The Health Requisite for Development
Last month, as I attended presentations at the World Economic Forum, I came away impressed by many of the conversations on addressing the world’s overlapping economic, social, and environmental threats. But I also came away hoping for more discussion about health as central to meeting these global challenges.
Of course, I arrived at the Forum with strong and specific interests. As the leader of an organization that works with partner nursing and medical schools in Africa to train, support, and empower the continent’s next generation of health providers and health system leaders, my interests are focused on health, sustainable economic development, and especially the connections between them.
Over four days in Davos, panelists and experts talked at length about development in resource-constrained settings — energy, technology, and the “Fourth Industrial Revolution.” They also addressed urgent global health issues, including pandemics and health security. But what the event underscored for me was the need to better explore the vital role that stronger health systems play in creating conditions for sustainable, long-term growth in places suffering from poverty and disease.
On a panel that featured some of Africa’s most recognized and articulate leaders discussing “Africa’s Next Challenge” — including President Paul Kagame of Rwanda, Prime Minister Hailemariam Dessalegn of Ethiopia, and the President of the African Development Bank, Akinwumi Ayodeji Adesina — nobody addressed what is arguably the single biggest challenge facing African countries and their economies: the crushing burden of disease that shortens lives, stunts education, employment, and productivity, impoverishes families and communities, and hamstrings economic growth.
Today, life expectancy in sub-Saharan Africa is 58. That’s about what it was in the United States at the start of the Great Depression and a full 20 years shorter than Americans enjoy today. Nearly one out of every 10 African children will die before reaching her fifth birthday, compared to roughly one in 140 in the US. Overall, 80 percent of deaths in Africa occur in people younger than 60. In high-income countries, over 80 percent of people are older than 60 when they die.
The sad truth is that the overwhelming majority of these deaths — particularly those of African children and young adults — are caused by wholly preventable and treatable diseases, such as lower respiratory infections, malaria, HIV/AIDS, and diarrheal diseases. And they are exacerbated by stark disparities in access to quality health care and the skilled health providers who deliver it. In sub-Saharan Africa, for example, there are only two doctors and 10 nurses for every 10,000 people. In the United States, there are over 20 doctors and 90 nurses for the same number of people.
And there is no disputing the impact these health problems have on development and prosperity. Unexpected illnesses and subsequent health-care costs are leading causes of impoverishment in many low-income and middle-income countries. Malnutrition and disease reduce school attendance and impair cognitive development for millions of children, severely damaging their employment, productivity, and earnings as adults. Among adults, disease and disability cause major losses in hours worked and productivity, keeping families mired in extreme poverty and destitution.
A Zambian study found that two-thirds of urban households that lost their main breadwinner to AIDS experienced an 80 percent decrease in income. Sixty-one percent of these households moved to cheaper housing, 39 percent lost piped water, and more than 20 percent of girls and 17 percent of boys dropped out of school.
On a macroeconomic level, malaria alone has been estimated to cut economic growth in many African countries by up to 1.3 percent per year, due to lost work time, economic losses associated with infant and child mortality and illness, and the costs of treatment and prevention. Compounded over time, this translates into a loss of nearly 20 percent of GDP by the fifteenth year. Conversely, every 10 percent reduction in malaria results in a 0.3 percent increase in economic growth.
More broadly, improvements in health have been shown to both reduce poverty and contribute to long-term economic growth and development. Data driven models project that health investments of just five dollars per person per year in 74 countries, which bear 95 percent of the global burden of maternal and child mortality, would yield up to nine times the economic and social benefit by 2035.
Lessons from history and recent evidence from Africa tell us there is no guarantee that economic growth will automatically yield gains in nutrition and health for the population at large. But there is strong evidence that the reverse is true, that improved health is an important catalyst — or even an essential precondition — for long-term economic growth.
Those were the conclusions of an Africa Health Forum that brought finance and health ministers from across the continent together in 2013. The Forum report cites historical data confirming that health and nutrition improvements preceded (and almost certainly contributed to) economic take-off in East Asian “tigers” that have achieved both health and wealth. More recently, on the other hand, strong economic growth alone from mineral revenues in several African countries has not translated into improved health and nutrition for all.
As the Africa Health Forum stated, “Better nutrition, health, and demographic outcomes have spurred productivity worldwide. Securing Africa’s future rests on achieving large-scale rapid health results.”
The connections between disease and poverty — and between health and economic development — are clear and they are compelling. I just wish they were better recognized and made central to every conversation about economic growth and investment.