Intended for healthcare professionals

Feature Data Briefing

Does good healthcare score as highly with the public as education and protection from crime?

BMJ 2013; 347 doi: https://doi.org/10.1136/bmj.f4705 (Published 07 August 2013) Cite this as: BMJ 2013;347:f4705
  1. John Appleby, chief economist, King’s Fund
  1. j.appleby{at}kingsfund.org.uk

What do people across the world rate most highly in their economic, social, and political life? John Appleby dissects the findings of a massive survey by the UN

As part of its efforts to come up with new development goals from 2015,1 the United Nations initiated what could turn out to be one of the largest international surveys ever.2 The “my world” survey aims to collect the views of people around the world on the things that concern them most about their lives. Voting will continue until 2015, and you can have your say at: www.myworld2015.org. Currently, around 800 000 people have responded from 194 countries.3 The survey—with data collected online, by mobile phone, and face to face—asks people to choose six aspects of their economic, social, and political life (out of 16 options) that are “most important to [them] and [their] family.” The choices range from better education and an honest and responsive government to equality between men and women and action on climate change. So, what does the world vote for?

So far, after seven months of voting, “a good education” has topped the world’s list of important issues in life (see fig 1). “Better healthcare” is second and “a responsive government we can trust” is third. The sheer scale of the total responses (around four million because six choices are sought from each respondent) means that all differences between results in fig 1, for example, are statistically significant. However, this does not necessarily translate into an important difference in policy terms of course.

Figure1

Fig 1 My world survey priorities: “Which of these are most important to you and your family?”4

There is considerable consistency in the top choice across all countries. For example, in 175 out of 194 countries education was the most commonly cited issue (nearly always with health second). However, there are some notable exceptions. “A responsive government we can trust” was the main priority for people living in Belarus, Ukraine, the Russian Federation, and the Republic of Korea, for instance. And “better healthcare” was the top priority for people in 12 countries, including China, Gabon, Nigeria, and Cote d’Ivoire.

However, below first choice the ranking of other issues is much less consistent. Better healthcare may be the second most important priority for the world as a whole, but this is not the case in all countries. Grouping countries by their score on the human development index (HDI)—a composite measure based on gross domestic product, life expectancy, and education—shows that for high (and in particular “very high”) HDI countries (with high gross domestic product per capita, long life expectancy, and so on), healthcare is less important than for medium and low HDI countries (fig 2). For the UK, healthcare ranks only eighth, below, for instance, protection against crime and violence and protecting forests, rivers, and oceans.

Figure2

Fig 2 My world survey priority issues by country, grouped by the human development index4

More specifically, there also seems to be an inverse association (with a reasonably high negative correlation of −0.7) between how much a country spends on healthcare and the proportion of people voting for better healthcare (fig 3). Is it the case then that “what’s important to you and your family” depends in part on whether you already have access to the things you think are important? But if that were true then the high ranking for “access to clean water and sanitation” in high income/developed countries (second to education in the United Kingdom) relative to medium/low HDI countries seems anomalous. On the other hand, what could be more important to health than access to clean water?

Figure3

Fig 3 Per capita spending on healthcare versus proportion of all responses for “better healthcare.” Countries with fewer than 1000 total options chosen were excluded because the number per option was relatively small. The (red) regression line was fitted on the basis of best explaining the variation between the two variables (to maximise the measure of fit, R2—which is the square of the correlation coefficient, r, which in this case is equal to −0.7). The fitted curve is exponential and the countries (including the UK) are identified solely to give the reader some idea of which countries lie at the extremes of the distributions4 5

However, what “better healthcare” means to someone living in a country like the UK with a developed and accessible healthcare system is almost certainly very different from what it means to someone living in Nigeria or Cameroon, where even basic and safe healthcare is harder (and personally more expensive) to come by. Also, it’s not as if access to clean water is considered unimportant in such countries.

Overall, the survey’s results so far suggest that the world wants a better (personal) economic future (education and jobs), better politics (trusted governments), and better health (through healthcare, but also other determinants such as food and water).

Notes

Cite this as: BMJ 2013;347:f4705

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Footnotes

  • Competing interests: “I have read and understood the BMJ policy on declaration of interests and declare the following interests: None.

  • Provenance and peer review: Commissioned; externally peer reviewed.

  • Data for this briefing were downloaded on 8 July when 696 962 people had responded. Charts are based on cleaned data that excluded 33 553 votes where no responses to country of origin or any priorities (or both) were specified.

References

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