Congratulations on your honorary doctorate and thank you for accepting the invitation to visit Stockholm University. In your public lecture, you presented many original findings, for example the unfavorable cohort trends in obesity or mental health problems among women. Most of these findings were from a large nation-wide study directly funded by the Australian government. Could you tell us more about the importance of that study and its potential to continue to inform practice and policy in your country but also in an international perspective?

Gita Mishra AO after having received her honorary doctorate at Stockholm University. Photo: Alex Summerfield

“Thank you. To receive this award is a such wonderful honour! The public lecture was also a great opportunity to present my research with more context than I can usually do in a scientific conference.

“My research in Australia mainly uses data from the Australian Longitudinal Study on Women’s Health (ALSWH), which is a flagship national study that has running since 1996. It has regular survey data on more than 50,000 women in four age cohorts. It also has record linkage to medical administrative data, such as for hospital admissions and prescriptions. This is why ALSWH is such important an outstanding research resource to inform policy and practice.”

“We now have data all the way from age 18 through to over 90 years. The cohorts partly overlap so we can see not only changes with age (for example bodyweight gain through midlife) but the differences between cohorts at the same age.  For example, around one third of women who are currently in their early 30s have obesity, in the previous cohort we did not see that prevalence until the women were in their mid 40s. Even for that cohort the prevalence is much higher than we saw in the next older cohort. Seeing this worrying trend visually, rather than just reading statistics, can really help convey to policymakers the implications for increased health services use and for chronic disease risks in the years ahead. This type of evidence is important not just for Australia, but internationally as we are seeing the same general trends in many countries.”

“Another more positive example with international relevance is the drop in current smokers in among Australian women both with age and across cohorts. There is some indication this drop corresponds with specific policies in Australia to reduce smoking, such as the use of plain packs for cigarettes. Other countries can consider this evidence when developing their own health policy initiatives in this area.”

You lead an extensive international collaborative project on cross-county comparisons of women health InterLACE. What do you see as the main added value from this international collaboration and which results from InterLACE were most impactful in changing practice of policy?

“I established InterLACE to address some of the key issues I saw with existing studies. The reason InterLACE is such a powerful collaboration, is that we combine individual level data form many different studies – we now have individual data from 1.2 million women from 35 studies in 19 countries. InterLACE provides the scale and scope to investigate topics and generate robust evidence not possible with any single study. For example, if you see the same result across different ethnic groups, then it is likely to be some common biological mechanism at work. Alternatively, if one country is different, it may be due to a specific policy at work. Overall, the findings carry far more weight for professional and international agencies, such as the WHO, than a study from an individual country.”

“One of the best examples is our work on primary ovarian insufficiency (POI) and early menopause. It is usually challenging to do epidemiologic research on the 1-2% of women with POI, where menopause occurs before age 40 years. With InterLACE we have the numbers to show that early menarche, nulliparity, and a history of infertility or recurrent pregnancy loss are all risk factors for POI and early menopause, which in turn are both linked with increased CVD risk, osteoporosis, and multimorbidity. These results were the first to reveal robust evidence in relation to POI and early menopause. It is a slow process, but these findings are starting to be reflected in the greater emphasis placed on POI and early menopause in clinical guidelines (for example NICE in the UK) and in position papers (for example from European Menopause and Andropause Society).”  

Your work in developing methods for life course epidemiology is very well known and you also published numerous review papers, chapters and edited a book on Life course approach to women’s health. What are the main advantages of this approach for informing policy and for improving the health and well-being of women? Could you give us an example?

“The various outputs have different roles beyond the research realm. The scientific papers form the evidence base, but we have reviews or commentary on their implications in publications that are specifically directed at clinicians. The book provides a foundational text in the field for students and for those who want a more comprehensive background. Another important form of output is the evidence review that is used to support policy development. In Australia this has been crucial to ensuring the life course approach is central to the Women’s Health Strategy both at the national and state level.”

Co-production of research, acknowledging the importance of lived experiences, and interactions with users and stakeholders are very important for addressing complex societal issues such as women’s rights, violence or access to effective care. What is your experience from working with different actors in the specific area of women and girls’ health and what do you see as immediate priorities for research on women and girl’s health in the context of high-income countries and in the context of middle- and low-income countries?

“This follows on from the response above, where it is essential that we engage with stakeholders and the community at each stage. This is a two-way process as we can listen to their perspectives and that collaboration not only informs the research questions but frames our knowledge translation activities.”

“I think the key priority in high income countries is to ensure we have full involvement of women from diverse backgrounds as these groups can often be overlooked in datasets, especially those that date back several decades. We are starting to see considerable progress in InterLACE with the growing availability of data from low and middle income countries. One of the interesting areas emerging is comparison of specific communities living in high income countries, say South Asian women in Australia with women in India.”

Your public lecture at Stockholm University was well attended, with many students and junior researchers engaging in the discussions. For students and junior researchers who would like to join this specific research field and contribute to improving the health of women worldwide, what would be your main advice? 

“I think the key is to develop one or two specific areas of expertise, this may be biostatistics, or paper writing, or organizational and people skills for collaboration and knowledge translation. Then combine these with a research topic that you are passionate about and where you want to make a difference. This means you will always stand out and will have something of value and enthusiasm to contribute to a team.”

We have just learnt that you were awarded The Officer of the Order of Australia for your distinguished service to Australia and humanity at large. Could you tell us more about the importance of this honor and how it will help to advance your work for women’s and girls’ health and rights in the near future?

“This year has been very special. The award in Australia is wonderful recognition by the broader community and a seal of approval for all the hard work. It’s a well-recognized national honor and it provides an ongoing opportunity and an influential network to highlight our research.”