In health, economic policy only tells half a story – for universal coverage to include all health drivers, as well as the health of all people, consideration must be given to agriculture, food and nutrition
By Laurette Dubé, James McGill chair, Desautels Faculty of Management, Center for the Convergence of Health and Economics, McGill University; Raphael Lencucha, professor, School of Physical and Occupational Therapy, McGill University; and Nick Drager, CEO of the TuBerculosis Vaccine Initiative
Achieving universal health coverage, a key target of the third Sustainable Development Goal to ensure healthy lives and promote universal well-being, cannot be accomplished by the health sector alone. Nor can other targets for the same goal, such as reducing premature mortality from non-communicable diseases by one-third through prevention and treatment or promoting mental health and well-being, or substantially reducing the number of deaths and illnesses from hazardous chemicals and polluted air, water and soil.
Pathways to these goals lead through the everyday lives of individuals, organisations, economies and societies. Solutions cross boundaries between industrial sectors (such as agriculture, food, transportation, education and health care) and societal sectors (for-profit, non-profit and government). Those solutions are needed to contain the contribution of the non-health sectors to the demand and costs for health care because of their impact on the social determinants of health.
A pragmatic approach is needed to achieve a healthy society where universal health coverage can be affordable, with government catalysing a convergence of health and economic policy. This approach contains reciprocal contributions by the health and non-health sectors with capacity-building strategies through transformative innovation. Agriculture, food and nutrition offer an illustrative case.
Government plays a critical role in shaping food environments through interventions that promote the economic performance and competitiveness of the agri-food sector, public health interventions that control the nature and types of foods available to consumers, and interventions that seek to influence consumer food choice.
There is an ongoing exploration of the most effective and appropriate role of government in building multi-sector strategies to control unhealthy foods and promote healthy food environments. Given that food environments are key health determinants, with the commercial sector – such as farmer markets, grocery stores and restaurants playing a major role – the relationship between government and the commercial sector is relevant.
The principal controversy at the heart of this relationship pertains to the potential influence of commercial enterprises on public institutions. Navigating the tenuous relationship between government and the commercial sector is at the core of the whole-of-society approach underlying the United Nations recommendations to curb the progression of NCDs and associated risk factors.
Taking the lead
The regulatory and catalytic roles of government need to be distinguished in any consideration of the nature of the relationship between government and the commercial agriculture and food sectors. Controversies often centre on whether governments can develop sound policies with the public interest in mind, particularly as market regulators, while in partnership with the private sector.
How can government regulate health-harming products and simultaneously promote transformation in the agriculture, food, nutrition and healthcare sectors so that consumer environments make healthy food choices easy and accessible? Can government set the foundations for the public health/healthcare sector viewing itself, with other social and economic sectors, as generating demand for economically viable nutritious diets from sustainable food systems as a key path to universal health coverage?
When consumers acquire most of their food through commercial channels, even in emerging economies, there can be major benefits for government to serve not only as regulators or norm setters, but also as catalysts for change in the consumer food environment. There are three forms this catalytic role can take.
Gathering, interpreting and sharing information
Governments are well situated to facilitate information generation and sharing. In an era of social media and big data, governments are a credible source that links consumer information to health-promoting commercial practice in the agriculture and food sectors while inspiring demand for healthy food and diets through professional and organisational practices in education, health and social sectors.
They can also capitalise on the rapid rise in information and communication technologies to support consumers in making healthy choices in real time, more consistently and better adapted to their real-world conditions.
Hybrid forms of coordination
Governments can facilitate new institutional forms of coordination between public and private actors, and can also build synergy with social innovators in non-government organisations. These community-based partnerships typically serve as brokers in connecting individuals and families with supportive programmes and socio-environmental transformation in agriculture, education, sports, transportation, media, health, industry, commerce and service.
Part of the strategy is to use ‘pull’ mechanisms to foster results-based financial incentives that reward successful commercial and social innovations that address health and other social problems in person-centred and community-focused ways that are also financially sustainable and support economic development.
Financial resources provision and mobilisation
Government can serve as a catalyst through providing or mobilising funds for cross-sector partnerships at the juncture of agriculture, food, nutrition, education, health and healthcare systems. In some cases, state agencies can serve as members of networks or partnerships, or participate in structuring or managing networks.
Governments can serve as orchestrators to facilitate movement towards a joint governance goal. A more integrated approach to providing and mobilising individual and collective financial resources for crucial actors in key sectors may be an essential step towards health and economic policy convergence.
In summary, health and economic convergence is needed to achieve solutions at scale to achieve universal health coverage and other components of SDG 3. Political leaders on both sides of the prevailing health and economic divide must reach a common view of the nature of the problem and the solution, and acknowledge that the current policy and its goals, instruments and governance institutions are failing to reach sufficient scale.
Governments must invest in innovative solutions to break down the health and economic silos and create environments conducive to human health. The challenge facing governments is to identify legitimate non-state actors that can contribute to the economic well-being of a society that is rooted in genuine care and commitment for the health and well-being of individuals.