Women live an average of five years longer than men in the United States, but data suggest they spend 25 percent more of their lives in poor health. This paradox is the result of persistent and significant barriers to adequate and quality healthcare for women, such as inadequate representation in research, misdiagnoses and biases in healthcare, lack of affordable care, and a prioritization of family, careers, or other responsibilities over health.

Several researchers at the School of Public Health and beyond who are dedicated to closing this gender gap have contributed to the third edition of Women and Health, a new book that provides a comprehensive review of the current state of women’s health research in both established and emerging or understudied topics. Rather than focus primarily on reproductive health as other publications have done, the new book shines a light on the conditions and diseases that affect women at all ages, from breast cancer and heart disease to domestic violence, occupational hazards, substance misuse, sexually transmitted diseases, immigration, racial and ethnic disparities, aging, and more. As growing research suggests that behavioral changes in mid-life can improve health later in life, the book places an emphasis on middle-aged and older women. 

Coedited by Yvette Cozier, associate dean for diversity, equity, inclusion and justice and professor of epidemiology, the publication is geared towards the medical and scientific communities, as well as the general public, aiming to drive informed decision-making between patients and healthcare providers. Clinical treatment today is still largely based on male biology, as women were largely excluded from clinical trials until the 1990s; the book identifies a myriad of conditions and treatments that affect women differently than men, and explains how female and female-presenting individuals engage (or disengage) with the healthcare system through a racial, cultural, and geographical lens.

“Historically, women were always thought to be substitutes for men with different hormones,” says Cozier, who is also an investigator on the Black Women’s Health Study at BU’s Slone Epidemiology Center and studies the social and genetic determinants of health in African-American women. “This book provides updated data on a wide range of issues that affect women, and explore how circumstances influence the health of different groups—such as people of color or immigrants—in many different ways,” she says, “We can’t guarantee that the health data among one group will generalize to another group, and the health we see in any one country is a reflection of all who have come into it.”

Among SPH authors, Women and Health features chapters written by Cozier, Stephanie Ettinger de Cuba, research associate professor of health law, policy & management; Bernard Harlow, emeritus professor of epidemiology; Julie Palmer, professor of epidemiology; Lynsie Ranker, assistant professor of community health sciences; Lauren Wise, professor of epidemiology; Andrew Stokes, associate professor of global health; Virginia Cafferky and Claire Pernat, doctoral students in epidemiology and health services and policy research, respectively; Carley Ruemmele (SPH’24), alum and research policy analyst for BMC’s Children’s HealthWatch; Amy Zheng (SPH’20, ’26), alum and postdoctoral research fellow in the Department of Epidemiology, and Jonathan Berlowitz, research fellow in the Department of Global Health. Carl Streed, Jr., associate professor of general internal medicine at BU’s Chobanian & Avedisian School of Medicine and a primary care physician at Boston Medical Center (BMC), also wrote a chapter.

The authors synthesize the latest data and controversies around the scientific changes that have occurred within the field since the last edition, such as the role of genetics in medicine. They also address the major consequences of national policy changes on, and increased regulation of, women’s health—such as the elimination of the federal right to abortion in 2022, the Trump administration’s severe crackdown on immigration, and ongoing cuts to federally funded research—all of which have prevented many women from accessing necessary care.  

“Women’s health can only be as good as the laws allow, and right now, women’s health is being managed and adjudicated by people who are not women or who know very little about women’s health,” Cozier says.

Ettinger de Cuba, Ruemmele, and Pernat coauthored a chapter (along with Theresa Osypuk, professor of epidemiology and community health at the University of Minnesota School of Public Health) that explores how various social policies have affected women’s health. The chapter focuses on the structural levers underpinning women’s health and how policies can be shifted or redesigned to improve conditions for women and their families, says Ettinger de Cuba. 

“We review what research tells us about the relationship between women’s health and the content and design of diverse policies, including immigration policy and status, healthcare access, tax credits and cash transfers, family leave, childcare and work participation, and housing and place,” she says. “Our aim was not just to document challenges, but to explain why policies create conditions where women, especially from systemically marginalized backgrounds, face health and economic disparities.” 

They also recommend specific actions people can take to enact policy changes and promote research and education to better understand these issues—“all only more important in the current moment, where support of all kinds is being cut and stripped away,” Ettinger de Cuba says.”

Women and Health also examines the prevalence, risk factors, and knowledge gaps around several chronic illnesses and conditions, especially those that disproportionately affect women. Cafferky coauthored a chapter with Cozier on sarcoidosis, an inflammatory disease that commonly affects the lungs, skin, and eyes, and is often difficult to diagnose because there is no known cause, nor a specific blood test or scan to confirm it. Their chapter presents an overview of the epidemiology of the disease, including disease manifestations, risk factors, and downstream consequences, with considerations for women’s health.

“Sarcoidosis is a really complex condition, and there’s a lot of ongoing work to better understand it,” says Cafferky. “For example, female patients with sarcoidosis are more likely to see skin and eye symptoms than male patients, and there may be sex-based differences in certain risk factors for disease, such as menopausal hormone therapy.”

Harlow pens a chapter with Zheng and Nina Bohm-Starke, researcher at the Karolinska Institute in Stockholm, Sweden, on vulvodynia—another severely understudied disease that is also challenging to diagnose.  

“Based on updated literature, we estimate that by age 40, about eight percent of women may experience this debilitating and stigmatizing condition,” Harlow says. “We provide updated evidence that the etiology of vulvodynia may have immunological underpinnings with immune-related events as early as birth, and throughout the lifecourse, impacting subsequent onset.”

Click here to learn more about Women and Health.