Following the money

Maryann Selfe approaches women's health as a healthcare investor, and her first instinct is to look at capital flows. Speaking to Michael Macfarlane, she points to about US$4 billion flowing into health tech venture capital in the first quarter of 2026, roughly 25% more than a year earlier. Healthcare private equity funds raised about US$18 billion in 2025, she says, while generalist funds struggled. In women's health specifically, she cites an SVB report showing about US$10.7 billion raised in 2024, a 55% increase on the year before, and more than a tripling between 2019 and 2025.

She also follows corporate buyers. Selfe notes that a Belgian pharmaceutical company, UCB, paid US$2.2 billion for a company with technology targeting autoimmune disease, which she describes as primarily affecting women, and that Eli Lilly paid US$3.25 billion for Kelonia, whose platform has a secondary indication in lupus. Her reason for leading with these numbers is practical. Male or female, an allocator wants to win, so the most persuasive case is the investment thesis and the path to a return, with impact as a strong secondary argument.

Three forces converging

Selfe's view that the trend is durable rests on three forces arriving together. The first is scale. By 2030, she says, there will be 1.2 billion women in menopause, an area with little research and few therapeutics until recently, and she notes that two new treatments for hot flushes have just reached the market. The second is longevity. For the first time, women may spend up to a third of their lives after menopause, bringing conditions such as Alzheimer's and dementia, where two of every three sufferers are women, and autoimmune disease into sharper focus. She points to almost US$10 billion flowing into autoimmune therapeutics platforms in a single quarter.

The third force is the one Macfarlane raises at the outset. More women are becoming decision-makers over capital as part of the great wealth transfer, which Selfe sees as a multi-decade process running to 2048. What matters, in her account, is that capital, lived experience of the gaps in healthcare and decision-making power are converging in the same hands for the first time. These allocators, she says, will recognise that they pay out of pocket for menopause care and that diagnoses such as endometriosis can take 10 to 15 years.

So it's not if the capital will flow into building solutions for the future of health care for all. It is as a capital allocator, what side of that trade do you want to be on?

— Maryann Selfe, Wealth Office

Macfarlane adds a caution of his own. Most major investment decisions are still made by men, he says, and the value-creation potential, which he compares to the commercial impact of Viagra, should interest them too.

Europe's funding gap

The opportunity has a geography. Selfe compares successful European biotech companies, which she says raised about US$25 billion between 2015 and 2025, with their US counterparts, which raised about US$219 billion over the same period, nine times as much. Europe's capital pool, in her view, is not as deep or as well organised. Of 67 European biotech companies that raised capital through public listings in the last six years, she says 66 did so on foreign exchanges, mostly in the US, and many are acquired by US firms at attractive valuations simply to survive.

Macfarlane sees a parallel in his own work with Asian families. Europe and the UK, he argues, have long struggled to monetise their intellectual property, and he regards much of Europe as a difficult place for businesses to grow. Selfe sees a specific role for Asian long-duration capital in cross-border partnerships with European life sciences companies. She notes that Singapore has more than 2,000 single family offices compared with about 400 in 2020, and that Hong Kong has around 3,800, a large concentration of flexible, intergenerational capital. Asia's ageing populations, she adds, mean the social impact would be felt strongly there.

Where value inflects

Selfe's case for family capital over institutions turns on the shape of the opportunity. These are scientific and medical innovations in drug discovery, drug delivery and diagnostics, with long commercial timelines. She argues that venture capital is probably not the ideal vehicle, and that pension funds and endowments are often excluded because the investment infrastructure is immature or regulation prevents them. Long-duration capital with a flexible mandate and purpose at its heart, she says, is a natural fit.

It's not just a health care issue, it's a systems design issue.

— Maryann Selfe, Wealth Office

She compares the stages of value in healthcare to inflection points. An idea leaves the laboratory, gains a proof of concept, passes preclinical safety work, enters clinical trials and secures regulatory approval. In her view, much of the value is created between seed and Series A or B, before commercialisation, a stage occupied mainly by early-stage investors and family offices. She cites Kelonia, which raised a US$104 million Series A in 2022 before its acquisition.

The harder question, Selfe says, is how to gain exposure. Innovation is spread across the United States, Europe's universities and Asia, where she notes Korea ranks third in the world for drug discovery. Private markets carry heavy information asymmetry at the early stages. A family office can build an internal team able to run scientific, clinical and commercial due diligence, or work with advisers who have that network. Identifying the theme, she says, is only the starting point. Constructing the portfolio is where the work lies.