Health, development and governance

Deborah Johnston (SOAS)MIF Residential School, Addis

Ababa, March 2012

Does development

improve health? The simple view

At the micro level too?• A wealth gradient for many

health outcomes and healthy activities. (Data: Yazbeck 2009)

• Poorest have few resources• Poorest have poor health

information• Poorest have worst

incentives

Simple policy menu for simple view• Strong relationship

between levels of health (life expectancy, child mortality) and levels of GDP per capita

• Causality running from wealth to health

• Historical evidence from now-rich countries

World Bank Investing in Health:

• Promote income of the poor through liberalisation and economic growth

• Refocus public spending to most cost-effective health services

• Allow greater competition in health services

Criticisms

• Anomalies

• Levels and changes?

• History

• Causality?

The complexity of the relationship: social factors, governance ??

Data on child mortality in China and India from Deaton (2006)

Criticisms

• Anomalies

• Levels and changes?

• History

• Causality?

Health, Development and Governance?

• Role of public policy in health back at heart of the discussion

• Health inequalities may mirror economic inequalities, which also suggests that the policy focus must be wide

• Health inequalities may also reflect global factors, with particular challenges for policy (not only the obvious area of patents, but also entry of private medical services, and patterns of migration and economic activity)

A CASE STUDY OF HIV/AIDS

But....

• At the regional level, patterns that do not match the income thesis neatly

Also true at the micro level

Simple policy menu?

• Promote income of the poor through liberalisation and economic growthBut, evidence…..

• Refocus public spending to most cost-effective health services. Allow greater competition in health servicesYes, but access, appropriateness (new ‘dependency’)…..

• Narrowness?

Using HIV to think of a wider health and governance agenda?

• Role of public policy in health back at heart of the discussion

• Health inequalities may mirror economic inequalities, which also suggests that the policy focus must be wide

• Health inequalities may also reflect global factors, with particular challenges for policy (not only the obvious area of patents, but also entry of private medical services, and patterns of migration and economic activity)

• Tailored HIV policy to meet specific needs: ‘Know your epidemic’ (biomedical characteristics of disease and intersection with society)

• A broad view of health service provision to understand role for complementary health system changes: M2C, ARV, medical transmission risk, STIs, circumcision, nutrition

• Role for influencing social norms and practices – both directly and through economic policy