Interesting Comment in The Lancet which is worth reading

Advancing the economics of health for all
Mariana Mazzucatoa iipp-director-pa@ucl.ac.uk ∙ Tedros Adhanom Ghebreyesusb

Volume 404, Issue 10457P998-1000September 14, 2024

Full article can be found at
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)01873-7/fulltext?dgcid=raven_jbs_etoc_email


 Summary Highlights

"The incredible economic growth of the past century has delivered many benefits, including for health. But this growth has come at a heavy price in terms of pollution, climate change, unhealthy diets and behaviours, and the increasing burden of non-communicable diseases and antimicrobial resistance. Moreover, the benefits of economic growth have not been shared equally, with 4•5 billion people—more than half of the global population—still without access to essential health services and 2 billion individuals experiencing financial hardship when trying to do so, driving huge inequalities in health outcomes. Governments need to rethink the narrow focus on growth in gross domestic product (GDP) that typically dominates economic decision making.

The interlinked crises of health, climate change, and inequality are the direct result of economic policy choices. The primary goal of economic policy is assumed to be growth, with the danger that health, social, and environmental policies then have to respond to resultant problems. Under this framework, health and wellbeing are seen as inputs to or by-products of economic growth.2 Instead, the health of people and the planet should be the goal of economic policy and growth.
The WHO Council on the Economics of Health for All, chaired by one of us (MM) and composed of ten female economists and area experts, was founded by WHO to fundamentally rethink how the relationship between health and the economy is framed in economic policy and consider what it would mean for the economy to serve health. It flipped the assumptions around: instead of health serving the economy, what would it mean for the economy to serve health? The Council reimagined how economics and health relate across four inter-related areas and made recommendations in each: valuing health, financing health, directing innovation, and building public sector capacity. These recommendations have informed the new resolution on the Economics of Health for All that was endorsed by WHO member states at the 77th World Health Assembly (WHA) in May, 2024. The resolution gives WHO and its member states a mandate to pursue this new approach. But the success of the resolution will require fundamental policy changes.

Panel Recommendations of the WHO Council on the Economics of Health for All

Valuing
•   Valuing the essential: treat health and wellbeing, health workers, and health systems as a long-term investment, not a short-term cost
•   Human rights: use legal and financial commitments to enforce health as a human right
•   Planetary health: restore and protect the environment by upholding international commitments to a regenerative economy that links planet and people
•   Dashboard for a healthy economy: use a range of metrics that track progress across core societal values, above and beyond the narrow, static measure of gross domestic product
Financing
•   Long-term finance: adopt a comprehensive, stable approach to funding health for all
•   Quality of finance: redraw the international architecture of finance to fund health equitably and proactively, including an effective and inclusive crisis response
•   Funding and governance of WHO: ensure WHO is properly funded and governed to play its key global coordinating role in health for all
Innovating
•   Collective intelligence: build symbiotic public–private alliances to maximise public value, sharing both risk and rewards
•   Common good: design knowledge governance, including intellectual property regimes, for the common good to ensure global equitable access to vital health innovations
•   Outcomes orientation: align innovation and industrial strategies with bold cross-sectoral missions to deliver health for all
Strengthening public sector capacity
•   Whole of government: recognise that health for all is not only for health ministries but for all government agencies
•   State capacity: invest in the dynamic capabilities of the public sector, institutionalising experimentation and learning, to lead effectively in delivering health for all
•   Build trust: demonstrate transparency and meaningful public engagement to hold governments accountable for the common good."

For those of us of a certain age and those striving to reach it!

Café Economics: Worry Free Retirement (imf.org)


https://www.imf.org/en/Publications/fandd/issues/2024/09/cafe-economics-worry-free-retirement

Two changes which were significant

1. Change from Balance of Payment support to Budget Support where no one was concerned with what the money was used for apart from imports which were counted often from the supplying country to justify the amount.

2  In 1999 IMF introduced the Poverty Reduction and Growth Facility (PRGF) to replace its Enhanced Structural Adjustment Facility (ESAF).  This meant that budget support (by Bilateral and multi-lateral donors) was moved above the line as revenue rather than a below the line financing instrument.  This allowed an expansion of expenditures on, it was hoped, health and education.

A programme for greater health equity for the next UK Government
Michael Marmot, Jessica Allen m.marmot@ucl.ac.uk
www.thelancet.com Vol 403 June 22, 2024
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)01243-1/abstract?dgcid=raven_jbs_etoc_email

I found this article interesting – although it is aimed at the UK it has some very interesting international comparisons and its theme is universal.  I also found it quite chilling as it, to a certain extent, reflects the situation when I moved to the North East to the Northern Region Strategy Team in the mid 70s.  Although the hospital infrastructure in the North East is now excellent,  perhaps the underlying social conditions in terms of preventative health education is not so.

To quote the article: “The UK is unhealthy, literally and metaphorically. Literally, since 2010, many health indicators have stopped improving, health inequalities are increasing between social groups and regions, and health for people who live in the most deprived areas is declining. Of course, the National Health Service (NHS) should be properly funded, but attention to the social determinants of health is vital. The principle of proportionate universalism should be applied to all policies aimed at reducing inequalities. Health follows a social gradient—the greater the deprivation of an area the higher the mortality rate and the worse the health.  A policy of targeting only the people who are worst off misses people with social disadvantage and related health disadvantage who fall above the threshold of intervention.

Eight principles to prioritise health equity
• Give every child the best start in life
• Enable all children, young people, and adults to maximise their capabilities and have control over their lives
• Create fair employment and good work for all
• Ensure a healthy standard of living for all
• Create and develop healthy and sustainable places and communities
• Strengthen the role and impact of ill-health prevention
• Tackle racism and discrimination and their outcomes
• Pursue environmental sustainability and health equity together”

These Marmot Principles are from the 2010 report Fair Society, Healthy Lives: the Marmot Review. Marmot M, Allen J, Goldblatt P, Boyce T, McNeish D, Grady M. Fair society, healthy lives: the Marmot Review. London: Institute of Health Equity, 2010. https://www.instituteofhealthequity.org/resources-reports/fair-society healthy-lives-the-marmot-review/fair-society-healthy-lives-full-report pdf.pdf (accessed June 10, 2024)

We'll need universal basic income - AI 'godfather'

The computer scientist regarded as the “godfather of artificial intelligence” says the government will have to establish a universal basic income to deal with the impact of AI on inequality.

Professor Geoffrey Hinton told BBC Newsnight that a benefits reform giving fixed amounts of cash to every citizen would be needed because he was “very worried about AI taking lots of mundane jobs”.

“I was consulted by people in Downing Street and I advised them that universal basic income was a good idea,” he said.

He said while he felt AI would increase productivity and wealth, the money would go to the rich “and not the people whose jobs get lost and that’s going to be very bad for society”.

https://www.bbc.co.uk/news/articles/cnd607ekl99o.amp