Why Government Matters: It Can Save Women's Lives

Good governance matters not only for tackling the issues in the headlines but also for saving lives from a cancer that we don’t much talk about.

I had a message the other day from Karen W., a Substack reader who wrote: “I have lost faith and trust in government. Could you please address why I should become a believer again?”

Let me try, because I genuinely believe in the capacity of government to improve lives. Good governance brought us the New Deal, civil rights laws, state universities and Medicare. Bad governance brought us the Vietnam and Iraq wars, soaring inequality, and shameful rates of child poverty. Wise leaders saved lives from Covid, while demagogues killed their constituents.

But sometimes good government is about steps that aren’t controversial or even very visible. So let me try to answer Karen by talking about a specific thing state government could do in this category that would save lives: a determined effort to make Oregon the first state to pretty much eliminate cervical cancer mortality.

A woman still dies every two hours in the United States from cervical cancer, and we can eliminate almost all those deaths. But we need a state to lead the way, and that can be Oregon.

In decades of writing about health, some issues have been particularly frustrating to cover, including AIDS, addiction, mental health, and reproductive health. I think that’s because we are at our worst at making policy on issues we find it hard to talk about. If AIDS had been transmitted by handshakes, we would have addressed it much more quickly. And cervical cancer kills women unnecessarily in part because it involves cervixes and sex.

In the United States and abroad, I’ve interviewed too many women experiencing this cancer, which is searing; in developing countries, it’s sometimes diagnosed in part by the smell of rotting flesh. The other thing that is wrenching about meeting these women is that deaths are so unnecessary: What is unusual about cervical cancer is that almost all mortality from this cancer is preventable today.

I’ve also written a great deal over the years about the need to address maternal mortality, but belatedly there’s now a serious effort in some states to reduce maternal deaths in the United States. Progress is being made, albeit too slowly. We need a similar push to address cervical cancer, which kills about six times as many women in America as maternal causes do. Cervical cancer gets so little attention partly because the women suffering from it are disproportionately poor, uninsured, and people of color.

I once interviewed a woman named Betty who had felt abdominal discomfort and bleeding, but she kept putting off a check-up because she was uninsured. Finally, the pain became too much, and she saw a doctor — who found a golfball-sized tumor on her cervix. Caught early, cervical irregularities can be dealt with before they even become cancerous; found late, in stage four cervical cancer, only 16 percent survive five years.

That’s why Betty spoke to me. “If one person doesn’t get cancer because I talked to you, it’s worth it,” she said.

Frequent testing can save lives by identifying cervical cancer early on, as shown by this data from the NIH.

Australia has become the first nation to be on a path to eliminate cervical cancer mortality, and Oregon could become the first state to do so. That would require two steps. First, we would need widespread HPV vaccination, for boys as well as girls and probably for some adult women as well (it’s best administered to children but evidence is emerging of efficacy even among adults, partly because the vaccine combats nine different strains of the cancer-causing virus). Second, we would need more widespread cancer screening among adults who have not had the HPV vaccination.

Oregon has a head start in both areas. In Oregon, 15-year-olds can make their own vaccination decisions, and doctors, nurses, and dentists can all vaccinate, making it easier to reach kids. Oregon’s version of Medicaid also offers broad access, and Title X-supported clinics including those of Planned Parenthood make free screenings fairly accessible. And with increased vaccination and screenings, we can pretty much eliminate deaths from cervical cancer as well as many deaths from other related cancers.

I reported a few years ago from this Title X-supported women’s health clinic, which provides contraception, STD treatment and life-saving exams for cervical cancer. Despite Republican efforts to cut it, Title X supports similar clinics in Oregon and across America.

I never again want to see a single woman suffering from this preventable cancer, and that motivates me. Yes, there’ll be challenges — vaccine hesitancy will be one — but the point of leadership is to tackle problems even when they are hard. And I believe in a vision of public service that isn’t reactive and isn’t limited to the issues in the headlines but also articulates its own agenda, rallies people behind it, and works hard to improve people’s lives in every way possible.

So, back to your question, Karen: If we have a moral compass and empathy, there are many ways to make a difference: nonprofits, health, education, journalism, public-spirited corporate behavior, and so on. But government can also be an instrument to serve our values, and it’s too important to give up on.

So, Karen: I understand your frustration and disillusionment, but to give up is to let the wrong side win. We have to fight the good fight, and maybe we can show that good governance matters not only for tackling the issues in the headlines but also for saving lives from a cancer that we don’t much talk about.