The public debate has framed the response to the COVID-19 pandemic as a trade-off between lives and livelihoods, between health and the economy. This is a false choice. In this blog, MSc student Marine Delgrange discusses themes from the recent Global Health Initiative and Department of Health Policy event, How much is your health worth? The Human and Economic Value of Health in the Era of COVID-19
In his opening remarks, WHO Director-General Dr Tedros pointed out that “when people are healthy, they can learn and innovate, but when people are sick, the whole of society suffers.” This recognition highlights that health and economic development are in fact much more interlinked than we might first think – investments in health do not just prevent damage, they also boost the economy.
There have been moves to recognise the nexus between health and the economy. Two years ago, Alan Donelly and Ilona Kickbusch argued in favour of the appointment of a chief economist within the World Health Organization (WHO), in an article published in the Financial Times. Their call for a stronger integration of health and economics was not ignored, since it resulted in the creation of the WHO’s Council on the Economics of Health for All, announced in November 2020 at the end of the resumed 73rd World Health Assembly.
The new Council was the focus of How much is your health worth?, a recent event organised collaboratively by the LSE’s Global Health Initiative and the Department of Health Policy, which brought together in conversation the WHO’s Director General, Dr Tedros Adhanom Ghebreyesus, the new Council’s Chair Prof. Mariana Mazzucato, who is also the founding Director of the Institute for Innovation and Public Purpose at University College London, and Dr Clare Wenham, Assistant Professor of global health policy at LSE and a specialist of global health security.
Reaffirming the centrality of health in our societies: health as a “social good”
Until now, the main rationale underlying investment in health has ultimately been economic benefit. Unanimously, the speakers agreed that the time has come to reverse this mode of thinking, and instead recognise health as a “social good”. Recognising health as a core objective of economic policies is at the heart of the new Council’s mission: to “bring together different areas of policy which can no longer be seen separately from health”, and to “put health and well-being at the centre of how we think about purpose, value and growth”.
Recognising the centrality of health raises important questions about how we, as a global society, value health. If health is an investment, then we should not only account for it in terms of spending but look at the value it creates. “If we do not have a way to capture this added value, health only gets talked about as an expenditure”, argued Prof. Mazzucato. Far from being unprofitable, investing in the health sector has been shown to have a multiplier effect, by creating jobs that allow people to reinvest in the economy.
If health is an investment, then we should not only account for it in terms of spending but look at the value it creates
Should we put health at the centre of all policies? Investing in health is essential for economic growth, yes, and healthier people can better contribute to shaping productive, resilient and stable economies. But at the heart of the matter, investing in health also is a moral obligation we have to care for each other. “There are so many things in our healthcare system to which you cannot attribute an economic value”, recognised Dr Wenham when asked about how to include end-of-life care in the way we measure and value health. Many countries are struggling today, not only because they fail to identify health as the underlying route to development, but also because they do not see it as a fundamental human right.
Thinking about how we value health also raises the important issue of how to measure unseen and invisible labour, which are particularly common in the health and care sector. “People like community health workers are the most undervalued, underpaid people in our system. We need to find some way of attributing monetary or other value to the work they do” added Dr Wenham.
Reimagining the welfare state: what does a “health for all” economy look like?
The economics of health for all go far beyond the health system itself. In fact, the most cost-effective investments are those that prevent or delay people needing to use the healthcare system by addressing the reasons they get sick – the food they eat, the water they drink, the air they breathe and the conditions in which they live and work. In sum, investing in the health of our societies requires that we broaden our horizons by reaching beyond the health sector to tackle the social, economic and commercial determinants of health.
Achieving those objectives requires a complete redesign of the policymaking space, starting with what Prof. Mazuccato called “mission-oriented” policies. Instead of designing siloed strategies for each sector, we must identify the key issues at stake and bring all sectors together to solve them. Shaping policies with their objectives in mind goes hand in hand with outcomes-based budgeting. This implies rethinking how we invest in health, shifting from drug-focused investment to a greater emphasis on preventative changes, public health and primary healthcare. Importantly, the speakers warned that the success of such changes relies on strong political leadership as well as science- and evidence-based decision-making, drawing on the lessons learned during the pandemic.
When wars or pandemics occur, countries are forced into unprecedented spending and debt. We must recognise that investment is possible, if we treat the health of our societies with the same urgency as we do crises. Yet, instead of simply flooding the system with liquidity stimulus, which risks repeating the mistakes of the 2008 financial crisis by turning the current recession into a proper depression, reimagining the welfare state calls for our full creativity. “Building back better” first requires asking what that means – what do we need from the welfare state? How can we better work together to build a more resilient society?
When wars or pandemics occur, countries are forced into unprecedented spending and debt. We must recognise that investment is possible, if we treat the health of our societies with the same urgency as we do crises
Change will only be possible by making different, bolder and outcome-driven choices addressing the key challenges of today and tomorrow. First, we need to think of value as collectively created. Today, most of the liquidity generated ends back in the FIRE (financial, insurance and real estate) sectors. Instead, we need to ensure the value we create is reinvested in the real economy to benefit all. We must also discuss how to govern innovation for the common good, starting with research and development (R&D). We have to especially reimagine how to govern intellectual property rights in a way that meets the ‘health for all’ objective, and introduce the notion of collective intelligence. This requires a shift away from the prevalence of profit maximisation and towards that of collective value. Finally, we must look to corporate governance – the issues we are facing today require businesses, governments and civil society organisations to reinvent the way they work together and develop more symbiotic partnerships.
Some of the tools we need are already in our hands. Thinking about how to democratise access to COVID-19 vaccines and ensure fair distribution, for instance, the TRIPS agreement offers flexibilities to provisionally waive intellectual property. Implementing conditionalities around the use of COVID recovery funds, by restricting government aid to companies that do not use tax havens and are taking steps towards reducing their carbon emissions, is another way of ensuring that commitments which contribute to collective well-being are made. If we have the will, the ‘health for all’ economy is already within reach.
The views expressed in this post are those of the author and in no way reflect those of the Global Health Initiative blog or the London School of Economics and Political Science.
Photo by Benjamin Schneider on Unsplash