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Commission on Macroeconomics and Health
Background
To date, there have been very few linkages made between the spheres of public health and macroeconomics. Consider three examples. First, it is clear that poverty predisposes individuals and countries to ill health. Thus, sound macroeconomic policies that reduce poverty will, to some extent, improve health. But it is also clear that ill health perpetuates poverty. Appropriate investments in improved health could provide an important set of instruments for poverty reduction and economic growth. However, there is a lack of specific research or operational tools to place health within an overall developmental agenda. Second, new research commissioned by WHO adds to recent literature suggesting that countries with higher levels of health grow faster and, indeed, improvements in health may account for a significant fraction of the rapid economic growth of much of the world in the 20th century. Third, the global macroeconomic incentives for research and development of new health technologies have not been well studied. In contrast to health, other sectors such as environment have made substantial linkages to the macroeconomic and developmental agendas, partly by improving the scientific and economic base on which policy can be based.
The increasing use of the International Development Targets, including targets in public health, as the encompassing framework to evaluate the progress in the fight against poverty, is a testament of the increasing recognition of the linkages from improved health to the escape from poverty. Improving health is recognized as a poverty alleviation goal in itself, and is increasingly understood to be an input into improved economic performance.
The World Health Report (WHR) 1999 emphasized health as a key item in the developmental agenda, including a focus on health investments to improve health outcomes of the poorest billion in the world. Dr. Brundtland has drawn on these findings to argue that health should be a major concern of Finance and Prime Ministers. This is particularly so because the development agenda is moving from an exclusive focus on trade and macroeconomic stabilization to a real concern for poverty. Yet health remains far from the top of the development agenda. Many health professionals continue to argue that the health sector itself is only a minor player in efforts to improve the health of populations. And the overwhelming majority of finance officials and development economists agree – or believe – that health itself is relatively unimportant as a development goal or as an instrument for reducing poverty. Thus a major challenge for WHO over the next few years was to stimulate strengthening of the evidence base and to communicate much more effectively what is already known.
In May 1999, WHO and the United Kingdom’s Department for International Development (DFID) organized a meeting called "World Health Opportunity: Developing Health, Reducing Poverty". This meeting clearly emphasized WHO’s role as the lead technical agency on health to provide the analytic and operational basis for health to be at the “heart” of development.
WHO’s response
A key WHO response to this consultation, in line with the conviction that health is an issue of importance to macroeconomic specialists, was the creation of the Commission on Macroeconomics and Health (CMH) by Dr. Gro Harlem Brundtland, in January 2000.
The goal of the Commission was to place health at the top of the development agenda. The premise is that the health sector is a major player in efforts to improve the economic well-being of populations in general, and in reducing poverty in particular. Thus, the Commission is a crucial part of WHO’s strategy to meet the challenge of assembling and analyzing the evidence linking health status and poverty reduction. The Commission sought to communicate its findings in this area effectively to policy makers in national governments and development professionals in development agencies.
Why is WHO involved in macroeconomics?
It is clear that WHO’s comparative advantage is in technical advice on health and not on macroeconomics. The rationale behind WHO’s involvement in macroeconomics is twofold. First, the CMH is a continuation of WHO’s emphasis on evidence. By critically examining selected key aspects of health and development, the CMH
increased the set of tools and policy conclusions available to ministries of health and finance. Second, the CMH
helped relate key aspects of WHO policy (such as financing health services for all, but not all health services) into practical issues that must be addressed by ministries of finance (e.g. types of tax systems to use in different settings).
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© 2007 by the President and Fellows of Harvard College.
Last revised 10/31/2007