Climbing out of our boxes: advancing women's health for the twenty-first century

Abstract

Women's health research has come of age. The breadth, depth, and pace of discovery in women's health research in recent decades have been astounding. Whether one looks at basic, clinical, public health, or behavioral and social sciences, the explosion in the knowledge base is evident. Continued progress at an accelerating pace is expected for the foreseeable future. Advances in the basic sciences are unraveling the molecular and genetic mechanisms underpinning sex differences in health and illness, and are teaching us that hormones are only part of the story ( Institute of Medicine, 2001 Institute of MedicineExploring the biological contributions to human health. Does sex matter. National Academy Press, Washington, DC2001 Google Scholar ). Genomic research is providing new tools to advance the diagnosis and treatment of breast and ovarian cancer ( Burke, 2003 Burke W Genomics as a probe for disease biology. New England Journal of Medicine. 2003; 349: 969-974 Crossref PubMed Scopus (59) Google Scholar ). The landmark Women's Health Initiative study has dispelled long held beliefs about the risks and benefits of hormone replacement therapy ( Chlebowski, et al., 2003 Chlebowski, R. T., Hendrix, S. L., Langer, R. D., Stefanick, M. L., Gass, M., Lane, D., et al. (2003). Influence of estrogen plus progestin on breast cancer and mammography in healthy postmenopausal women: The Women's Health Initiative Randomized Trial. Journal of the American Medical Association, 289, 3243–3253 Google Scholar , Wassertheil-Smoller, et al., 2003 Wassertheil-Smoller, S., Hendrix, S. L., Limacher, M., Heiss, G., Kooperberg, C., Baird, A., et al. (2003). Effect of estrogen plus progestin on stroke in postmenopausal women: The Women's Health Initiative: A randomized trial. Journal of the American Medical Association, 289, 2673–2684 Google Scholar ). New evidence is rapidly accumulating about the role of diet and exercise in promoting women's health across the life course ( Jakicic et al., 2003 Jakicic J.M Marcus B.H Gallagher K.I Napolitano M Lang W Effect of exercise duration and intensity on weight loss in overweight, sedentary women A randomized trial. Journal of the American Medical Association. 2003; 290: 1323-1330 Crossref Scopus (377) Google Scholar ). There is a growing armamentarium of effective interventions to prevent and delay the adverse sequellae of chronic and disabling conditions, and a growing understanding of the nonclinical determinants of health. Dr. Bierman is the first Ontario Women's Health Council Chair in Women's Health Research in the Faculty of Nursing at the University of Toronto, and Senior Scientist in the Inner City Health Research Unit at St. Michael's Hospital, Toronto. Her research examines the impact of models of service delivery and finance on access, quality, and health outcomes, with a special focus on disadvantaged elderly populations and the unique needs of older women.