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Moving Forward for the Health of Women: A Conversation with Dean Nancy J. Brown

April 11, 2022

Dean Nancy J. Brown, a physician-scientist and the first woman to become dean of the 212-year-old Yale School of Medicine, arrived in February 2020. Since her return to Yale, having graduated from Yale College, Dean Brown has championed efforts to enhance the medical school’s research, clinical service, and education.

Woven throughout these efforts is her dedication to a diverse, equitable, and inclusive environment in which all have a sense of being welcome. This is matched by the dean’s commitment to health equity, through which everyone’s health is optimized.

These goals guide the vision of both Dean Brown and Women’s Health Research at Yale. With the support of the school, WHRY advances equity by ensuring that the health of women is studied and differences in health outcomes between and among women and men are a focus of investigation. Aligned with the school’s commitment to improving health, WHRY also incorporates research findings into our teaching, shares new health information with the community, and uses emerging data to inform clinical interventions.

In a recent conversation, Dean Brown and WHRY Director Carolyn M. Mazure, PhD, spoke about the importance of research, the value of a focus on studying women, the influence of biology and social factors that differentially affect the health of women and men, community outreach, diversity, equity, and more.

Dr. Mazure: You have spent your professional life in academic medicine and have had the chance to see how academic health centers contribute to the greater good. In your view, what role do academic health centers like Yale School of Medicine play in advancing research to improve the health of our nation?

Dean Brown: Academic health centers and schools of medicine are the engines for discovery that drive improvements in health. Our scientists strive to discover new ways to think about pressing health concerns and compete for funding based on the innovation of the proposed research in shedding light on a critical health problem and the potential impact of the findings. In a medical school, clinical observations may inform research, enhancing its impact. Additionally, academic health centers offer the community early access to the application of discoveries into new therapies and diagnostics. Scientists from different fields can cross disciplines and work together to solve problems that cannot be solved by expertise in a single field. In addition, faculty collaborate across laboratory, clinical, and community research to provide multiple platforms for understanding the biological and social mechanisms that promote health and underlie disease.

Dr. Mazure: As you know firsthand, for a long time women were largely excluded as study participants, and the health of women was not adequately studied. Do you think this has changed?

Dean Brown: We have made great progress in the inclusion of women in research. Women’s Health Research at Yale has played a national role over the last two decades and has been rightly recognized for launching new research on women’s health, educating students and faculty about the health of women, and advocating for change. Yet, many more areas with regard to the health of women need our attention, and we have made less progress in delving deeply into differences in mechanisms of disease and responses to therapies in men and women. Here WHRY is leading the way by emphasizing the importance of understanding how sex and gender influence biology and behavior.

Dr. Mazure: For those who might be less familiar with the current scientific landscape, what would you say are the most urgent health concerns for women that research needs to address?

Dean Brown: We need to understand the impact of sex and gender on diseases and conditions that cause significant morbidity and mortality. These include cancer, cardiovascular disease, diabetes and obesity, and disorders in behavioral health. We also need to study reproductive health broadly, for example, in understanding that the health of a mother influences the health of the next generation. In addition, there is much work to be done in studying epigenetic effects — how environment and behaviors affect the way our genes operate. At a place like Yale School of Medicine, where there is so much scientific depth, it is possible to bring together scientists from diverse areas to tackle these issues.

Dr. Mazure: As WHRY approaches our 25th anniversary, why do you think it is important to have a center within Yale School of Medicine focusing on how sex and gender influence health?

Dean Brown: Centers such as WHRY serve as a model, a catalyst, and an academic home for the pursuit of knowledge covering a wide area of interests. By bringing investigators together, offering funding and guidance, and involving the community in its vision, WHRY has inspired research questions that might not have been considered. WHRY also contributes essential functions as a conduit for health information to medical and public communities and as a source for mentoring students and junior faculty members so they are prepared for their careers and embrace life-long learning.

Dr. Mazure: We know both biology and social factors, such as gender and race, influence health. Is the future of research to study both?

Dean Brown: We must study both, and we must rigorously test hypotheses. This requires following questions where they lead us. Too often investigators set out to prove a hypothesis rather than test a hypothesis. We must probe interactions among biological, environmental, and social factors with open minds and eyes for possible differences with significant health impacts. For example, we know that women of color more often give birth to low-birth-weight babies and suffer from higher rates of maternal mortality and that both biological and environmental factors interact to affect these outcomes. In my own area of research, hypertension, we understand that there are important interactions among genetic factors, dietary salt intake, and the production of hormones that increase under stress.

Dr. Mazure: Yes, this is a key point. At WHRY we often say that difference does not mean better or worse but that we need — without judgment — to account for how disease can affect people differently. I sense that more people need to hear this message when it comes to studying the influence of biological sex on health. From what you have seen, has studying sex as a biological variable kept pace with studying women in clinical investigations and become an integrated part of institutional research portfolios?

Dean Brown: Since the National Institutes of Health’s policy went into effect in 2016 requiring grant recipients to include female vertebrates and study sex as a biological variable, we have seen accelerated progress. Research has already shown how differences between and among women and men affect the risk of various diseases, the prevalence and course of those disorders, and response to treatments. This holds true across a wide variety of diseases and conditions, including cancers, cardiovascular disease, Alzheimer’s disease, and more. Again, more work is needed to encourage researchers to study mechanisms of sex differences in the laboratory. We now know that sex chromosomes affect signaling inside of cells, and cellular pathways are often regulated differently in male and female cells. These data contribute to promising avenues of research that would help us understand the mechanisms of disease and develop better prevention and treatment strategies for both women and men.

Dr. Mazure: We talked about translating research for the greater good in a broad sense. Can you comment on the importance of how research can help local communities advance? For example, how important is it for centers like WHRY to collaborate with communities that want to take action to improve health?

Dean Brown: As faculty, students, and staff of Yale School of Medicine, we are part of our larger communities of New Haven and Connecticut. It is not enough to advance discovery if we do not also benefit our community as well as the society as a whole. We need to listen to community members as we consider which health research questions we need to answer. We must engage local, state, national, and global partners in clinical trials and research and advance efforts to improve public health by implementing data-based results. I am encouraged by how WHRY is advancing community-based efforts in partnership with the Yale policy lab Elevate. It is exciting to see our school enabling public-private relationships that fund data-driven interventions and formulate cost-effective health policies to improve the lives of those living in difficult circumstances, especially pregnant and parenting women.

Dr. Mazure: The medical school has incorporated language into its mission statement to promote “an inclusive environment enriched by diversity.” You have called for YSM to be a place “where women and underrepresented in medicine (URiM) faculty, staff, and students thrive, and where diversity and excellence are inextricably linked.” What are some of the next steps in building diversity, equity, inclusion, and belonging (DEIB)?

Women’s Health Research at Yale has played a national role over the last two decades and has been rightly recognized for launching new research on women’s health, educating students and faculty about the health of women, and advocating for change.

Yale School of Medicine Dean Nancy J. Brown, M.D.

Dean Brown: Under the leadership of Dr. Darin Latimore, our deputy dean for diversity and inclusion, the YSM community has been engaged in self-examination and strategic planning. We understand that we must not only focus on recruiting a diverse student body, faculty, and staff but also on mentoring, sponsoring, and promoting those who are here as we continue to build an inclusive community. An important component of our strategic plan is measurement of our progress.

Dr. Mazure: How do you see WHRY advancing this work?

Dean Brown: Since early on, WHRY aligned with the individuals and groups advancing the tenets of DEIB at Yale School of Medicine. Most recently WHRY has been collaborating with the Office for Health Equity Research under the leadership of Dr. Marcella Nunez-Smith.

Dr. Mazure: Thank you Dean Brown for this opportunity to speak with you.

Dean Brown: You are welcome. We have a lot of good work ahead, and I look forward to making progress together.

Submitted by Rick Harrison on April 01, 2022