The cure for global poverty: Health

Mother and child, Madhya Pradesh, India
Mother and child, Madhya Pradesh, India
Flickr, DFID

Researchers Discover Powerful Cure for Poverty and Inequality – Health

If you could only do one thing to reduce poverty and inequity around the world, say experts in global development, the best thing you could do is reduce the disproportionate burden of disease on those living in the poorest communities.

Improving health, according to a relatively new and perhaps still under-appreciated report written by a blue-ribbon panel, remains the most powerful tool for improving lives and reducing extreme poverty worldwide.

But it’s still a woefully underused tool that, as Humanosphere will report on tomorrow, is actually losing ground on the anti-poverty agenda even as the evidence of its import swells.

Dean Jamison
Dean Jamison

“We have an unprecedented opportunity, unlike any time before in human history, to significantly reduce the level of inequity in the world,” said Dean Jamison, a health policy expert at the University of Washington and, with Harvard University’s Lawrence Summers, one of the lead authors of the report, dubbed Global Health 2035.

“Even in the United States, the single largest cause of poverty is medical expenditures, usually due to some health crisis,” Jamison said. “Europeans have a hard time understanding this, because for the most part they don’t experience medical bankruptcies. But the connection between illness and poverty is also especially the case for the poor in developing and middle-income countries.”

Not everyone agrees, of course, that improving health should be at the top of the anti-poverty agenda.

Some say improving governance, human rights or business development are more powerful means for fighting poverty. Some say we need less targeted efforts and an agenda that emphasizes sustainable development (whatever that means….). The aid and development community, it should be noted, argues about almost everything.

Some of the most popular talking points these days among the anti-poverty expert class can seem a bit odd – pondering whether or not aid works (a question that, stated as such, seems absurd), if giving cash directly to poor people is a good thing (economists have discovered, through carefully conducted trials, that poor people do benefit from having more money … Duh.) and even about what the words ‘aid’ and ‘development’ actually mean.

It can all start to sound to a newcomer or outsider a bit like freshman philosophy class, in which the whole point is for your professor to make you question your assumptions, or your very existence … or if we all see the same thing when we see the color blue. That’s a good thing to do if the goal here is to demonstrate critical thinking or to try to get ‘outside the box’ and be innovative, but billions of people are suffering and dying today.

It’s important to do something now, based on the best evidence we have as to what most reduces suffering and inequity.

And Jamison, Summers and the other development experts who wrote the Global Health 2035 report think the evidence is overwhelming: You can’t get more anti-poverty bang for the buck than can be gotten from the right kind of health improvements.

“Reductions in mortality account for about 11 percent of recent economic growth in low-income and middle-income countries,” the report states. That’s a lot, and yet this accounting is still based on the bizarre metrics of standard economics which usually fails to factor in ‘externalities’ like the quality of the air and water, people’s sense of security or enjoyment of daily life … you know, most of what matters.

When Jamison and his colleagues (many of them economists yet still somewhat interested in reality) wanted to get a more comprehensive view of the impact health improvements have on a person, or population’s, well-being, they turned to what’s known as the ‘full-income’ measure. This includes factoring in trying to measure the intrinsic value of, well, not dying – which they call (because they’re still wonky economists) “VLYs” – Value for additional Life Years.

“Between 2000 and 2011, about 24 percent of the growth in full income in low-income and middle-income countries resulted from VLYs gained,” the report states.

Okay, wow. Again. Unless I misread these folks, they are saying a quarter of all the growth experienced in poor and middle-income countries over the last decade is due to health improvements and, yeah, not dying. Below is a positive-feedback illustration from the report that basically says if people stop getting sick and dying, their productivity increases, kids go to school, the environment wins and the country’s overall GDP goes up. Yes, that seems kinda obvious but experts like charts….

Health GDP
Global Health 2035

This seems like a fairly big deal that the anti-poverty crowd should be celebrating as a clear evidence-based pathway to cutting through all the babble and gobbledygook that now characterizes the debate over setting the next stages for the aid and development agenda.

But it’s not, yet anyway. The Global 2035 report, which was published by The Lancet just before Christmas, got some media attention when it first came out – such as this Guardian story noting that if we increased global health spending annually by $60 billion we could see a ‘grand convergence’ and reduction in the kind of inequality that separates the rich and poor worlds.

Bill Gates later tried to push it at the elite World Economic Forum in Davos. Gates, whose philanthropy helped fund the report, also used it as ammo for his popular but somewhat controversial prediction that most countries would escape poverty by the year 2035. Gates’ optimistic prediction got plenty of media attention, but few media ever even asked why he picked the year 2035 (as opposed to 2030, the consensus finish line for the international community’s next set of Millennium Development Goals, established in 2000 with a target date for accomplishing them in 2015 … which mostly won’t happen).

Humanosphere reported that Gates was focused on the year 2035 because of Jamison, Summers and the Global Health 2035 findings. Yet the report is seldom mentioned, even by some within the global health and development community. Maybe this is because it’s so wonky, has no funny viral video and because the aid and development community isn’t as evidence-based as it likes to think it is.

Or maybe it’s just following the path of its predecessor report, the World Development Report of 1993 – the first (and still only?) World Bank report devoted to examining the relative contribution of health to economic development. Jamison and Summers were lead authors of that report as well, which surprised many by demonstrating in the otherwise dry, drab and statistic-laden lingo of the institution that you can do some amazing things in poor countries simply by getting kids vaccinated, making childbirth safer and such.

Nothing much happened in 1993 or in the years immediately following this revelation. But then, in the late 1990s, this one guy stumbled upon these statistics and things started changing.

“Every page screamed out that human life was not being valued in the world at large,” said Bill Gates, recalling his response to being handed the WDR 1993 report by his then-adviser Bill Foege. The new Bill & Melinda Gates Foundation had found its mission, global health, starting with an emphasis on expanding access to childhood immunizations.

The Global Health 2035 report, which makes an even stronger case for emphasizing health as a primary means of fighting poverty and inequity, awaits its eureka moment. And for no apparent reason, here’s the wonderful Bobby McFerrin singing Don’t Worry, Be Happy.

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About Author

Tom Paulson

Tom Paulson is founder and lead journalist at Humanosphere. Prior to operating this online news site, he reported on science,  medicine, health policy, aid and development for the Seattle Post-Intelligencer. Contact him at tom[at]humanosphere.org or follow him on Twitter @tompaulson.