Amanda Pritchard is to be the new head of NHS England. I am sure everyone wishes her luck in her new and challenging role. The appointment of female head is not remarkable however, the workforce of the NHS is 75% female and the previous Chief Medical Officer (before Chris Whitty) was female. Women are doing very well out of the NHS, as employees and as patients. I do not care if the appointee is male, female, or a stuffed halibut as long as they are appropriately qualified and there was due process in making the appointment.
It was, however, disappointing to read in the Times, that ‘she was delighted to represent women‘. It sometimes a problem with high-profile female appointees that they see it as their role to represent women rather than the population as a whole. It is the reason why the Labour Party’s women-only shortlists have been such a disaster. Though parity between men and women in parliament is a desirable aim, appointees from such shortlists too often see it as their role to represent women and not their constituencies as a whole.
I hope Amanda Pritchard will be doing a lot more than representing the 51% of the population who are female. After all, the other 49% of the population is already underserved by the NHS. It is worth asking why 49% of the population are male rather than 50%. The reason is simple, every year from birth, the death rate for men is higher than that of women.
To put it stark terms, about 1 in 5 men doesn’t reach retirement age whereas the figure for women is 1 in 8. However, this gender death gap falls prey to the prevailing narrative that inequalities affecting men are their fault whereas the smaller number inequalities that affect women are due to structural problems with the NHS.
There is good evidence that health care facilities are less accessible to men of working age who, on average, work longer hours and at a greater distance from home. Though men are blamed for not visiting the doctor as frequently as women this is only true for men of working age. That suggests that it is not masculinity itself that is the problem. Men of working age are underserved by the NHS in general and primary care in particular. The figure below, that shows the gap in consultation rates between men and women of working age, is evidence of a health service that is more strongly focused on the needs of working women.
Looking at causes of death from the age of 5 to 49 the commonest cause of death among males is suicide. Will the new NHS chief be representing the interests of potential suicide victims who are three times more likely to be male? I hope so.
Similarly for cancer, though most charity fund raising and screening services are focused on female cancers, men are more likely to die from almost cancers that affect both sexes. There is, once more, a gender death gap.
Again, a gender death gap has been noted with COVID19, men are about two times more likely (age adjusted) to die from COVID. As usual the prevailing narrative has been that this is mens own fault and instead, the media concentrated on ‘long COVID’ that may affect women more, and mental health issues associated with lockdown where, once again the experiences of women have been in the foreground.
If you look at deaths from COVID19 among health care workers, 95% of deaths among doctors were men even though they comprise 55% of the workforce and among nurses 55% of deaths were among men although they comprise 10.5% of that workforce. Caroline Noakes, who is the Chair of the Women and Equalities Commission of the UK Parliament, at a time when many men were barely cold in their graves, sent the tweet below. This might have acceptable from an immature teenager but not form an elected representative with an equalities brief.
A more rational response to this higher risk of dying might have been to vaccinate men at an earlier age than women. When pregnant women were found to be at a slightly higher risk of hospitalisation from COVID compared to other women (but still lower than men of equivalent age), British MP Nadine Dorries was ‘shocked’ and attributed the problem to a lack of women on the Joint Committee on Vaccination and Immunisation – see here. Double standards from a feminist MP once again.
Given the adverse outcomes affecting men you might think men’s health would be a priority. If so, you would be disappointed. Alison Saunders when she Chief Medical Officer published a report The Health of the 51%: Women there was no equivalent report into the other 49%:Men. The situation has hardly improved – the department of health recently launched a sexist consultation on Women’s Health Strategy. When Nadine Dorries (again) who is a minister in Boris Johnson’s Government with responsibility for mental health, suicide prevention and patient safety was challenged on this matter in parliament, she replied that “The Department does not have a specific men’s health strategy” and “There are no current plans to launch a consultation on men’s health outcomes.” this is really and exercise in confirmation bias. If you only ask women about the problems that face them that is all you will find. The public in general and men in particular deserve something better than this.