Health Care and Research Spend

[It has proved difficult to obtain a comprehensive, quantitative, picture of health care or health research spending in the UK by gender. This article is therefore rather woefully incomplete, but it’s what I have at present].

Contents of this Article

  • Total Health Spend in the UK
  • Cancer
  • Cardiovascular Diseases
  • Reproductive Health
  • Social Care Versus Health Care
  • London Data on Gendered Health Care Spend
  • Global Position

Total Health Spend in the UK

The UK Health Research Analysis Report 2014 estimates that a total of £8.5bn was spent on health relevant research and development in the UK in 2014. This includes spending by private companies. The report itself breaks down the spend provided only by 64 funding organisations, corresponding to £3bn of spend in 2014 (£2bn directly on research projects and £1bn on infrastructure). This should be born in mind when interpreting data from this source, below.

Cancer

The UK Health Research Analysis Report 2014 shows that cancer receives by far the greatest research funding of any health Category, namely £370M in 2014.

The article on All Cancers has already noted that 8,313 more males died of cancer in 2012 than females. Despite this greater mortality rate for males, we find the following funding situation…

The article on Sex-Specific Cancers has already noted that,

  • The cost of female-specific cancer screening programmes in the UK is £250M annually, but there are no male-specific screening programmes.
  • Girls are vaccinated against HPV via an NHS funded and organised programme, providing girls with protection against various cancers. Boys are not vaccinated on the NHS, nor even warned of the risk of HPV, despite being almost equally at risk of HPV related cancers.

Data shows prostate cancer has somewhat greater incidence and greater mortality than breast cancer. Despite that, this site indicates that research spending on prostate cancer is only about one-third that on breast cancer,

Breast v Prostate Research Funding

But the same site argues that because prostate cancer predominantly kills older men, whereas breast cancer has a higher incidence in younger women, this may justify the skew in funding. We shall see below, in the context of cardiovascular disease, that the same argument (that older people are less worthy of care) is regarded as invalid when the disadvantaged would be women.

In truth, the skew in funding may simply be due to the public empathy gap for males which is endemic. (For example, funding drives for prostate cancer, e.g., fun runs, attract only a few percent of the support as do equivalent funding drives for breast cancer).

Parliamentary Written Question No.24172 asked the Secretary of State for Health, what proportion of the NHS’s budget is spent on research and campaigns on (a) gender-specific cancers and (b) fertility treatment. The answer, given on 26/2/16, was essentially that, “Information on total spend by the National Institute for Health Research on research on gender-specific cancers and on fertility treatment is not available.” This strikes one as rather convenient. Perhaps they should be obliged to make it available.

The same parliamentary question gave data on the spend on publicity campaigns on cancer over the last three years, thus,

cancer 2012/13 £ million 2013/14 £ million 2014/15 £ million

Breast 70+

0.50 1.48
Ovarian 0.44 0.57

Prostate

0.07

Cardiovascular Diseases

The UK Health Research Analysis Report 2014 shows that cardiovascular diseases receive the fourth largest research funding of any health Category, namely £133M in 2014.

Anita Holdcroft writes, “research funding for coronary artery disease in men is far greater than for women, yet the at risk population of women, which is an older age group, suffers more morbidity and mortality. The lack of funding for women’s disease in effect maintains women’s lower economic status.” The second sentence appears to be a non-sequitur and reflects a political stance. No reference is given for the claim of greater funding into men’s coronary artery diseases (and I have not been able to find data). I suspect this claim about a gender funding shortfall actually refers to the bias towards using men in clinical trials of drugs, etc. One of the quoted references does indeed indicate that women form only 24% of clinical trial subjects on average (though up to 48% in some trials). However, this proportion of female subjects seems reasonable in view of the fact that women account for only 28% of deaths due to coronary artery diseases in the under-75s (see Heart Attacks / Coronary Disease).

There does appear to be evidence that coronary disease has in the past been under-diagnosed in women compare with in men (though I have a suspicion that this may be an artifact of failing to appreciate Bayes Theorem). However, modifications to the standard troponin test – now adopted by the NHS – will correct that issue. [Not to loose the opportunity for a spot of propaganda, on 21/1/15 Radio 4’s Today programme concluded a report on this issue with the false statement that “women are at greater risk of dying from a heart attack than men“. This is, of course, the reverse of the truth].

Having made these points, the reader should not loose sight of the fact that one of the (other) principal inequalities in respect of cardiovascular disease is socioeconomical group, with a strong north-south divide in the UK. Also, there are substantially fewer deaths due to coronary disease now than there were at the start of the millennium, due to the deceasing popularity of smoking. Deaths from heart attacks have halved over this period.

Reproductive Health

Reproductive health is arguably the area where the disparity between gendered need and research/clinical funding is most marked. Neil Lyndon has summarised the situation.

In Sperm Counts and Fertility in Men, Richard Sharpe has exposed the following serious issue. Sperm counts in men fell to half their 1930 level by the end of the twentieth century. This has led to men being roughly three times more likely to be in a nominally sub-fertile range. The cause is unknown. But the speed of the decline implies either a lifestyle or an environmental factor rather than a genetic cause. Sharpe says, “This also means that the decline is probably preventable, and possibly reversible. For this to happen, the problem has to be recognized, its causes elucidated and appropriate intervention or prevention implemented. To identify the causes requires that we know where and when to look.” But unfortunately almost no work is funded on the matter.

The hypothesis is that maternal lifestyle and/or environmental chemical exposure during the 8th to 14th weeks of gestation is to blame. There is strong evidence to show that maternal lifestyle during pregnancy can adversely affect sperm counts in adulthood. Smoking is one possibility, given that 25% of women smoke throughout pregnancy. But other environmental chemicals may be implicated, e.g., diesel fumes.

Sharpe opines, “sperm count also matters for men for reasons even more fundamental than fertility. It is a barometer of overall health; the lower your sperm count the greater your risk of dying“.

The UK Health Research Analysis Report 2014 includes a Category “Reproductive Health and Childbirth”, defined as covering: fertility, contraception, abortion, in vitro fertilisation, pregnancy, mammary gland development, menstruation and menopause, breast feeding, antenatal care, childbirth and complications of newborns. This Category is 17th in order of spend (total funding £47M in 2014). However, there is no specific mention of men’s fertility and the word “sperm” does not occur in the document. This does seems to reflect a gross neglect of this area.

To quote Neil Lyndon’s article, “No major subject in all of medical science is more neglected than male infertility. Treatment hasn’t advanced in 50 years. It still consists largely of general health advice – wear loose pants, don’t smoke, don’t drink, don’t be overweight.”

Collapse of the Sperm Count (Richard Sharpe)

Sperm Count

Social Care Versus Health Care

A 2015 BMJ paper illustrates the importance of social care in the overall spend. Whilst cancer is easily the heaviest funded of the research Categories, the total spend on dementia is far greater due to the social care costs, thus,

Dementia Cancer Stroke CHD

The relevance of this to gender is that dementia is twice as common in women than in men (probably simply due to women’s longer average life). Consequently the social care element for dementia may involve a gender-skew that swamps everything else. Note that the scale of the above histogram is £billions.

London Data on Gendered Health Care Spend

In 2012 investigative journalists Dan Bell and Emma Slater published the following articles Why is men’s health suffering in London?Male health initiatives get less money than those aimed at women and Get the data: Spending on male health and wellbeing services from which the following statements are derived.

In some parts of London men die up to 17 years younger than in wealthier areas.

This socioeconomic issue is strongly gendered. In some of the most deprived areas of London men die up to 12 years younger than women.

These observations stand in stark contrast to the relative health spend on the two sexes.

Of those boroughs that replied to enquiries, only four Primary Care Trusts (PCTs) commissioned specifically men’s services (at a cost of £11,135,291), while 15 PCTs commissioned women’s services (at a cost of between £13,156,785 and £13,429,785). For those with gender-based services that replied, women’s health services received £1,775,766 to £2,048,766 more funding than men’s over the past five years. The disparity in spending among PCTs was greatest in Brent, where nearly £3.5m was spent on female-focused third sector initiatives over the past five years, and nothing spent on men’s.

Through FOI requests it was discovered that in Haringey, Brent, Hammersmith & Fulham, and Camden, NHS PCTs spent a total of £4,830,095 commissioning women’s services outside the NHS over the past five years, and nothing on men’s. Westminster PCT did spend a significant amount on men’s services: £272,478, but spent £423,560 on women’s services – 50% more.

To be fair, Cathedrals, the ward with the greatest difference between male and female life expectancy, lies in the borough of Southwark and Southwark has bucked the trend – spending nearly £4.7m more on men’s initiatives.

Dan Bell quotes Alan White, Professor of men’s health at Leeds University and lead author of a recent EU report into men’s health, as saying that there was a real lack of initiatives directed at the male population. White said,

At the moment there is a blindness to the fact that there are men wanting to use the services and they can’t. There is a particular problem with working class men, who cannot adjust their hours. “If you’re not in the van at 8am, you don’t get paid, and so any services that are set during the working day are understandably difficult to access unless you have to go.” So that means a lot of preventative services are not accessible to men – would you lose a day’s pay to get your blood pressure checked, just in case it’s high? You tend to find no thought has been put into reaching out to men.’

The same sources provide data on the gender break-down of spending by local authorities on all third sector charities or voluntary services. Of the councils that responded, three times more was spent on services aimed at, or predominantly used by, women (£20,111,866.20), than men (£6,022,289.62).

Within these, the largest disparity in funding was in Barking and Dagenham, where nearly £4.8m more was spent on women’s services. Men’s life expectancy in this borough is the sixth lowest in the capital. The huge gap in spending is in part because a lot of the money directed at women is for services aimed at children, or women caring for older residents, or women who have suffered domestic violence. I note in passing that neither funding of carers nor funding of domestic violence victims should, if need be taken into account fairly, be so biased towards women (see Who are the carers? and Domestic Abuse).

Three of the wards with a large life-expectancy gap lie in Hammersmith and Fulham, where, borough-wide, the average life expectancy disparity between men and women is 6.5 years. In three of its 18 wards, the gap is 10 years or more. However, in 2011/12 Hammersmith and Fulham Borough Council spent £2,282,022 on third sector services primarily used by women, and just £282,970 on third sector services targeted at, or primarily used by, men — eight times as much was spent on female focused services. Meanwhile, the Borough’s PCT spent £428,319 on women’s third sector services and nothing at all on those for men.

The Global Position

The emphasis on women’s health issues to the detriment of men’s is not confined to the UK of course. For the USA see this for example. The global problem has been exposed forcibly by Sarah Hawkes in Gender and global health: evidence, policy, and inconvenient truths (The Lancet, Vol.381, No.9879, 2013) and also in this video. She is calling for more gender equality in global health funding,

In the past decade, global health funding has focused heavily on women. Programs and policies for men have been notably absent. If you look at the top 10 health problems around the world, they are much more common in men. But the current focus is predominantly on women’s health.”

Quoting the Good Men Project,

In 2000, global leaders at the United Nations agreed on eight ways to improve the lives of the poorest people around the world. One goal is specifically targeted at maternal health, and all of the other goals “touch on essential aspects of women’s well-being, and in turn, women’s empowerment is critical for achieving the goals,” according to the U.N. Women’s website. There are no goals specifically targeted at men, and men’s health doesn’t get its own website.”

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