Achieving Universal Health Coverage Can Lead To Economic Development, Experts Say

Alongside the annual World Health Assembly last week, an event brought experts together to discuss how the attainment of universal health coverage (UHC) can lead to growth and development of the economy.

The side event on “Innovation, Equity and the New Health Economy” was organised by the Global Health Centre at the Graduate Institute, Rabin Martin, and Johns Hopkins University on 24 May. The 71st session of the World Health Assembly (WHA) took place from 21-26 May.

Universal health coverage is a top priority of the World Health Organization (WHO) said Jeffrey Sturchio, president and CEO of Rabin Martin, and moderator of the event. According to Sturchio, the health sector is highly innovative and economies that provide strong healthcare are more successful over the long term, especially when looked through the lens of human capital.

Discussing the idea of a new book focusing on a “new health economy,” experts on the panel highlighted how the health economy can contribute to economic welfare and development. But they also emphasised the role of all stakeholders: government, civil society, and the private sector in making the goal of achieving UHC become a reality.

According to Christian Franz, CEO of CPC Analytics and co-author of the new book (Ilona Kickbusch, director of the Graduate Institute Global Health Centre, is also a co-author), a political case for the health economy is usually made by looking at health from the perspective of achieving the UN Sustainable Development Goals (SDGs), and the newly approved 13th WHO General Programme of Work (GPW 13), which calls for 1 billion more people enjoying benefits from UHC by 2023, he said.

An economic policy case also has to follow this political case, said Franz. This can be seen in different countries looking at what UHC means in many countries: expansion of health coverage, effect of this expansion on people’s choices and consumption, supply chains, training of people, and effect on other sectors, he added.

But even the economic case is not something new, said Franz. Past works like a 2001 report by Jeffrey Sachs that focused on the idea of “philanthropists will save the world,” and the 2013 Lancet Commission where investing in health was the new paradigm, are examples, he said.

The Lancet Commission quantified that “24% of the total income growth in low-and-middle-income countries from 2000-2011 was actually because of improved healthy lives,” he added. Hence, this kind of perspective is already there but these are not the kind of arguments needed when speaking to finance ministers and people used to economic policy arguments as well as people thinking of fiscal priorities, he stressed.

Franz explained that the new book looks at a broader concept. Elements of where health is contributing to economic output were identified using Germany as a case study, he said. The idea of a “Health Satellite Account” using the German national account statistics was the focus.

It was discovered that the health sector is divided into a core (for instance, reimbursable in-and-outpatient visits, over-the-counter drugs) and an extended sector (elderly care, activities surrounding health), which needs to be included in the notion of the health economy or industry, he highlighted.

It was further discovered that both sectors add around 12 percent to the German global gross value added, which is an economic output the size of Austria’s, he said. Looking at consumption in Germany, every fifth euro spent between 2005 and 2012 was in the health sector, so, out of 100 euros, 20 were spent on health, he explained.

The health economy, therefore, contributes to economic output, stabilises economic growth and drives as well as stabilises employment growth as a sector that is hardly affected during economic crisis, he added.

Jim Campbell, director, Health Workforce Department, World Health Organization, also highlighted the contribution of the health economy to employment. According to Campbell, the health sector is one of the fastest growing employment sectors in the world, in the European Union, Organization for Economic Cooperation and Development (OECD) and other high-income countries.

The economic demand within various national boundary jurisdictions is increasing demand for qualified health and social care workers and it is also increasing demand for services in ageing, he said.

However, he also mentioned that these developments are not purely from the public sector either in education services or service delivery. Provision and purchasing of care may be publicly funded through social health insurance systems but privately provided through different mechanisms, commissions and engagements, he said.

“The evidence is overwhelming,” he said, “six economic pathways were identified in terms of investing in the education and appointment, retention on lifelong learning and the social protection of the health and social care workforce.”

This “generates economic growth…, it promotes social cohesion, and it promotes good health security, it promotes good health,” he added.

But there is need for good governance, enabling environment, and skills and competencies, he said.

The role of women as participants and contributors to the health sector was also underscored by the experts. Women interact as producers as well as consumers in the health sector, said Felicia Marie Knaul, director, Institute for Advanced Study of the Americas, and professor, Miller School of Medicine, University of Miami.

According to Knaul, women interact as paid participants in the health labour force as well as unpaid producers of healthcare. “Female labour force participation is a model of economic growth,” she said.

This participation is also crucial to many of the SDGs on health, gender, economic growth and wellbeing, as well as the idea of a new health economy and achieving universal health coverage, particularly in the face of growing demand as a result of non-communicable diseases (NCDs) and services in ageing, she added.

She also highlighted that “the majority of paid producers of healthcare are women but also the majority of unpaid producers of healthcare are women.” Hence, “the bottom line is that women produce the majority of health and healthcare around the world, paid and unpaid and it is largely undervalued, unrecognised and unsupported or ignored by policy,” she said.

The unpaid work of women in healthcare is a very important hidden subsidy to economies, so when we talk about the size of a health sector, when we say 20 percent, it is actually much larger because there is a part of that health sector not being measured because it is unpaid, unrecognised and undervalued, she revealed.

On the role of the private sector in the health economy and in achieving UHC, and how this occurs in different countries, Cicely Thomas, program director, Results for Development, and also a contributor to the new book, highlighted what needs to be done.

The work and opportunity that we have is to shape the private sector so that it grows and works towards universal health coverage through public-private sector engagement, she said. However, she also pointed out that navigating this engagement is complex due to political, organisational, economic, as well as legal and regulatory barriers.

Nevertheless, she emphasised that these barriers should not stop the work. “We know that the economy is moving towards domestic resource mobilisation and away from these donor-funded projects,” she said, “and with this transition, many social franchises as many private sector providers, for-profit and not-for-profit are looking for sources of financing that are sustainable and one of those is engaging in public financing mechanisms.”

 

Image Credits: Damilola Adepeju.

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