Learning Lessons: Asserting the prominence of Health in Economic Development

The COVID-19 pandemic has brought to the fore the importance of health to economic growth. This realization is neither  novel nor new.  The Wealth of the Nations (1773)  highlights Adam Smith's insight about the true engine of wealth creation as  the division of labor, which itself is dependent on the size and extent of markets.  This is relevant to understanding the underlying  risks  of the coronavirus pandemic due  to negative labour shocks,  caused by a rapidly declining working age population and  its effects on the supply chain across borders.  This, in essence, was   the vision behind the CARICOM Heads of Government Declaration, the Health of the Region is the Wealth of the Region (July 200O) when HIV was literally a death sentence. The 1998   Nobel Laurette in Economics,  Amartya Sen,  had previously concluded that health,  like education is among the basic capabilities that gives value to human life. Then,  The Commission on Macroeconomics and Health established by World Health Organization (WHO)  in 2000 and chaired by Professor Jeffrey Sacks,  established that health is both a central outcome of development and an  important  investment  to promote economic development and poverty reduction, especially in the world’s poorest countries. This was the period of the Millennium  Development Goals (MDGs) that  committed the world to dramatic reductions in poverty and marked improvements in the health of the poor by 2015, requiring seriousness of purpose, political resolve and an adequate flow of resources from high to low income countries on a sustained and well targeted basis.  
 
To what extent has this mission been achieved?  There are several  lessons from the coronavirus   pandemic that illustrate the need for a healthier and more prosperous future.
 
First, coronavirus exposed the weakness of the World's infectious -diseases- surveillance response to pandemics. It included the slow start up in many countries: in public communications, testing , contact tracing, critical care capacity and other systems for containing infectious disease.  As a result,  the case for strengthening the world’s pandemic-response capacity at the global, national, and local levels is compelling. According Mc Kinsey's "Crushing coronavirus uncertainty: The Big unlock of our Economy" (May 2020), the economic disruption caused by the COVID-19 pandemic could cost between $9 trillion and $33 trillion—many times more than the projected cost of preventing future pandemics.  Preventive investment estimated at $40 billion annually,  could substantially reduce the likelihood of future pandemics.
 
Second, reports from the IMF research (July 2020) shows that health continues to stimulate growth,   accounting  for about one-third of the overall GDP-per-capita growth of developed economies in the past century.
 
Third,  is the need to invest in health to build resilience. The COVID-19 pandemic has hit people with underlying health conditions hardest—for example, diabetes, hypertension, chronic obstructive pulmonary disorder, and obesity, which are common across most of the world’s economies. They have been associated with higher risk from COVID-19.  Hence it is predicted that by using what we know today, can improve the health of the world’s population, and that would not only build resilience against future pandemics but also dramatically improve the quality of life of millions of people.
 
Fourth,  is focusing on reducing economic and social inequalities. In many countries, the pandemic has disproportionally hurt minorities and low-income households. In the United States, for example, mortality rates have been much higher among Latinos and Black people than among the white population. Similarly, in the United Kingdom, ethnic-minority groups reported mortality rates 40 to 200 percent higher than those of white British people. Minorities and low-income households face a double whammy of health and economic risk. Black Americans are almost twice as likely to live in the counties at highest risk for health and economic disruption if the pandemic hits those counties. Even before the COVID-19 pandemic, researchers found a ten-year gap in life expectancy between the most and least disadvantaged groups in the United States. Disparities of this magnitude are observed in most countries and societies around the world. Poorer people tend to have worse health, which can limit their economic potential.
 
Fifth, is the building on COVID driven innovations. According to a WHO Report (July 2020) scientists around the world have shared more than 50,000 viral genome sequences, and around 180 vaccines were in the pipeline, many representing cross-sector and cross-country collaborations.  In addition, the adoption of telemedicine has skyrocketed: in 2019, 11 percent of US consumers used telehealth services; now 46 percent use them to replace in-person consultations suspended during the crisis. The pandemic response has also demonstrated that when the situation demands it, the architecture of healthcare can be transformed rapidly.
 
Sixth, are the lessons learned from the accelerated response to HIV.    In the final analysis, eliminating unnecessary deaths is at the core of global health efforts, from responses to COVID-19 to HIV, non-communicable diseases, and maternal mortality. However, experience with HIV shows that reducing mortality especially in the absence of a vaccine,  requires a more robust approach to tracking and intervening than has been used in the COVID 19 response in many counties, especially the USA,  to date.  A UNAIDS presentation at the recently concluded virtual International AIDS Conference (July 6-12)  shows that  38 million people are living with HIV, a consequence of a pandemic that spread worldwide. The multinational AIDS response grew out of a global concern for the catastrophic loss of life, as HIV devastated communities in highly burdened countries. From a time when it seemed impossible for interventions to reach people globally, today about 79% of all people living with HIV know their status, and more than half of all people living with HIV have achieved viral suppression using advanced antiretroviral therapy. This according to UNAIDS is an  historic response  that has saved more than 11 million lives in the past decade alone.
 
However, progress against mortality has slowed considerably. They are far off-track from the globally agreed goal of fewer than 500 000 HIV-related deaths by 2020.  Nevertheless, the UNAIDS Report concludes "as global health efforts mature, the HIV experience can provide lessons for tackling mortality from other causes" .
 
 
 
Conclusions  
 
We started this blog by referring to  the mission of equity,  inspired by placing health at the center of economic development. It is therefore fitting to refer to a new book, by Martin Sandbu, Economics of Belonging: a radical plan to win back the left behind and achieve prosperity for all, (Princeton 2020). Its premise  is that behind today’s political liberalism and rejection of globalization is a widespread feeling that economic opportunities are reserved for an elite to which “normal people” do not belong. It sets out an agenda to create an economy where everyone feels they belong. Hence it is heartening to note from a report in the Washington Post (July 15) that  leaders from Canada, Ethiopia, South Korea, New Zealand, South Africa, Spain, Sweden, and Tunisia have issued a joint call for any coronavirus vaccine to be distributed equally and according to a “set of transparent, equitable and scientifically sound principles.” The statement comes as worries grow that protectionism may prevent poorer countries from receiving a vaccine at the same time as richer ones. That would be in contradiction to the primacy of health to economic development.
 
Eddie Greene