Advancing Sex and Gender Equity in Health Research: A Roundup of the MESSAGE Project's Achievements
In the UK, medical research has long suffered from a significant oversight – the failure to adequately consider sex and gender in study design, participant selection, and data analysis.
This gap has perpetuated biases in medical knowledge, diagnosis, and treatment that can affect health outcomes for all people, in particular women and girls, trans, non-binary and intersex people.
Enter the MESSAGE (Medical Science Sex and Gender Equity) project, a collaborative initiative led by The George Institute for Global Health and Imperial College London, funded by Wellcome. Since its conception in 2022, MESSAGE is transforming how the UK approaches sex and gender in biomedical research, setting a new gold standard for scientific rigour and inclusivity.
The Problem at Hand
For as long as 30 years, the UK’s lack of dedicated sex and gender research policies has lagged behind other high-income countries, such as Canada, the US and European nations under Horizon Europe.
Our preliminary research in 2021 showed that none of the 17 largest UK medical research funders, nor the UK’s key regulatory bodies, required researchers to account for sex and gender in their studies.
A growing amount of evidence is highlighting how sex and gender can affect health outcomes – it is clear that something must change.
The MESSAGE Project: A Bold Step Forward
Through a series of Policy Labs beginning in 2023, MESSAGE has sought perspectives on this issue from across the research community. From funders, regulators, and researchers to academic publishers and patient representatives, all have played an important role in co-designing a new gold-standard sex and gender policy framework for the UK.
The framework, launched publicly in November 2024, will be used by research funders to adopt new policies, meaning all funding applicants will need to explain how they plan to account for sex and gender at the application phase.
The framework guides research funders and researchers on how to account for sex and gender, clarifying the definitions of sex and gender in the context of medical research, and providing guidance on designing equitable representation in study populations and conducting sex- and/or gender-disaggregated data analysis. It also makes recommendations for reporting sex and gender dimensions of studies in academic papers.
The framework will be accompanied by in-depth training resources on effective implementation of policies for funders, as well as how to meet new policy expectations for researchers.
A Wave of Sector-Wide Support
MESSAGE has sparked widespread engagement and commitment from key players in the UK’s medical research landscape. Over 30 organisations, representing £4.1 billion in annual research funding, have published statements of intent supporting MESSAGE’s aims.
These include some of the nation’s biggest funders, such as the National Institute for Health and Care Research (NIHR), along with regulatory bodies such as the Medicines and Healthcare products Regulatory Agency (MHRA), and academic publishers like The Lancet and BMJ.
In December 2023, MESSAGE was also cited in the UK Parliament by the Minister of State for Science, Research and Innovation, underscoring the project’s impact.
Building Momentum for Change
MESSAGE’s achievements are not just theoretical; they are paving the way for tangible policy change. Research funders, such as NIHR, have already begun to implement the MESSAGE policy framework into their funding processes, which in turn will foster equitable research practices.
To commemorate the launch of the policy framework, MESSAGE held a webinar featuring notable guest speakers, including Lucy Chappell, CEO of NIHR, Richard Horton, Editor-in-Chief at The Lancet, Diego Baptista, Head of Research and Funding Equity at Wellcome, Susan Cole, HIV activist, and Cat Bohannon, academic and author. This event wonderfully captured the enthusiasm and unity amongst the research community to advance research equity.
The Road Ahead
While the MESSAGE project has made great strides in addressing inequities in health research, there is still much more work to be done. We plan to collaborate further with academic publishers as well as pursue additional avenues to achieve sex and gender health equity, such as translating sex and gender evidence into clinical practice, through both medical education and revision of clinical guidelines.
We are also excited to expand the work of MESSAGE, applying our methodology to other geographic contexts and through the new MESSAGE Maternity project – which seeks to improve inclusion of pregnant and breastfeeding women in clinical research.
As awareness for MESSAGE continues to grow, we look forward to welcoming more individuals and groups to our cause to deliver equitable health research.
