Beginning with the ambitious goal of Health For All, we should work backwards to reorient our policies in the direction of well-being societies and values-based economies, and advance a healthy planet
The Covid-19 pandemic and ensuing global economic crisis helped lay bare what we truly value as a society – health and well-being for all – and our collective failure to build an economy on those values. It showed us that if we fail to design our economic systems to tackle humanity’s greatest challenges in ‘normal’ times, no amount of money and last-minute firefighting will fix them in a crisis.
We need to start with the core goal of Health For All to decide what we should value moving forward, and then work backwards to reorient our economic and financial policy levers and metrics according to those goals. This has been the work of the World Health Organization Council on the Economics of Health For All. It proposes three key values as the foundations of a well-being society and values-based economy. These are:
- valuing planetary health, including essential common goods such as clean water, clean air and a stable climate;
- valuing diverse social foundations and activities that promote equity, including social cohesion, supporting people in need and enabling communities to thrive; and
- valuing human health and well-being, with every person able to prosper physically, mentally and emotionally, and provided with the capabilities and freedom to live lives of dignity, opportunity and community.
Beyond economic growth
Such a reimagining of values means moving away from fetishising economic growth as the North Star and guiding light of all economic policies, institutions and governance systems. It means taking a ‘dashboard’ approach to assessing economic performance, where gross domestic product growth is just one of many metrics that help us assess how we are advancing the health of people and the planet and promoting equity in our societies. For example, by introducing time-use data into its national household surveys, Uruguay identified a 20% gender gap in labour force participation, and ultimately introduced a national care plan that in 2017 reallocated $67 million for early childhood services and people with disabilities, among other things. By collecting data on the things we value, we can then identify new gaps and redirect budgets towards Health For All in powerful ways.
Achieving a values-based economy also means taking a much more proactive, market-shaping approach to the governance of innovation, where governments are an active driver and partner in stimulating innovation, rather than seeing their role as a ‘market fixer’ when the private sector fails to deliver on Health For All. A great example of this is intellectual property rights – we need to rethink how we govern patents in such a way that we can truly foster collective intelligence and equitable access to innovation, rather than transferring billions in public resources to pharmaceutical companies for research and development, and then allowing them to reap all the upside at the public’s expense. We need to reimagine public-private partnerships in ways that enable society to capture and benefit from more of the value being created by governments when they partner with the private sector in areas such as health and climate.
Major government investment
Reimagining economic systems to achieve a well-being society also means major government investment in the values that underpin Health For All, as well as the capacity to deliver on them. For many low- and middle-income countries, the current economic landscape of enormous debt, high inflation, climate disaster and a global food crisis have created overwhelming fiscal challenges and thrown the Sustainable Development Goals years off track. These countries require radical new forms of support from the global community, from massive debt relief and cancellation, to access to more substantial, longer term, deeply concessional finance from development banks, to the issuance of new special drawing rights, to the end to the decades-long theology of austerity, which even according to the International Monetary Fund has only exacerbated inequality and gutted public sector capacity in the process. Alongside external support for increasing fiscal space to advance Health For All, countries can also pursue more equitable domestic tax systems that ask those with the most to pay the most, rather than relying on regressive value-added and sales taxes that disproportionately burden the poor to finance government services. Countries at all income levels can also introduce outcomes-based budgeting, where values-based metrics such as ‘reducing maternal and child mortality’ or ‘reducing the carbon footprint of the industrial sector’ are the basis for allocating and assessing government expenditure.
Achieving a well-being society that functions within planetary boundaries will not happen by accident. Indeed, deferring to the invisible hand of unfettered capitalism in pursuit of constant economic growth is what helped generate the unprecedented levels of economic inequality and planetary crises we now confront. We need a clear, massively ambitious goal such as Health For All to reorient our economies around and guide us out of this mess. The well-being of our societies and our planet itself hang in the balance.