A new report from the World Health Organization Council on the Economics of Health for All raises many timely challenges for Australian governments and agencies, and also opportunities for reform and public health advocacy.
Melissa Sweet writes:
Governments have been urged to abandon economic frameworks that are devastating the health of people and the planet, and to adapt new paradigms that prioritise health for all.
A landmark report, released at the World Health Assembly in Geneva this week, says existing economic narratives, assumptions and tools need to be transformed so that economies support health for all.
The report – which highlights many relevant issues for the Australian political and policy context – argues that human and planetary health must be at the heart of how social, health and economic systems and policies are designed.
It calls for “a fundamental rethink of how value in health and wellbeing is measured, produced and distributed across society; and the adoption of a dashboard of metrics that prioritises human and planetary health”.
Given the disastrous consequences climate change is already having on health, Health for All should be seen as a guiding principle in making a just transition to a post-carbon economy, says the report.
It also calls for an end to governments’ aversion to investing in prevention and the social determinants of health, noting that subsidies for oil and gas industries end up burdening healthcare in the form of respiratory conditions from air pollution.
Rather than pursuing economic growth and Gross Domestic Product (GDP) maximisation regardless of the consequences, we need to value and measure the things that truly matter – human and planetary flourishing, says the report. It suggests as relevant metrics equal pay, childcare, mental health, Universal Health Coverage for all ages and access to green spaces.
GDP, on the other hand, treats many economic activities that are bad for human and planetary wellbeing as contributions to growth, and excludes many vital activities, including women’s unpaid caregiving work and the preservation of the natural environment by local and Indigenous communities.
The report is the result of two years of work by the World Health Organization Council on the Economics of Health for All, which was created by WHO Director-General Dr Tedros Adhanom Ghebreyesus in November 2020 in response to the COVID-19 pandemic.
An all-female group of 10 distinguished economists and area experts, the Council focused on re-imagining how to put Health for All at the heart of government decision-making and private sector collaboration at regional, national and international levels.
While the report references some of the literature around Health in All Policies, it does not use this term, or explain why it is not used.
New economic narrative
“We need a new economic narrative that transforms financing for health from an expenditure to an investment, grounded in fundamental truths: that wellbeing and the economy are interdependent; that health is not only a key economic sector but also a cross-cutting lens through which to view many different sectors; that health is critical to the resilience and stability of economies worldwide; and that states can move from reactively fixing market failures to proactively and collaboratively shaping markets that prioritise human and planetary health,” writes the Council’s Chair, Professor Mariana Mazzucato, Professor in the Economics of Innovation and Public Value at University College London.
The report urges governments to bust silos to enable departments and public sector agencies to develop, implement and oversee policies that achieve Health for All, and for ministers responsible for finance and the economy to see themselves not only as guarantors of macroeconomic stability, but also as active supporters of healthy and equitable societies.
Budgets across government for the likes of housing, transport and employment should be viewed and managed through the lens of determinants of health, says the report.
“Budgets for community centres, green walkways, nutritious food production and affordable housing should harmonise with progressive taxes and regulation targeting negative commercial determinants of health, such as the sale and marketing of ultra-processed foods,” it says.
As well, governments must investment in boosting the capacity of the public sector rather than relying on external consultancies, the report says.
“As COVID-19 made clear, the quality and capacity of government matters. Effective governments are not the smallest, but those that are well designed and properly resourced, both financially and in terms of their people and infrastructure. Re-investing in government capacity is crucial to delivering Health for All.
The report says conventional economic theory has convinced policy-makers that at best they can fix “market failures” – investing public money only when there is not enough private money. Instead, policy-makers must actively create and shape an economy that delivers on goals that are critical to human and planetary wellbeing.
“Reform is not just about spending more but about building the dynamic capabilities required to design public policies, partnerships, institutions and tools that are capable of delivering on bold goals, and to align investment, innovation and growth with these goals.”
Trust matters
Meaningful public engagement, accountability and trust are critical to ensure that governments can anticipate new needs and set goals that resonate with people, and to build support for the changes required to reshape economies.
In addition to building their capacity to work in the public interest, governments need to build public trust that they are doing so. Participatory mechanisms must be adopted more widely that both capture the public’s opinions and reflect them in central decision-making.
The public sector also needs to work harder and be smarter to communicate effectively with the public, especially on digital platforms, in order to tackle fake news and disinformation, which erode trust in public institutions. Digital infrastructure must be subject to standards that protect the public interest and personal information.
The report also calls for reforms to the governance of health innovation, including patents, arguing that the pandemic showed global innovation is not designed to facilitate access to all in need.
“The intellectual property system in the health sector currently protects secretive competition, monopolies and extractive financial behaviour. It thus entrenches structural patterns of dependency between high- and low-income countries.”
The authors say their findings are relevant for all countries – rich and poor – as it is likely that no country is currently meeting the needs of all its people and operating within ecological boundaries.
“Many high-income nations have strong social foundations but their carbon and material footprints are unsustainable. Many low-income countries are not putting undue pressure on the planet but experience severe shortfalls in providing for people. In this sense, every nation must take an unprecedented journey of transformation to bring about human and planetary health.”
The report gives a number of examples of health-promoting frameworks, including the Doughnut model and Genuine Progress Indicator, as well as the Wellbeing Economy Alliance, a network of six governments – Canada, Finland, Iceland, Scotland, Wales and New Zealand – and over 600 organisations, ambassadors, researchers and an increasing number of local hubs worldwide.
Another case study comes from Thailand, where joint budgeting has been used to pool resources from different departments and agencies into a common budget and bank account.
The report’s authors say they hope to have succeeded in articulating and advancing a new narrative that recognises health and the economy as interdependent and recasts financing for health from an expenditure to an investment.
Further reading
BMJ: Health for All: Transforming economies to deliver what matters
BMJ: An economics of health for all
Croakey: Calling all “frustrated champions” – Australia’s future needs you, now
