyPeople.gov Web site. 3 , 4

Defining Health and Well-being

Healthy People 2030 refers to health and well-being in every aspect of the framework, including the vision, mission, foundational principles, plan of action, and overarching goals. 5 The expanded role for health and well-being in Healthy People 2030 was supported by the Secretary's Advisory Committee's recommendations and its definition of health and well-being as how people think, feel, and function—at a personal and social level—and how they evaluate their lives as a whole. 6 How people think, feel, and function affects their beliefs about whether their lives have meaning and purpose 7 , 8 (Table ​ (Table1). 1 ). This definition recognizes the multilevel nature of health and well-being. It acknowledges that social structures, such as families, neighborhoods, communities, organizations, institutions, policies, economies, societies, cultures, and physical environments, strongly influence health and well-being. Such influence is reciprocal between individual, social, and societal health and well-being. *

The terms “health” and “well-being” describe separate but related states; health influences well-being and, conversely, well-being affects health. 9 Health incorporates both physical and mental conditions; it implies fitness under changing circumstances, such as degradation of the physical, social, or economic environments, and must be safeguarded against threats from illness, injury, or death. Safety, as a result, is an important determinant of health. Well-being is both a determinant and an outcome of health. 10 It encompasses objective and subjective elements and reflects many aspects of life and states of being. These include physical and mental, as well as emotional, social, financial, occupational, intellectual, and spiritual, elements. 11 The terms apply to individuals as well as to groups of people (eg, families, communities) and environments (eg, physical, social, economic).

The World Health Organization defines health promotion as:

The process of enabling people to increase control over, and to improve, their health. 12 Health promotion ... covers a wide range of social and environmental interventions that are designed to benefit and protect individual people's health and quality of life by addressing and preventing the root causes of ill health, not just focusing on treatment and cure. 12

The World Health Organization identifies 3 key elements for health promotion: good governance for health; health literacy; and healthy cities. Adding the concept of well-being to this definition emphasizes that promotion of health and well-being takes place across different environments and users.

Promoting Health and Well-being

The concept of promoting health and well-being at both personal and systems levels has evolved over history, starting with ancient and classical civilizations. 13 Policy strategies for promoting health have been proposed since the 1970s. 14 More than 3 decades ago, the Ottawa Charter for Health Promotion described health as a “resource for everyday life, not the objective of living.” It noted that prerequisites for health include “peace, shelter, education, food, income, a stable ecosystem, sustainable resources, social justice, and equity.” 15 This guidance remains relevant today. Promoting well-being requires engaging an expanded and diverse array of users, disciplines, and sectors that extend beyond public health, such as mental health, housing, childcare/education, business, and aging.

Interventions to promote health and well-being occur at the individual, site-specific community, and societal levels. They address economic, social, and physical environmental and political factors (“determinants of health”) that influence health and well-being. Promoting health and well-being is critical because determinants of health—the physical, social, and economic circumstances in which people are born, live, learn, work, play, worship, and age—have disparate effects on vulnerable populations. These factors interact to affect people disproportionately based on race and class. All sectors are needed to remedy such disparities and achieve health equity.

At the individual level, interventions to promote health and well-being might focus on health behaviors, employment, housing, food security, or childcare. These interventions also would apply to the community level since they target settings where people spend their time, including home, school, work, or places where they socialize such as community centers and parks. These interventions can address designs of the built environment for ease of access and to ensure safety. The Robert Wood Johnson Foundation's Culture of Health initiative is one such national model. The Foundation defines a culture of health as one in which “good health and well-being flourish across geographic, demographic, and social sectors; fostering healthy equitable communities guides public and private decision making; and everyone has the opportunity to make choices that lead to healthy lifestyles.” 16

The concept of promoting health and well-being has evolved over the decades (Figure). Health and well-being operate on more than 1 level. Broader conditions shape individual experiences of health and well-being, and organized efforts can influence those conditions. Social structures, such as families, neighborhoods and communities, and policies, economies, and cultures also play important roles. 17 – 21

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How the Concept of Health Promotion Has Evolved Over Decades of Healthy People

Engaging users from many sectors and ensuring the effective use and alignment of resources will strengthen implementation of Healthy People 2030. To promote health and well-being for all people and foster equity and social justice, socioecological factors and determinants of health must be addressed at all levels. A dynamic mix of resources will be needed for long-term improvements to livability (eg, stable housing, healthy food, clean air, education, living wage jobs) and for urgent needs (eg, acute care for illness or injury, food assistance, shelter, addiction treatment, disaster relief). Such resources will need to address a more diverse range of factors than in the past.

All too often, communities and institutions function in a reactive and responsive mode, deferring or delaying long-term investments. This way of functioning generates persistent needs for urgent services, along with pressure to maintain them. Collaborative decision-making across sectors can optimize the positive impact of resources and reduce the number of crises that happen in the first place. Identifying evidence-based programs to promote health and well-being among users can serve common interests, help users expand their thinking about solutions, and set priorities for limited time, money, and other scarce resources.

Multisectoral Collaborations to Improve Health and Well-being

Achieving population-level improvements in the coming decade will require users working at all levels to function across sectors and establish or participate in multisectoral collaborations. Such efforts can improve outcomes—not only in the health sector but also in nonpublic health or health care sectors, such as education, economics, the environment, and social cohesion. Collaboration among various users groups can benefit all partners by creating win-win solutions that recognize the interrelatedness of population health status with factors that lie outside the health care and public health systems.

Achieving optimal health and well-being requires efforts that include partners from different sectors, who operate at multiple levels (eg, state, local, community) and address the circumstances of people's lives. † Such efforts could span the behavioral, psychosocial, socioeconomic, cultural, and political circumstances of the population. No single actor has sole ownership of, accountability for, or capacity to sustain the health and well-being of an entire population. 22 – 24 The 10 “causes of the causes” of poor health comprise psychological influences (eg, social gradient, stress, and social exclusion), as well as elements of community infrastructure, such as food and transportation. 25 Thus, success depends on strengthening the capacity of communities to cocreate their own futures. 26

The COVID-19 pandemic is a case study of the reciprocal, complex relationships between the health of individuals and the health of society as a whole, as well as the resulting unintended consequences. An individual's decision not to wear a mask at a grocery store or other indoor gathering place can result in the virus' spread to other people who are present. Defining some workers as essential and required to work, such as those who work in grocery stores, transportation, health care, and in other occupations that require interaction with the public, increases the risk of infection for many low-wage earners. When essential workers are compensated with low wages, lack of financial viability creates challenges to their overall health and well-being. When health insurance is tied to employment and unemployment is soaring, unemployed people often delay seeking care. When older adults stay in isolation to avoid the possibility of infection, they can experience loneliness, depression, and mental health issues. When schools are closed and children stay at home, those who lack Internet connectivity are at risk of falling behind in their schoolwork. Those who receive free school lunches may go hungry.

To help local health departments identify strategies for promoting population health and well-being and addressing determinants of health, the National Association of County and City Health Officials (NACCHO) identified 9 domains of determinants, 27 as well as data sources for each (Table ​ (Table2). 2 ). Healthy People users at the state and tribal levels may find NACCHO's domains and data sources useful for identifying and acting upon opportunities to improve and monitor measures of health and well-being. These include indicators that are important to the success of other sectors, such as high school graduation, crime reduction, and economic prosperity.

Measuring Health and Well-being

Monitoring and documenting changes to the population's health and well-being will require the use of new data sources and types of measures. The way people evaluate their own lives as a whole is one indicator of health and well-being. Yet, systems that are outside of an individual's control shape the exposures, choices, and services that people experience. An important distinction exists between individuals' subjective ratings of their own health and well-being and the objective conditions that surround and support people as they strive to improve their health and well-being.

Measures of progress that go beyond those specific to public health and health care settings will require tapping into existing data sources across other domains and sectors. For example, data used by agricultural extension offices, planning departments at all levels, schools, businesses, parks and recreation agencies, transportation systems, the Bureau of the Census, aging services, and the financial sector, among others, can inform health and well-being. Data partnerships between public health, health care settings, and other sectors can often benefit collaborators by providing a much richer source of information for each partner as well as for the entire partnership. 28

Healthy People 2020 used functional measures, including Healthy Life Expectancy, ‡ Summary Mortality and Population Health, § and Disparities, as global health measures for assessing progress. Earlier iterations of Healthy People used life expectancy and other measures. ∥ Holistic evaluations of health and well-being status of individuals, communities, and systems require broad measures, such as life satisfaction or social cohesion. 29 – 33 Assessing progress toward improved health and well-being must consider health disparities, health literacy, multisectoral policies, and determinants of health and well-being.

Realizing the potential of Healthy People 2030 will require accurate data from credible sources at all levels, with a renewed emphasis on local action. There are barriers to generating high-quality data (eg, funding, staffing, technology). Healthy People supports local action by providing guidance for consistent data collection methods and measures, as well as examples of best practices and innovations. A data partnership infrastructure and network focused on Healthy People objectives could address and respond to new developments in data sources and data analytics. For example, a data partnership could expand the availability of locally relevant data, stimulate access to new data sources to measure determinants of health and health equity, and enable linkage of geographic and demographic data in presentation formats for Healthy People users.

Partners would be able to share data, methods, and analyses and access guidance on data developments relevant to all 3 Healthy People objective types—core, developmental, and research. A data partnership infrastructure and network that links national, tribal, state, territorial, and local data through partnerships and collaborations could enhance the nation's capacity to identify and record the achievement of Healthy People objectives and overarching goals.

Healthy People 2030 continues the Healthy People initiative's tradition of serving as a catalyst for action by expanding the focus of health promotion to promoting health and well-being (see Supplemental Digital Content file, available at http://links.lww.com/JPHMP/A716 ). This emphasizes the need to shift from a disease-specific orientation to more upstream policy efforts. Healthy People 2030 offers data, objectives, and tools for creating well-being and a healthier nation. Realizing the potential of Healthy People 2030 will require the active involvement of a variety of public and private institutions and organizations, including national, tribal, state, territorial, and local health departments. Health departments at all levels can contribute to this work by engaging multiple sectors in the implementation and monitoring of objectives.

Discussions within the public health community, and between public health and other sectors, around defining health and well-being offer opportunities to engage partners that historically have not been involved in Healthy People. Engaging new partners in the Healthy People initiative will require those who traditionally have led the initiative to understand what those partners need to succeed, communicate how new partners' goals complement those of Healthy People, and convey how engaging with Healthy People can benefit the new partners. For example, partnering to improve high school graduation rates benefits the education and public health sectors, as well as the financial sector and potentially the criminal justice system. Accomplishing that goal might involve engaging with the telecommunications sector to support students' access to affordable Internet service. By engaging in such partnerships, everyone would become more familiar with the goals of other sectors and discover more win-win opportunities.

In their health improvement plans, public health departments at all levels should think broadly about which partners from other sectors could help them advance health and well-being goals, while considering what public health can offer those sectors in achieving their own goals. For example, in Maryland, each county has been charged with having a local health improvement coalition that brings together key users to achieve locally identified needs for health and well-being and to eliminate health disparities. Organizations and individuals often need to see value for investing their time and resources before they agree to participate. Involving partners early allows them to be part of identifying issues and finding solutions.

Open access data portals at the state level are proliferating and can inform decision makers as well as the public. These data portals and related data dashboards provide community leaders and residents with current geographically tracked data and tools that support assessments and linkages to evidence-based interventions. These data initiatives offer yet another opportunity for partners to convene and develop collaborative programs for their respective populations.

One of Healthy People 2030's foundational principles is that “the health and well-being of all people and communities are essential to a thriving, equitable society.” Achieving health and well-being for all will benefit society as a whole. Achieving such benefits requires eliminating health disparities, achieving health equity, attaining health literacy, and strengthening the physical, social, and economic environments. Promoting the nation's health and well-being is a shared responsibility—at the national, state, territorial, tribal, and community levels. By enlisting the involvement of the public, private, and not-for-profit sectors in efforts to promote the health and well-being of our populations, we will improve the health of the nation and the achievement of Healthy People 2030's targets.

Implications for Policy & Practice

  • Across the field of public health, the focus on health promotion should be expanded to include health and well-being.
  • No one sector has the ability, responsibility, or needed expertise to promote health and well-being for all. Multisectoral approaches are needed to address the social, economic, and physical determinants of health and well-being.
  • It will be critical to identify common data sources and indicators that can be used to measure and evaluate trends in health and well-being.

Supplementary Material

* Other definitions exist of the terms “health” and “well-being,” respectively. This is the definition proposed for Healthy People 2030, and it considers “health and well-being” as a single term.

† In the coming decade, Healthy People 2030 will highlight innovative and successful state- and local-level efforts through HealthyPeople.gov, webinars, and other channels.

‡ Healthy Life Expectancy (HLE) includes the following: HLE free from activity limitations at birth/age 65 years; HLE free from disability at birth/age 65 years; HLE in good or better health at birth/age 65 years.

§ Summary Mortality and Population Health includes the following: life expectancy at birth/age 65 years; any activity limitation at birth/age 65 years; any disability at birth/age 65 years; percentage in fair or poor health at birth/age 65 years.

∥ Healthy People 2010 used Life Expectancy, Healthy Life Expectancy, and Disparities. Healthy People 2000 used Years of Healthy Life; Disparities; and Clinical Preventive Services.

This article is based on 2 briefs that were prepared by the Secretary's Advisory Committee on National Health Promotion and Disease Prevention Objectives for 2030 and are available online at HealthyPeople.gov . The authors acknowledge and thank the following contributors to these original briefs: Tom Kottke, MD, MSPH; Bobby Milstein, PhD, MPH; Rebecca Rossom, MD, MSCR; Matt Stiefel, MPA, MS; and Elaine Auld, MPH, MCHES.

The authors declare no conflicts of interest.

Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal's Web site ( http://www.JPHMP.com ).

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Women may realize health benefits of regular exercise more than men

Two women laugh and talk while power walking.

An NIH-supported observational study finds that even when women and men get the same amount of physical activity, the risk of premature death is lower for women

Women who exercise regularly have a significantly lower risk of an early death or fatal cardiovascular event than men who exercise regularly, even when women put in less effort, according to a National Institutes of Health-supported study. The findings, published in the  Journal of the American College of Cardiology , are based on a prospective analysis of data from more than 400,000 U.S. adults ages 27-61 which showed that over two decades, women were 24% less likely than those who do not exercise to experience death from any cause, while men were 15% less likely. Women also had a 36% reduced risk for a fatal heart attack, stroke, or other cardiovascular event, while men had a 14% reduced risk.   

“We hope this study will help everyone, especially women, understand they are poised to gain tremendous benefits from exercise,” said Susan Cheng, M.D., a cardiologist and the Erika J. Glazer Chair in Women’s Cardiovascular Health and Population Science in the Smidt Heart Institute at Cedars-Sinai, Los Angeles. “It is an incredibly powerful way to live healthier and longer. Women on average tend to exercise less than men and hopefully these findings inspire more women to add extra movement to their lives.”       

The researchers found a link between women experiencing greater reduced risks for death compared to men among all types of exercise . This included moderate aerobic activity, such as brisk walking; vigorous exercise, such as taking a spinning class or jumping rope; and strength training, which could include body-weight exercises.

Scientists found that for moderate aerobic physical activity, the reduced risk for death plateaued for both men and women at 300 minutes, or five hours, per week. At this level of activity, women and men reduced their risk of premature death by 24% and 18% respectively. Similar trends were seen with 110 minutes of weekly vigorous aerobic exercise, which correlated with a 24% reduced risk of death for women and a 19% reduced risk for men.   

Women also achieved the same benefits as men but in shorter amounts of time. For moderate aerobic exercise, they met the 18% reduced risk mark in half the time needed for men: 140 minutes, or under 2.5 hours, per week, compared to 300 minutes for men. With vigorous aerobic exercise, women met the 19% reduced risk mark with just 57 minutes a week, compared to 110 minutes needed by men. 

This benefit applied to weekly strength training exercises, too. Women and men who participated in strength-based exercises had a 19% and 11% reduced risk for death, respectively, compared to those who did not participate in these exercises. Women who did strength training saw an even greater reduced risk of cardiovascular-related deaths – a 30% reduced risk, compared to 11% for men.   

For all the health benefits of exercise for both groups, however, only 33% of women and 43% of men in the study met the standard for weekly aerobic exercise, while 20% of women and 28% of men completed a weekly strength training session.  

“Even a limited amount of regular exercise can provide a major benefit, and it turns out this is especially true for women,” said Cheng. “Taking some regular time out for exercise, even if it’s just 20-30 minutes of vigorous exercise a few times each week, can offer a lot more gain than they may realize.”  

“This study emphasizes that there is no singular  approach for exercise,” said Eric J. Shiroma, Sc.D., a program director in the  Clinical Applications and Prevention branch at the National Heart, Lung, and Blood Institute (NHLBI). “A person’s physical activity needs and goals may change based on their age, health status, and schedule – but the value of any type of exercise is irrefutable.”  

The authors said multiple factors, including variations in anatomy and physiology, may account for the differences in outcomes between the sexes. For example, men often have increased lung capacity, larger hearts, more lean-body mass, and a greater proportion of fast-twitch muscle fibers compared to women. As a result, women may use added respiratory, metabolic, and strength demands to conduct the same movement and in turn reap greater health rewards.  

The Physical Activity Guidelines for Americans  recommend adults get at least 2.5-5 hours of moderate-intensity exercise or 1.25-2.5 hours of vigorous exercise each week, or a combination of both, and participate in two or more days a week of strength-based activities.  

The research was partially supported by NHLBI grants  K23HL153888 ,  R21HL156132 ,  R01HL142983 ,  R01HL151828 ,  R01HL131532 , and R01HL143227 . 

Ji H, Gulati M, Huang TY, et al. Sex differences in association of physical activity with all-cause and cardiovascular mortality. J Am Coll Cardiol. 2024; doi: 10.1016/j.jacc.2023.12.019.  

About the National Heart, Lung, and Blood Institute (NHLBI):  NHLBI is the global leader in conducting and supporting research in heart, lung, and blood diseases and sleep disorders that advances scientific knowledge, improves public health, and saves lives. For more information, visit  www.nhlbi.nih.gov .

About the National Institutes of Health (NIH):  NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit  www.nih.gov .

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Tuesday, February 20, 2024

Women may realize health benefits of regular exercise more than men

An NIH-supported observational study finds that even when women and men get the same amount of physical activity, the risk of premature death is lower for women.

Women who exercise regularly have a significantly lower risk of an early death or fatal cardiovascular event than men who exercise regularly, even when women put in less effort, according to a National Institutes of Health-supported study. The findings, published in the Journal of the American College of Cardiology , are based on a prospective analysis of data from more than 400,000 U.S. adults ages 27-61 which showed that over two decades, women were 24% less likely than those who do not exercise to experience death from any cause, while men were 15% less likely. Women also had a 36% reduced risk for a fatal heart attack, stroke, or other cardiovascular event, while men had a 14% reduced risk.  

“We hope this study will help everyone, especially women, understand they are poised to gain tremendous benefits from exercise,” said Susan Cheng, M.D., a cardiologist and the Erika J. Glazer Chair in Women’s Cardiovascular Health and Population Science in the Smidt Heart Institute at Cedars-Sinai, Los Angeles. “It is an incredibly powerful way to live healthier and longer. Women on average tend to exercise less than men and hopefully these findings inspire more women to add extra movement to their lives.”    

The researchers found a link between women experiencing greater reduced risks for death compared to men among all types of exercise . This included moderate aerobic activity, such as brisk walking; vigorous exercise, such as taking a spinning class or jumping rope; and strength training, which could include body-weight exercises.

Scientists found that for moderate aerobic physical activity, the reduced risk for death plateaued for both men and women at 300 minutes, or five hours, per week. At this level of activity, women and men reduced their risk of premature death by 24% and 18% respectively. Similar trends were seen with 110 minutes of weekly vigorous aerobic exercise, which correlated with a 24% reduced risk of death for women and a 19% reduced risk for men.

Women also achieved the same benefits as men but in shorter amounts of time. For moderate aerobic exercise, they met the 18% reduced risk mark in half the time needed for men: 140 minutes, or under 2.5 hours, per week, compared to 300 minutes for men. With vigorous aerobic exercise, women met the 19% reduced risk mark with just 57 minutes a week, compared to 110 minutes needed by men.

This benefit applied to weekly strength training exercises, too. Women and men who participated in strength-based exercises had a 19% and 11% reduced risk for death, respectively, compared to those who did not participate in these exercises. Women who did strength training saw an even greater reduced risk of cardiovascular-related deaths – a 30% reduced risk, compared to 11% for men. 

For all the health benefits of exercise for both groups, however, only 33% of women and 43% of men in the study met the standard for weekly aerobic exercise, while 20% of women and 28% of men completed a weekly strength training session.

“Even a limited amount of regular exercise can provide a major benefit, and it turns out this is especially true for women,” said Cheng. “Taking some regular time out for exercise, even if it’s just 20-30 minutes of vigorous exercise a few times each week, can offer a lot more gain than they may realize.”

“This study emphasizes that there is no singular approach for exercise,” said Eric J. Shiroma, Sc.D., a program director in the Clinical Applications and Prevention branch at the National Heart, Lung, and Blood Institute (NHLBI). “A person’s physical activity needs and goals may change based on their age, health status, and schedule – but the value of any type of exercise is irrefutable.”

The authors said multiple factors, including variations in anatomy and physiology, may account for the differences in outcomes between the sexes. For example, men often have increased lung capacity, larger hearts, more lean-body mass, and a greater proportion of fast-twitch muscle fibers compared to women. As a result, women may use added respiratory, metabolic, and strength demands to conduct the same movement and in turn reap greater health rewards.

The Physical Activity Guidelines for Americans recommend adults get at least 2.5-5 hours of moderate-intensity exercise or 1.25-2.5 hours of vigorous exercise each week, or a combination of both, and participate in two or more days a week of strength-based activities.

The research was partially supported by NHLBI grants K23HL153888 , R21HL156132 , R01HL142983 , R01HL151828 , R01HL131532 , and R01HL143227 .

About the National Heart, Lung, and Blood Institute (NHLBI): NHLBI is the global leader in conducting and supporting research in heart, lung, and blood diseases and sleep disorders that advances scientific knowledge, improves public health, and saves lives. For more information, visit https://www.nhlbi.nih.gov . 

About the National Institutes of Health (NIH): NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov .

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Ji H, Gulati M, Huang TY, et al. Sex differences in association of physical activity with all-cause and cardiovascular mortality. J Am Coll Cardiol . 2024; doi: 10.1016/j.jacc.2023.12.019.

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