Can a healthy economy be an economy for health?

It’s all about what we value

The fundamental organising principle of most western democracies – the principle against which all others are tested – is the maintenance of a healthy economy.  A healthy economy, in this model, is focused on fostering economic growth.

The current orthodoxy is that, if it’s good for business, it’s good for all of us.  We all benefit from the ability of businesses to trade freely, to compete with one another without hindrance, and to make and invest profits.  This ability makes them more efficient, and enables them to produce goods and services more cheaply.

One of the givens is the inevitability – and the desirability – of global competition, and the need to free up international trade, with individual nation states being bound by a common set of minimally-prescriptive rules.  Governments have limited freedom to intervene for fear of being punished by the markets.

The principal objective of the global trading system is to promote economic efficiency and economic growth.  National social objectives are acceptable, but only insofar as they do not impede the drive for economic growth and efficiency, or interfere with the rules of trade.

The goal is a level field on which to play the game of international commerce in accordance with the rules of the market place.

So we might characterise the parameters of a healthy economy thus:

• Its purpose is to allow wealth creation, where wealth is defined as “an abundance of valuable possessions or money.”[1]
• It is competitive – and the nature of competition means that there must be winners and losers
• It has a minimum level of regulation – just enough to ensure that there is a level playing field; that everyone plays by the same rules.
• It is global in orientation, and encourages unrestricted trade between nation states, and between trans-national enterprises.
• It celebrates wealth creation and the acquisition of wealth
• It values and rewards individual risk-taking in the pursuit of wealth creation and acquisition.
• It requires inequality.  For example, the efficient operation of the employment market requires that there is a pool of unemployed.
• The stabilising levers are fiscal and monetary policy – interest rates, money supply, etc.
• It is oriented towards achieving growth in the economy at the nation state or global level.

 What We Know About Health

“Health is created by caring for oneself and others, by being able to take decisions and have control over one’s life circumstances, and by ensuring that the society one lives in creates conditions that allow the attainment of health by all its members.” (WHOOttawa Charter for Health Promotion).

Ron Labonté, a Canadian professor of public health, asked people to talk about their experience of health, and from that he articulated six ‘fields’ of positive health, or well-being:  feeling vital, full of energy; having good social relationships; experiencing a sense of control over one’s life and one’s living conditions; being able to do things one enjoys; having a sense of purpose in life; and experiencing a connectedness to ‘community’.

We know that life expectancy in different countries is dramatically improved where income differences are smaller and societies are more socially cohesive.  What matters is not the direct health effects of absolute material living standards so much as the effects of social relativities. 

It is not the richest countries which have the best health, but the most egalitarian.  Those countries have a strong community life, and the individualism and the values of the market are restrained by a social morality.  The quality of the social life of a society is one of the most powerful determinants of its health.  This, in turn, is very closely related to the degree of income inequality that exists in the society.

Canadian work has shown that, if the poorest 20% of the population had the same health status as the wealthiest 40%, they would enjoy 13 more years of disability-free life; whereas, if heart disease and cancer were eliminated for the poorest 20%, they would experience only 2 to 5 more years disability-free life.

The Canadian 1997 National Forum on Health was clear:  the bottom line is that distributing money and power is the same as distributing health status.

If this is the case, then it seems unlikely that an economy that is based on fostering economic growth can be health enhancing, but some seem content to see a wide gap between rich and poor.  The issue, they say, isn’t whether the very richest person ends up becoming richer. The issue is whether the poorest person is given the chance that they don’t otherwise have.

Wealth share estimates, though, reveal that the richest 2 per cent of adult individuals own more than half of all global wealth, with the richest 1 per cent alone accounting for 40 per cent of global assets. The corresponding figures for the top 5 per cent and the top 10 per cent are 71 per cent and 85 per cent, respectively.

In contrast, the bottom half of wealth holders together hold barely 1 per cent of global wealth. Members of the top decile are almost 400 times richer, on average, than the bottom 50 per cent, and members of the top percentile are almost 2000 times richer.[2]

If our economy was structured so as to promote the health of our population, then, what would be its parameters?

• Its fundamental organising principle would probably be to nurture and protect its children
• Wealth would probably be defined in terms of the quality of social (including economic) interactions, not the quantity.
• It would be almost certainly be co-operative in the way it worked, and would make sure that everyone wins.
• It would tilt the playing field to assist the disadvantaged – i.e. it would focus on (perhaps insist on) equality of outcomes.
• It would celebrate wealth creation (as defined above) and equal sharing of the wealth.
• It would probably be oriented primarily at the level of neighbourhood, however defined, and would encourage ethical trade between global neighbourhoods.
• It would value and reward collective processes – where the widest possible participation occurred – in wealth creation.
• It would avoid inequality, recognising that inequality is the most serious of the non-communicable diseases.
• It would focus on maximising social inclusion to promote stability.
• It would be oriented towards sustainable development at the neighbourhood and global levels.

Sit the two sets of parameters together.  At all points they are diametrically opposed.

Some would argue that giving any group primacy would infringe the rights of other groups.  In my view, it is right to focus on children because they are the most vulnerable of groups.  In creating a society in which they can prosper, we create a society in which all vulnerable people can prosper; and therefore where all people can prosper.

Let’s acknowledge, too, that it is never right to give advantage to one’s own children at the expense of someone else’s children.  If, as the American Declaration of Independence says ‘all men are created equal,’ then it is never better that someone else’s child starves rather than your own; never better that someone else’s child has to live in fear, nor that they have less chance to be educated.

So what might be some of the implications of running an economy for health?  Relevant discussions might include:

• How would you demonstrate the benefit to children of television advertising?
• Should the most valued occupations be those involved in the nurture and protection of children – healing, education, policing, child care (including parenting).  (Certainly, though, we would surely value people on the basis of who they are, not what they do).
• We would probably not value playing the stock or other money markets unless the rewards were shared equally amongst the world’s children.
• We would reduce the volume of motorised traffic in areas that children live, on both road safety and air quality grounds.
• And so on….

That kind of world sounds attractive to me.

It’s all about what we value.

Brian MacKenzie  B.A. (Otago); M.Sc (London); Dip. Imperial College