Intended for healthcare professionals


Commentary: Look after the pennies

BMJ 2009; 338 doi: (Published 01 April 2009) Cite this as: BMJ 2009;338:b1380
  1. Andrew Jack, pharmaceuticals correspondent
  1. 1Financial Times, London
  1. Andrew.Jack{at}

    The economic crisis means that rather than ask for more money for health, we are going to have to be more careful how we spend it, says Andrew Jack

    As international political leaders left London’s G20 meeting last week, their concluding communique1 offered a few bright spots for the health of the world’s poorest, but only an indirect nod to Michael Marmot and Ruth Bell’s well timed call to highlight the dangers of the global economic crisis on health. With the global economy contracting sharply, there will certainly be an overall negative impact on health, to which the latest pledge of a fresh $1.1 trillion in lending offers only a little palliative care. Government, consumer, and philanthropic spending alike are under pressure; unemployment is rising, as is work related stress for those still with jobs (including in the health sector); and remittances are down from migrant workers, a vital source of non-official aid to those on lower incomes.

    Variable effects

    While troubling, the consequences for health will be highly nuanced between countries and among different groups of individuals, and will vary over time. The new pressures should be a spur to fresh thinking on how best to spend scarce resources over the next few years. Studies of previous financial crises—notably in Asia—have shown that short term reductions in basic health services such as child immunisation have contributed to rising infant mortality2; while the overall impact of a downturn can affect mental health and wellbeing.

    Calling for substantial extra financial support to the vulnerable, the World Bank recently cautioned that at least 400 000 additional children could die each year as a result of the current crisis.3 The European Union’s health commissioner has warned of the need for vigilance by national ministers of health to avoid a drop in provision …

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