Why econ­o­mists put health first

Financial Mirror (Cyprus) - - FRONT PAGE -

In short, yes. That’s why we joined hun­dreds of fel­low econ­o­mists in al­most 50 coun­tries to urge lead­ers to pri­ori­tise in­vest­ments in univer­sal health cov­er­age. And the broader i mpe­tus be­hind this Econ­o­mists’ Dec­la­ra­tion, con­vened by The Rock­e­feller Foun­da­tion and now with more than 300 sig­na­tures, has placed global health and de­vel­op­ment at a his­toric cross­roads.

In Septem­ber, the United Na­tions Gen­eral As­sem­bly adopted a new set of 15-year global goals to guide the world’s ef­forts to end poverty, foster in­clu­sive pros­per­ity, and se­cure a healthy planet by 2030. As world lead­ers pre­pare to en­act the most am­bi­tious global to-do list yet – the Sus­tain­able De­vel­op­ment Goals will be launched on Jan­uary 1 – de­cid­ing where to be­gin may seem a daunt­ing task.

For econ­o­mists, how­ever, the an­swer is clear: The next chap­ter of de­vel­op­ment strat­egy should as­sign a high pri­or­ity to bet­ter health – and must leave no one be­hind.

Reach­ing ev­ery­one with high-qual­ity, es­sen­tial health ser­vices with­out the threat of fi­nan­cial ruin is, first and fore­most, the right thing to do.

Health and sur­vival are ba­sic val­ues to vir­tu­ally ev­ery in­di­vid­ual. Fur­ther­more, un­like other valu­able goods, such as food, they can­not be sup­plied with­out de­lib­er­ate so­cial pol­icy.

The fact that “pre­ventable deaths” re­main com­mon in low- and mid­dle-in­come coun­tries is a symp­tom of bro­ken or un­der-re­sourced health-care de­liv­ery sys­tems, not a lack of med­i­cal know-how. If we in­crease in­vest­ments in health now, by 2030 we can be that much closer to a world in which no par­ent loses a child – and no child loses a par­ent – to pre­ventable causes.

Univer­sal health cov­er­age is also smart. When peo­ple are healthy and fi­nan­cially stable, their economies are stronger and more pros­per­ous. And, with ben­e­fits ten times greater than ini­tial costs, in­vest­ing in health first may ul­ti­mately pay for the rest of the new global de­vel­op­ment agenda.

So, the ques­tion is not whether univer­sal health cov­er­age is valu­able, but how to make it a re­al­ity. More than a hun­dred coun­tries have taken steps down this path; in the process, they have re­vealed im­por­tant op­por­tu­ni­ties and strate­gies to ac­cel­er­ate progress to­ward the goal of health for all. In par­tic­u­lar, we be­lieve that three ar­eas – tech­nol­ogy, in­cen­tives, and seem­ingly “non-health” in­vest­ments – have the po­ten­tial to ad­vance univer­sal health cov­er­age dra­mat­i­cally.

First, tech­nol­ogy is fast be­com­ing a game changer, es­pe­cially in de­vel­op­ing coun­tries, where the gap in ac­cess to health care is the widest. In Kenya, which al­ready leads the world in mo­bile money through “m-PESA,” an up­surge in telemedicine is en­abling ru­ral pa­tients and health prac­ti­tion­ers to in­ter­act, through video con­fer­enc­ing, with staff in Kenya’s main hos­pi­tals – thereby in­creas­ing qual­ity of care at very lit­tle cost.

The m-PESA Foun­da­tion, in part­ner­ship with the African Med­i­cal Re­search Foun­da­tion, has also be­gun im­ple­ment­ing on­line train­ing of com­mu­nity health vol­un­teers and com­ple­ment­ing th­ese train­ings with bulk SMS/What­sApp group mes­sages to keep the group con­nected and share im­por­tant up­dates. In­vest­ments in high-value, low-cost tech­nolo­gies will help us achieve more with ev­ery dol­lar.

Har­ness­ing the power of in­cen­tives is an­other way to ac­cel­er­ate health re­forms. This can and should be done with­out forc­ing the poor to pay for health-care ser­vices at the point of de­liv­ery.

For ex­am­ple, when the state pays the pri­vate sec­tor based on out­comes (for ex­am­ple, the num­ber or share of vac­ci­nated chil­dren), both ac­count­abil­ity and re­sults have been known to im­prove. Voucher pro­grams for re­pro­duc­tive health care in Uganda and Kenya are now pro­vid­ing ac­cess to qual­ity ser­vices from the pri­vate sec­tor.

Fi­nally, build­ing re­silient health-care sys­tems – flex­i­ble enough to bend, but not break, in the face of shocks – means im­prov­ing other pub­lic goods that are closely linked to hu­man health.

Th­ese in­clude clean wa­ter and san­i­ta­tion, and roads and in­fra­struc­ture that en­able emer­gency care and de­liv­ery of ser­vices. Health sys­tems do not ex­ist in a vac­uum, and if we are se­ri­ous about sus­tain­able de­vel­op­ment, it is time to understand that in­vest­ments in com­ple­men­tary sys­tems are “trade-ons” not trade-offs. We should be wary of view­ing medicine as the only path to bet­ter health.

The suc­cess of the world’s de­vel­op­ment goals hinges on our abil­ity to reach the poor­est and most marginal­ized pop­u­la­tions, who con­tinue to bear the brunt of death and dis­abil­ity world­wide. A nat­u­ral pro­gres­sion of the sta­tus quo will not be enough to reach them. In­stead, we must push pub­lic health sys­tems be­yond their usual bound­aries by in­vest­ing in and pro­mot­ing new tech­nolo­gies, sharp­en­ing in­cen­tives, and recog­nis­ing that health sys­tems do not ex­ist in a vac­uum.

Univer­sal health cov­er­age is right, smart, and over­due. To achieve a world where ev­ery­one’s health needs are met and no­body is trapped in poverty, our lead­ers must heed this mes­sage and act on it.

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