A Call for Government Agencies to Fill Research Gaps on Women’s Health

While women represent 50.4% of the US population, the costs of chronic conditions on women are likely underestimated due to underrepresentation of women in medical research.

To date, much of what is known about chronic disease is based on the bodies and health of men, which disservices women by resulting in inaccurate diagnoses, resulting in poorer health outcomes. And, although women live longer than men on average, women also have more years of disability or lowered quality of life due to disease years.

A new report by the National Academies of Sciences, Engineering, and Medicine (NASEM) reviews public health research related to many specific debilitating disorders including cardiovascular disease, depression, and metabolic disorders. It provides additional evidence that current efforts to understand women's health for regulatory science are incomplete-yet they are still used for policy decisionmaking.

NASEM is the nation's highest independent scientific body and is charged with providing objective analysis and advice to the US government so that policy can be guided by the best scientific expertise. US government agencies and departments will reach out to NASEM and ask it to investigate topics of interest. If it accepts, NASEM will assemble a committee of experts to investigate and create a publicly available report. NASEM reports can lead to many changes for the better, such as new, scientifically backed government policies, increased federal funding for research on the topic, or additional research projects.

NASEM report calls for a closer look at women's chronic health issues

In July, NASEM released a preliminary report identifying gaps in what is known about chronic health conditions that are specific to women or that affect women differently. It outlines glaring gaps in scientific knowledge of women's health and potential improvements to research methods, sheds more details on structural and social determinants of health, and provides a high-level description of differing impacts on women. The NASEM report recommends:

• Addressing inequities and women-centered research to improve diagnostic tools for women as it pertains to debilitating chronic disease

• Developing animal models that more closely resemble the human female

• Striving to understand, better diagnose, and create improved treatments for women living with multiple chronic conditions

• Seeking to better understand the mechanisms hormonal changes play in the development and outcomes of chronic conditions in women

• Creating new and better approaches for addressing symptoms during perimenopause, menopause, and postmenopause for women with chronic conditions

• Working to better understand the effects of structural and social determinants on chronic health conditions, by also focusing on the life experience of women and on trauma as a risk factor in the development of chronic conditions

• Investigating the role lifestyle behaviors have on the development of chronic disorders

Radiation exposure and women's health is still understudied

Evidence that radiation exposure affects women (and infants, children, and pregnant people) differently has grown over the years and has been examined by NASEM.

For example, NASEM has published landmark reports on the health effects of exposure to low levels of ionizing radiation. Two of these reports (BEIR V, BEIR VII) indicated that infants, children, pregnant people, and the female body are more susceptible than their adult, not pregnant, or male counterparts. This was proven by showing the health harms that can be caused by ionizing radiation disproportionately increased among these vulnerable groups after similar exposures in their counterpart peers.

Additional studies have been done by international scientific bodies, such as the International Commission on Radiological Protection (ICRP 84), to provide guidelines about using medical radiation during pregnancy, and the US Environmental Protection Agency Federal Guidelines Report examines cancer risk coefficients for environmental exposure to radionuclides (EPA FGR).

Overall, female breasts and thyroids are more radiosensitive (sensitive to radiation) than male organs, which implies that women and girls are more susceptible to harm caused by radiation (Makhijani et al. 2006, NCI 1997). Children are much more radiosensitive than their adult counterparts due to differences in size and development of organs (EPA's 1999 FGR 13 and CD supplement from 2002). For example, if an adult and infant drank milk contaminated with iodine-131 released by aboveground nuclear detonations, the infant would receive 13 times the radiation dose to its thyroid compared with the adult (Makhijani et al. 2006).

Unfortunately, the health harms of radiation for females and children are also often underreported when it comes to regulatory science. A briefing by the Nuclear Information and Resource Service (NIRS) explains this underreporting is due to only considering external exposures (gamma and X-rays) and not considering absorbed radiation, which the female body is much more prone to storing.

Still, there is not enough research or data to support a full understanding of these issues.

Organizations including the United Nation's Treaty on the Prohibition of Nuclear Weapons Science Advisory Group (SAG) advocate for newer research on radiation exposure that is not based on location from a detonation (since these exposures are rare). SAG also suggested further study on women's radiosensitivity.

When it comes to determining risks to the general population from harmful exposures to nuclear weapons materials, evidence-based research methods are a must to protect the public.

Sex and gender have different definitions

Often, the first step in defining women's health is in determining what defines a woman. Some gender rights problems in the regulatory science field are as fundamental as defining basic terminology. Inherent to this conversation is understanding the difference between sex and gender, and that currently regulatory science doesn't account for either accurately.

Within the NASEM report, the term "female" refers to biological sex (based on genetic coding or physical presentation) and "women" refers to the social construct of gender and how the person identifies. However, across the public health literature, these two concepts of sex and gender are conflated with each other, do not have inclusive gender categories, and rarely consider genetic aspects of sex to define biological sex.

Due to oppressive systems such as sex, gender, and gender expression bias, many studies assume people who identify as women were born female and that those born female identify as girls or women. This is still something the fields of regulatory science and public health need to better consider within their analyses since both can be false assumptions.

NASEM has also called for more study of low-dose ionizing radiation

There is also still far too little scientific knowledge about the effects of low-dose radiation on the human body in general. An earlier study by NASEM, published in 2022, highlighted the need for better understanding of low-dose radiation exposure (defined by NASEM as a single exposure of less than 100 mGy or 5 mGy/hour) on people across the United States.

One reason it is more difficult to understand the effects of low levels of radiation on cancer risk is because of the often-long latency from exposure to cancer development, but there is also a lack of research on chronic low-dose exposure and its association with health outcomes.

This report suggested creating tools for sensitive detection of radiation and precise characterization of cell and tissue changes, harmonizing across national health research databases, and ensuring access to research on low-dose radiation health effects. The recommended program is estimated to cost $100 million annually for its first 15 years of operation. Affected communities reported being excited about the following proposals:

• more research into non-cancer health outcomes

• additional focus on differential impacts (how exposure might differ based on gender, age, lifestyle, ethnicity, etc.)

• the importance of community involvement in research, including appropriate collaboration with Indigenous nations

More recently, research on low-dose radiation has been associated with increased cancer deaths as well. More specifically, mortality due to solid cancers among workers exposed to ionizing radiation increased with cumulative dose over time by 52% per Gy, when choosing a lag time of 10 years for cancer development. This lag time means that cancers that developed prior to 10 years after exposure are not included, since the science suggests the exposure would require at least 10 years to develop associated cancers.

"Regulatory scientists can protect all vulnerable people within the United States population by focusing regulations on the needs of those most at risk."

Dr. Chanese Forté, Union of Concerned Scientists

Current models used by regulatory scientists disservice women and children

These two NASEM efforts together highlight a key challenge in addressing low-dose radiation exposure in women and children. The "Reference Man" concept was developed by the International Commission on Radiological Protection (ICRP) and is used to estimate radiation doses and assess potential health risks. In a 1975 ICRP report, Reference Man is defined as a hypothetical individual with specific characteristics: he is an adult male, aged 20 to 30, weighing roughly 70 kg (154 lb), measuring 170 cm (5 feet 7 inches) in height, and lives in a climate with an average temperature from 10 to 20°C. Reference Man is also Caucasian and a Western European or North American in habitat and custom.

This model assumes specific anatomical and physiological traits that are considered average for the adult male population. It serves as a standard for designing radiation protection measures and for regulatory purposes. However, it has limitations because it does not account for differences in radiation sensitivity due to age, gender, or individual biological variability.

It is important to keep in mind the average modern male body is also very different from people who lived in 1975, especially by body mass index (height and weight).

Alternate models of a reference person exist and should be considered

More recently, regulatory scientists have chosen to average men and women's health risk estimates, but this overestimates men's risks and underestimates the risk to women. Regulatory scientists can protect all vulnerable people within the United States population by focusing regulations on the needs of those most at risk: women or children with increased radiosensitivity, and "frontline" communities (those with increased radiation exposure burdens due to their proximity to nuclear weapons testing, production, or waste). There are alternative models to Reference Man that could be employed, and you can learn more about centering women in regulatory science here.

Many community-led organizations have also called for a better understanding of women's health and exposure to radiation as well as a more protective standard for women. For example, Tewa Women's United (TWU), an Indigenous women's reproductive health and justice organization with a focus on the Pueblos (and a collaborator of UCS), has proposed a reference person called Nava To'I Jiya(Tewa for "Land Worker Mother Model"). The Land Worker Mother is a pregnant person who works and lives off of the land. As a universal environmental protection standard, this model would better protect the general public and the most marginalized in society.

Additionally, the Gender + Radiation Impact Project suggests "Radiation Girl," using a girl (15 years and younger) as the radiation model, which would also be more sensitive than current regulatory science methods for understanding women and children's health.

Nuclear weapons policy will benefit from more inclusive human health research

There are multiple aspects of the nuclear materials process such as uranium mining and plutonium processing that have harmed, and continue to harm, human health through intentional and accidental releases of toxic materials. Many people are still experiencing the health impacts of past exposures to the more than 500 atmospheric nuclear weapons tests conducted globally before such tests were banned in 1963. A study by the Centers for Disease Control and the National Cancer Institute concluded that any person living in the contiguous United States since 1951 has been exposed to some radioactive fallout.

Both nuclear policy and regulatory policy would be significantly improved by interrogating biased models of radiation exposure, improving our overall understanding of low-dose radiation, and increasing our sensitivity to the unique ways that women and female-identifying individuals experience chronic health issues.

Get involved with UCS and learn more about public health and nuclear weapons

The Union of Concerned Scientists is committed to creating more public health research and awareness of the risks to nuclear frontline communities. We would love to have more experts advocating for important changes to US nuclear policy in the name of public health-to join us in our fight against nuclear weapons, sign up here.

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