Dr. Justina Trott Interview with RWJF Alumni Network

RWJF Alumni Network Human Capital Community presents:

XX or XY: The Impact of Sex and Gender on Health

Online Interview with Dr. Justina Trott,  and RWJF Human Capital Alumni network

April 23, 2012
Health Policy Fellows alumni Justina Trott, MD, FACP, is the director of policy, research and education at Women's Health Services, a nonprofit organization designated as a National Community Center of Excellence in Women's Health by the U.S. Department of Health and Human Services.  She is a fellow of the American College of Physicians, a clinical professor of medicine at the University of New Mexico Health Sciences Center, a core faculty member for the Northern New Mexico Family Practice Residency Program, and a Senior Fellow at the RWJF Center for Health Policy at the University of New Mexico.
The RWJF Alumni Network asked Trott to discuss her research on the impact of sex and gender on the social determinants of health. Below is the full interview transcript, used with permission by Dr. Trott and the Alumni Network.
Alumni Network:
Tell us some about the work you do now as the co-director of the Women’s Health Policy Unit, RWJF Center for Health Policy, University of New Mexico.
Justina Trott:
This is a new position and a new unit. So the majority of my time is spent building a coalition/partnership of organizations and individuals committed to women’s health policy and research, and raising awareness of the importance of full inclusion of women and men from all walks of life in the planning, creation and implementation of policy, programs and services in order for them to be effective. This is not just an equity issue; it is a practical approach. No one group is more or less important than another group, and each has an important perspective to contribute in creating effective processes and better health outcomes.
This effort requires new approaches and trans-disciplinary teams and tools—moving beyond multi- and inter-disciplinary approaches and creating real partnerships between the health sciences and the main campus, which is no small task in most academic settings.
Alumni Network:
What is the importance of incorporating sex- and gender-specific research into clinical practice?
Using a sex/gender lens can lead to a deeper understanding of the social determinants of health. Everyone understands the concept of sex even if they do not understand the extent to which sex differences exist from the sub-molecular to the cellular, to organ systems and whole people. However, many do not understand the difference between sex and gender, a social determinant of health.
Both sex and gender (being male or female) have a profound impact on the determinants of health, access to health care, accessibility of health information, and health outcomes. Simply put, your health is directly related to your biology and your social roles. Ignoring these can lead to adverse health outcomes. Biology (DNA, especially having XX, XY or some other combination of sex chromosomes) determines how the body reacts to drugs and toxins—how they are absorbed and metabolized and how they affect organs and hormones. It also determines how the body interacts with the built environment. For example, how your body size and shape responds to machinery and equipment. There are differences in women’s and men’s hearts, kidneys, livers, lungs, musculo-skeletal systems and body mechanics.
Health is also related to gender roles. Every society assigns gender roles based on sex. Gender roles are experienced through the other social determinants of health—race/ethnicity, socioeconomic status, age, abilities, sexual orientation/identity, geography, etc. Gender roles expose one to different environments. On-the-job risks for a high-rise construction worker are different from those of a secretary—one prone to falls and broken bones, the other to carpal tunnel injury. And gender interacts with sex and the environment to produce different health outcomes. Women and men die from heart attacks at different rates due to different signs and symptoms and how symptoms are communicated—chest pain versus shortness of breath. There are also differences in the underlying mechanism of heart attacks, differences in accessing emergency rooms and differences in awareness of heart disease.
I believe a deep understanding of the biologic and social determinants of health (sex and gender), and the processes of interaction between them, is necessary to address our most pressing health problems.
Alumni Network:
What is your perspective on today’s public and policy debates about contraceptive care for women and insurance coverage?
What is clear to me is the “debate” on insurance coverage of contraceptives is a religious construction that does not belong in any discussion about health, health care and insurance coverage. There is no question that providing contraception without a co-pay is cost-effective and prevents unplanned/unwanted pregnancies for both women and men. So if economics and health outcomes are not the reasons to exclude contraception from insurance coverage, what is at the core of this “debate”? We can explore the logical argument to its conclusion. If the religious argument is that contraception should not be free to a woman because she should not be having sex unless she wants to get pregnant, then Viagra should not be covered unless a man wants to become a father. This would virtually eliminate the need for insurance coverage of Viagra.
Alumni Network:
You completed your Health Policy Fellowship in Sen. Jeff Bingaman’s office in 2009.  What was the highlight of that experience, and what did you learn that you are using in your current position?
A highlight of my RWJF Health Policy Fellowship was the opportunity to work with Sen. Bingaman and his staff on both the Senate Finance and HELP (Health, Education, Labor & Pensions) committees. He was very inclusive in crafting health reform—insisting on honest, balanced discussions in hearings and ensuring that those without a voice were represented, especially the uninsured. His insistence on working together and tackling the hard questions stood out in an otherwise partisan legislative environment.
What I learned was crafting legislation is messy, does not follow a straight-line path and is relationship dependent. This understanding has helped me approach my work differently. As physicians we analyze data, make decisions and take action. Working in policy requires different skills and a different team configuration.
Alumni Network:
What do you expect to be your prime research interest or area of focus in coming years?
I have an interest in how the physical, social and legal environments differentially impact women and men in different populations—how their different biology and their assigned social roles interact with those environments to produce different health outcomes. At this time, I am looking at the implementation of, dissemination of information about, and evaluation of the Patient Protection and Affordable Care Act using sex- and gender-specific analytic tools. Among the many questions to address: What services, communication methods and quality indicators might need to be different for women and men?
End of Interview