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Health and Development Investment Choices

Health and Economic Development: A Two-Way Relationship

  • Core Principle: Health and economic matters are closely linked, with a two-way relationship between health and development. Every concept discussed has real-world applications.
  • Health as Human Capital:
    • Health is a crucial contributor to an individual's human capital, which refers to the knowledge and skills people accumulate to be productive.
    • Good health status is a major determinant of enrollment and success in school, directly impacting future earnings.
  • Cost of Healthcare:
    • Healthcare costs are critical, especially for individuals in poverty, as out-of-pocket expenses can severely impact their financial status and push them further into poverty.
    • At a national level, health is a major item of expenditure in all countries.
    • The way countries finance and deliver health services raises significant issues of equity and inequality.
  • Illustrative Example:
    • Consider a child in rural India who repeatedly contracts malaria. This child misses school, falls behind academically, and is less likely to succeed later in life.
    • Extrapolating this to millions of children demonstrates how widespread illness can impede an entire nation's productivity and economic growth.
    • Health, therefore, is not merely the absence of disease; it is fundamental to building human capital.

Health, Education, and Human Capital Interconnections

  • Three Key Connections between Health and Education:
    1. Intergenerational Links: The health and education levels of parents directly influence the health and educational outcomes of their children.
    2. Malnutrition and Disease Impact: Childhood malnutrition and infectious diseases detrimentally affect children's cognitive development and school performance.
    3. Education for Prevention and Management: Education plays a vital role in disease prevention and management.
  • Empirical Evidence and Examples:
    • Maternal Education and Child Immunization: A higher level of education in a mother from a low- or middle-income country correlates with a greater likelihood of her child being immunized.
    • Measles Immunization Rates: Data shows that in various countries, one-year-olds whose parents have higher education levels exhibit significantly higher rates of measles immunization compared to those with no parental education.
    • Child Mortality Reduction: One study revealed that each additional year of schooling for a woman was associated with a reduction of 7-9 percent in the mortality of her children under five years of age.
    • The same study found that the mortality rate of children under five was almost 60 percent lower for children born to mothers with at least 7 years of schooling compared to those with no maternal schooling.
    • Ripple Effect: Improved education for women leads to healthier children and stronger future generations.
  • Global Progress: Significant advancements are being made globally, with more girls attending school than ever before, even in low-income countries, acting as a crucial driver for future health improvements.

Health, Labor Productivity, and Earnings

  • Direct Impact on Productivity: Good health directly impacts labor productivity and earnings, independent of its link with education.
    • Example: A construction worker suffering from chronic back pain will likely miss more work days and earn less than a healthy counterpart.
  • Longevity and Lifetime Earnings: Good health is known to increase longevity and, consequently, lifetime earnings.
  • Worker Productivity: Healthy workers are inherently more productive than unhealthy workers.
  • Income Loss due to Illness: When individuals fall ill, many are unable to work, leading to a loss of income.
  • National Economic Strength: Countries with healthier populations tend to have stronger economies.
    • Example: Japan: High life expectancy in Japan contributes to a robust working life and sustained productivity.
    • Contrast: Nations where infectious diseases shorten life expectancy often experience limited economic growth.

Economic Consequences of Illness for Individuals

  • Financial Hardship: Illness can impose severe financial burdens on individuals and households.
    • Asset Depletion: People may be forced to sell assets (e.g., land, livestock, jewelry) to cover medical expenses.
    • Decreased Earnings: Illness often leads to a reduction or complete loss of personal earnings.
    • Indirect Costs: There are also indirect costs associated with illness, such as transportation expenses to clinics or pharmacies, especially in rural areas, adding an extra financial strain.
    • Long-Term Disability: Prolonged disability can result in substantial ongoing expenses for health services and a significant loss of income over time.
  • Global Statistics (World Bank):
    • Approximately 2 billion people worldwide face financial hardship due to healthcare costs.
    • 1 billion individuals experience catastrophic out-of-pocket health spending.
    • 344 million people are driven into deeper extreme poverty solely due to health-related expenses.

Understanding Health Disparities

  • Definition of Health Disparities: A type of difference in health that is closely linked with social or economic disadvantage. These are a major concern in public health.
  • Key Terms:
    • Health Equity: Achieved when every person has the opportunity to attain their full health potential, and no one is disadvantaged from achieving this potential due to social position or other socially determined circumstances. It means everyone has the chance to reach their highest possible health.
    • Health Inequity: Differences in population health status and mortality rates that are systemic, patterned, unfair, unjust, and actionable, distinguishing them from random variations or differences caused by those who become ill.
    • Health Inequality (WHO Definition): Defined as differences in health status or in the distribution of health determinants between different population groups.
  • Illustrating Equality, Equity, Justice, and Inclusion (Conceptual Model):
    • Reality: Health resources are often distributed unevenly, with some populations receiving more than needed and others far less, leading to wider disparities.
    • Equality: Everyone receives the same level of support (e.g., identical access to clinics or medications). However, this approach ignores existing differences in need, meaning disadvantaged groups remain behind.
    • Equity: Recognizes individual and group differences in need and ensures people receive the specific resources they require (e.g., more prenatal care in high-risk communities, translation services for non-English speakers).
    • Justice: Goes beyond equity by addressing the fundamental, root causes of inequity (e.g., systemic racism, poverty, lack of infrastructure), thereby eliminating the barriers themselves.
    • Inclusion: All groups are not only given care but are fully engaged and valued in shaping the health system, ensuring absolutely no one is left out.
  • Summary Distinctions:
    • Health equity is about fair opportunities for everyone to reach their highest health potential, not just equal treatment.
    • Equality is sameness; Equity is fairness; Disparities are differences that lead to disadvantage.
  • Areas for Consideration: When discussing healthcare, it's essential to consider equity, equality, and health disparities across:
    • Health status.
    • Access to and coverage of health services.
    • Protection from financial risks.
    • Fairness of health financing.
    • Distribution of health benefits.
  • Key Questions: For these areas, it's important to ask: To what extent do they vary across groups? Why do they vary? What interventions can reduce inequity, inequality, and disparities?

Factors Contributing to Health Disparities

  • Factors Related to Access and Coverage of Health Services:
    • Geographic Availability: The physical distance or travel time required to access services.
    • Availability: The extent to which needed services are offered conveniently by properly trained staff.
    • Financial Accessibility: The ability and willingness of people to pay for services without experiencing financial distress.
    • Acceptability: The degree to which services align with cultural norms and expectations of the population.
  • Personal and Societal Factors Influencing Disparities: It's crucial to consider how equity, equality, and health disparities vary according to:
    • Socioeconomic status (SES)
    • Ethnicity
    • Gender
    • Religion
    • Location
    • Occupation
    • Social capital
  • Common Pattern of Disadvantage: Generally, less well-off individuals and groups with less social and political power experience worse health outcomes, poorer services, and less fairness and protection regarding health financing.
    • Specific Marginalized Groups: This often includes women, indigenous people, ethnic and religious minorities, residents of rural areas, those working in the informal sector, less educated individuals, and other marginalized groups such as the LGBTQ+ community.

Global Examples of Health Disparities

  • Basic Indicators and Life Expectancy:
    • In 2016 , life expectancy at birth in high-income countries was 80 years, approximately 27 % higher than in low-income countries, where it was 63 years.
    • These differences reflect the status of economic development, inequitable relationships between countries, and political choices.
  • Maternal Mortality: Maternal mortality in Sierra Leone is 450 times higher than in countries like Greece, Iceland, and Poland.
  • Intra-Country Variation:
    • Some countries, such as Scandinavian nations and other high-income European countries, exhibit little variation in health indicators across different population groups.
    • Conversely, many countries show substantial variance. Examples in high-income nations include Australia, Canada, and the U.S. (often due to disadvantaged ethnic minorities), and many lower-middle-income countries.
    • India Child Mortality Example: A graph illustrating deaths per 1,000 live births in different Indian states shows that the worst-performing state has a child mortality rate more than four times that of the best-performing state.
  • Location-Based Disparities (Urban vs. Rural):
    • Urban dwellers generally enjoy better health status, service coverage, and access compared to rural dwellers.
    • Rural populations often have lower incomes, less education, reduced access to services, and weaker political voice.
    • Stunting in Children (Selected Regions): A graph shows that the percentage of children aged 0-5 years who are stunted is consistently higher in rural areas (orange) compared to urban areas (blue) across West & Central Africa, South Asia, and East Asia & Pacific.
    • Contraception Use in Women (Selected Regions): A similar graph demonstrates lower rates of contraception use for married women aged 15-49 in rural areas compared to urban counterparts across West & Central Africa and South Asia. An exception is East Asia & Pacific, where rural use is slightly higher.
  • Income-Based Disparities (Income Quintiles):
    • Much global health literature focuses on the relationship between health disparities and income.
    • A significant gap in access, coverage, fairness, and benefits exists between the less well-off and the better-off, often examined by dividing populations into five equal income groups (quintiles).
    • Higher income is associated with better education, housing, water access, sanitation, health services, and safer work environments.
    • Births Attended by Skilled Personnel: Graphs for Sub-Saharan Africa and South Asia illustrate vast disparities between the poorest 20 % and the richest 20 % in terms of births attended by skilled personnel.
    • Stunting in Children by Income Quintile: Similar graphs for Sub-Saharan Africa and South Asia show significantly higher percentages of stunted children aged 0-5 years in the poorest 20 % compared to their richest 20 % counterparts.
  • Gender Disparities:
    • Quote: