Wes Streeting has said women have been treated like ‘second-class citizens whose voices don’t matter’. ‘The blunt reality is the NHS is failing women and girls on even the most basic measures of healthcare,’ he added. The Health Secretary’s new women’s health strategy promises £72 million. The problem is that his new men’s health strategy promises £79 million. The gap is small, but quite enough to put him in trouble. Athena Lamnisos, CEO of a gynaecological cancer charity, has deployed herself across an eager press to protest the inequity. ‘Acknowledgement is not enough,’ she has said. ‘Ring-fenced funding is what we need.’
£7 million is an NHS rounding error, but the argument shows how healthcare priorities get twisted by pressure groups, media opportunism, and habitual thoughtlessness. This is the modern NHS: ever more bloated, ever more inefficient, and endlessly in search of headlines, not outcomes. The question is not what produces the greatest gains in health, but who shouts loudest.
Despite being male, I have a professional bias toward women’s health. I’m an NHS physician, but I’m also chief scientific officer for a biotech startup. Our focus is on endometriosis, where tissue normally confined to the lining of the womb grows elsewhere in the body, causing a catalogue of misery. Diagnosis takes almost a decade, partly because it can still require surgery.
We don’t need more government. We need less, but better
Medical misogyny plays a part too, and women’s health complaints have been overlooked by a majority male profession. That situation is changing, not least because most doctors are now women. We’re looking at endometriosis, and in a rational market, that’s another way of saying we think we can make money. Unmet clinical need is unmet demand. Capitalism isn’t perfect, but in many situations it’s the best there is. We’re doing privately what the state hasn’t done and does poorly when it tries. I think we’ll succeed, and making money by doing good is one of capitalism’s more attractive features.
Ring-fenced state funding is different. A serious system would fund what works best, what delivers the best outcomes per pound. That should be the relentless focus, with allowances for a minority of cases where unusual suffering justifies special treatment. What we’re seeing in these latest announcements is nothing of the kind. This is not government in the best interests of society, but policy driven by advocacy groups, public relations, and the thirst for headlines.
We really are failing in women’s health, but it’s not in the way you might imagine. The biggest modifiable cause of death and disability in the UK is cardiovascular disease, chiefly heart attacks and strokes. Women are underdiagnosed and undertreated. Heart disease is still thought of as male, but it kills far more women than breast cancer. The gender gap in cardiovascular medicine is a national scandal, but it doesn’t lend itself to headlines. So neither the pressure groups nor the politicians have been as interested. They are driven by what plays well, not by what preserves health.
An analysis published this week by the Health Foundation showed that our healthy life expectancy is falling. Across other comparable countries it’s rising. Women live longer than men, but spend a smaller proportion of those years in good health: 73 per cent, compared with 77 per cent for men. The extra years are largely years of ill health.
The government has responded by promising ‘radical measures such as a generational ban on smoking and clamping down on junk food advertising’. The blob recognises that the fundamental problems are economics and lifestyle, and it reckons the right response is social engineering.
The state can’t help shaping behaviour, but it should try to resist doing it so badly. Bans and inspectors, and ever more intrusion by a swelling state and its public health allies, generate noise, not health. We don’t need more government. We need less, but better. We need the incentives that encourage people to work and be active, not ones that usher them into lives of income support and the disease labels that invite people to feel powerless and act the part.
If our goal were nothing more than gender equity in life expectancy, we would barely fund healthcare for women at all – they live much longer than men. But our better goals are effectiveness and efficiency. By these measures we fail women badly, and in different ways we fail men too. We often talk about the health of the body politic. Ours is failing, in grand strategy and in squabbles over £7 million alike. Our habit is to meddle incompetently. As a result, we provide our country with a worse economy, a deteriorating civil society, an ever bigger NHS, and ever poorer health outcomes.
If my work goes well, it will soon become straightforward to diagnose and monitor endometriosis without surgery. The same technique could also bring radical improvements in inflammatory arthritis and interstitial lung disease. The latest news adds to the ample evidence that, overall, we’re going backwards. Science ratchets forward. Politics does not.
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