Good health for its own sakeBMJ 2023; 381 doi: https://doi.org/10.1136/bmj.p1235 (Published 01 June 2023) Cite this as: BMJ 2023;381:p1235
For too long, societies around the world have tended to see money that is spent on healthcare as simply a cost to be borne, while considering spending on innovation, infrastructure, or education to be investments. But if you don’t see health as an investment, then you do not consider the importance of health when formulating policy, particularly economic policy.
Ally Brown points to the short term thinking caused by electoral cycles as one reason that UK governments have fallen into this trap (doi:10.1136/bmj.p1164).1 Michael Marmot says that politicians simply “don’t read the health literature” on the detrimental effects their policies are having on health, because the research is not written by economists (doi:10.1136/bmj.p1183).2
The consequences of failing to invest sufficiently to protect and improve health are seen throughout this week’s issue of The BMJ. Progress in tackling ethnic inequities in maternal health in the UK remains woefully slow, and the risk of maternal death is still almost four times higher for black women than for white women (doi:10.1136/bmj.p1040).3 People’s healthy life expectancy is declining, rather than increasing (doi:10.1136/bmj.p1139),4 and an initiative in England to provide care for patients outside NHS settings is being “severely hampered” by staff shortages (doi:10.1136/bmj.p1205).5
There has been an 89% rise in alcohol related deaths in England over the past 20 years, and more than eight in 10 dependent drinkers are not receiving treatment (doi:10.1136/bmj.p1214).6 There was an 8% fall in whole time equivalent GPs in Northern Ireland between 2014 and 2022 and a 9% fall in the number of general practices over the same period (doi:10.1136/bmj.p1080).7
It doesn’t have to be this way. A major report from the World Health Organization argues that health should be treated as a central goal of economies (doi:10.1136/bmj.p1207).8 Michael Marmot and Paulo Buss say that the report’s “credo” is that “health is not an instrument to some higher goal such as wealth but is an important human right in itself” (doi:10.1136/bmj.p1178).9 They argue that action is needed “by the whole of government striving towards the common good.”
Mariana Mazzucato, chair of the council that put together the report, further argues that we need “a new economic narrative that positions funding for health as an investment rather than an expenditure” (doi:10.1136/bmj.p1175).10 She calls for a redesign of our economic system, so that it is no longer “yielding poor, unequal health outcomes by design.” Nigel Crisp considers what can be learnt from the investments made by the Labour governments between 1997 and 2005 (doi:10.1136/bmj.p1078).11
The ultimate goal must be to break out of thinking that wealth and profit are the primary aims of society. In their place, we must prioritise health and wellbeing as the common goods that will save our species and our planet from disaster.