“The economy, until now, has measured the price of everything and the value of nothing. This needs to change. Healthcare spending is treated as a cost rather than a long-term investment. Economic policy has not favored society.”

In the first report, the WHO Council on the Economics of Health for All outlined a bold new path to reorient economies to deliver what matters: “health for all.”

Launched last Tuesday (23/5) during the Seventy-sixth World Health Assembly, the report, titled Health for All: Transforming economies to deliver what matters, provides a new framework built on the four pillars below (Figure 1), with specific recommendations for each of them.

The Council presented a bold narrative based on new economic wisdom to reorient economies towards health for all on four interrelated themes (Figure 1):

WHO Director-General Dr. Tedros Adhanom Ghebreyesus created the Council in November 2020 in response to the COVID-19 pandemic. Italian economist Mariana Mazzucato chairs it.

The Board has spent the past two years rethinking economics from a “health for all” perspective and aiming to forcefully affirm that human and planetary health must be central to how we design our social, health, and health systems and policies. And economical.

“Two years ago, I asked the world’s leading economists and public health experts – all women – to create a paradigm shift. Now, rather than seeing health for all as being at the service of economic growth, we have a roadmap for structuring economic activity to allow us to achieve our goal of seeing all people access essential health services more quickly and with better results, said Dr. Tedros.

“Over the past two years, the WHO Council on the Economics of Health for All has worked to craft a new economic narrative – one that transforms health financing from spending to investment,” said Council President Professor Mariana Mazzucato.

“We examine the changes needed – including in the patent structure, public-private partnerships, and budgets – to design an economy that delivers Health for All. In our final report, we call for a new economic policy, not about market fixing. Still, about proactively and collaboratively shaping markets that prioritize human and planetary health,” she added.

The report also offers suggestions on what can be done to implement the changes needed to reorient measures of economic value, health financing, innovation, and public sector capacity building in the service of health for all.

Among the specific cases presented, the following stand out:

• The installation of the mRNA technology hub in South Africa: a values-driven system that tries to get ex-ante innovation, funding, and capacity;
• Brazil’s public investment in a health industrial complex that serves the common good;
• Regional development banks as enablers of change in the Global South;
• The Wellbeing Economy Alliance – an alliance of several governments and more than 600 other organizations working together to transform economic systems in the service of life;
• Approaches to funding national plans of action (NAPs) on antimicrobial resistance through joint multisectoral budgeting, given that most NAPs remain unfunded.

The report’s recommendations could change how countries view and finance health. WHO calls on policymakers, civil society, and members of the health and economic communities to consider the suggestions and use them as a compass to develop new policies and economic frameworks that can guide us along the path to making the “health for all” reality.

An overview of the four pillars of the report

We reproduce below an explanation of the bases of the report, in the words of Mariana Mazzucato.

Valuing Health for All (Figure 1)

The report “argues that we must value health for all. This means embedding the goal of human and planetary wellbeing in economic decision making and in how we measure economic progress. The current dominance of GDP as an indicator of economic success focuses attention and policy efforts around a narrow measure of growth that excludes valuable activities—including the work of many care givers. This discourages the investments needed to truly prioritise health as a human right.”.

Financing Health for All (Figure 1)

The report “argues for a redesign of national and international financial systems to treat spending on health as a long term investment, and to increase the fiscal space available for this investment. We must align finance with the goal of Health for All. This will require both more money, and higher quality financing that is deliberately designed to be mission-oriented, proactive, long term, and equitable.”.

Innovating for Health for All (Figure 2)

The report  “argues for an innovation ecosystem that prioritises the common good, ensuring equitable access to health innovations. The design of innovation investments, policies, intellectual property rights and partnerships should recognise that innovation requires collective intelligence—from the public and private sectors, and from multiple government departments and businesses. Innovation can be directed to tackle health challenges, and the partnerships required to solve these challenges can be designed to better share the risks and rewards of innovation, for example by making government funding conditional on affordable access and requiring profits to be shared or reinvested in research and development rather than used for shareholder buybacks”.

Strenghtening Public Capacity for Health for All (Figure 2)

“as covid-19 made clear, public sector leadership matters. Achieving ambitious health goals requires governments with the capacity to structure effective partnerships, adapt, coordinate cross-ministerial collaboration, and meaningfully engage the public. Governments’ addiction to outsourcing core functions has undermined these capabilities. A reinvigorated understanding of the state as a market shaper, and investment in dynamic state capabilities, are crucial to delivering Health for All..”

With information from Organização Mundial de Saúde and from British Medical Journal