The COVID-19 pandemic has brought into focus the stark reality of the large and growing inequities across the globe in access to health care and health products: for every 100 people in high-income countries, 133 doses of COVID-19 vaccine have been administered, while in low-income countries, only four doses per 100 people have been administered.
Yet, to date, the world continues to follow the same economic paradigm that doesn’t change the underlying finance structure and applies outdated thinking on economic development, which stands in the way of “Health For All.” As the G20 Summit approaches in Rome on Oct. 29-31, where, first, health and finance ministers, and then heads of state and government, come together, there is a window of opportunity for a radical redirection from health for the economy to the economy for health for all. The critical challenge is both to increase the magnitude of the finance available for health and to govern it in a more directed and effective manner.
The World Health Organization’s Council on the Economics of Health For All calls now, more than ever, for clear, ambitious goals to mobilize and focus investments toward health, considering financing for health as a long-term investment and not a short-term cost. The council’s new brief on Financing Health for All prioritizes two key dimensions: more finance and better finance and lays out the way forward through three pathways to action:
Creating fiscal space by easing artificial constraints imposed by outdated economic assumptions and reversing the harmful effects of reforms that lead to big health cuts, allowing spending and investments toward Health For All to increase significantly;
Directing investments to ensure Health for All becomes the central purpose of economic activities, and increase public leadership and dynamic state capabilities to create a conducive regulatory, tax, industrial policy and investment environment; and
Governing public and private finance by regulating the functioning and financing of private health markets through measures that crowd in and direct private finance toward improving health outcomes globally and equitably.
The council believes that a new paradigm must be pursued that avoids macroeconomic policies and assumptions that move us away from Health For All. This means designing policies to reach health for all now and in the long-term and realigning finance from all sectors and sources through conditionalities that fuel symbiotic gains in the public interest. Not only more financing of the health sector, but better-quality finance is crucial to deliver Health For All, which must be equitable and ensure a sustainable impact on peoples’ lives.
The challenge is to change mindsets within countries that impose internal constraints on spending and to transform externally-imposed conditionalities that hinder spending on what matters for health and promote Health For All. Changing the rules of the game is a fundamental priority of any strategy to deliver Health For All, and policymakers have the ability to rethink finance now.
“The COVID-19 pandemic has demonstrated that the financing of health systems needs to change radically to protect and promote the health of all people,” said Dr Tedros Adhanom Ghebreyesus, director-general of WHO. “The latest report by the Council on the Economics of Health For All makes a clear and compelling argument for the need for sustained financing to be directed to achieving health for all people, and for investments to be understood as long-term gains for national and global development.”
“While health systems are under-resourced, more finance is not the only solution. The work of the council stresses the need to reform and redirect finance in radical ways so that the objective is Health For All is designed into the financial structures, the conditionalities and the partnerships between business and the state,” said Council chair Professor Mariana Mazzucato.
By way of background, the WHO Council on the Economics of Health For All was established in November 2020 by WHO director-general Dr Tedros Adhanom Ghebreyesus. The council’s core mission is to rethink how value in health and well-being is measured, produced, and distributed across the economy. It will recommend a new way to shape the economy with the objective of building healthy societies that are just, inclusive, equitable, and sustainable. Made up of 10 of the world’s most eminent economists and health experts, the council works on four areas on how to rethink measurement of economic development, financing, capacity, and innovation with the aim of achieving Health for All. Briefs in each of these areas, and a comprehensive final report to be produced in 2023, will be used to build momentum amongst finance ministers, heads of state/government, as well as other decision makers such as other financial authorities and international development authorities, toward changing the structure of economic activity in favor of Health For All.
The members of the Council are Mazzucato, Professor Senait Fisseha, Professor Jayati Ghosh, Vanessa Huang, Professor Stephanie Kelton, Professor Ilona Kickbusch, Zelia Maria Profeta da Luz, Kate Raworth, Dr Vera Songwe and Dame Marilyn Waring. (WHO Council on the Economics of Health For All)