PHM-Exch> [PHM NEWS] Council on Economics and Health pushes WHO for action on the economic determinants of population health

[Claudio Schuftan]

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From: David <dlegge at phmovement.org>

The challenge is now implementation

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Council on Economics and Health pushes WHO for action on the economic
determinants of population health

The Council on the Economics of Health For All was established on 13
November 2020 by the WHO Director-General “to rethink how value in health
and wellbeing is measured, produced, and distributed across the economy.”

The Council sought “to reframe health for all as a public policy objective,
and ensure that national and global economies and finance are structured in
such a way to deliver on this ambitious goal.”

The final report
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=7d81fec1ff&e=ade41a541f>
was launched in May 2023. In its forthcoming meeting, the Executive Board
of WHO will review the Council’s recommendations and consider their
implications for WHO’s program of work.
Thirteen excellent recommendations The Secretariat report introducing this
item (EB154/26
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=9e26bb39b8&e=ade41a541f>)
describes the context of the Council’s work as characterised by the
“interlinked crises of health, inequality and climate, which [...] disrupt
solidarity and stability”. The need for change is illustrated by extensive
references to the Covid pandemic.

There is a clear articulation in the Council report for the need for an
alternative economics that changes the way value is conceived and the
financing of health services operates. Such an alternate valuation is
described as including the role of health workers and health care as an
investment not a cost but there is no further examination of how this could
be achieved.

The Council’s report recognises that health system development (access,
quality, efficiency, etc) and the conditions which shape population health
are complexly determined by economic activities and trends and by the
pressures of economic actors.

The Council report critiques the subordination of health expenditure to
debt repayments. To address this, it recommends the exclusion of health
investment from sovereign fiscal deficit. The report also calls for a
suspension of debt repayments by lower income countries during health
pandemics and other disasters.

At the country level, the Council report critiques austerity policies and
favours generating public funding including taxes on wealth and on
multinational entities. It also promotes regulation of private sector
actors for the common good.

The 13 recommendations are all excellent ideas
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=fae7c5778f&e=ade41a541f>;
a package of directions which if achieved would make a big difference. The
recommendations all take the imperative mood - commanding that something
happen - but the agents who will drive the required change and their whys
and hows are not identified.

The recommendations of the Council articulate high level desiderata which
are flouted, in many respects, in the ways national economies and the
global economy operate. The Council does not analyse the barriers to the
implementation of its recommendations, nor does it explain how these
barriers might be overcome.  Analysis of causation There is no explicit
analysis of the forces and dynamics which have led to the interlinked
crises of health inequality and climate, and there is no explicit theory of
change articulated in the Council’s report. Without a credible theory of
change and implementable actions which arise from that theory, this could
be just another report on the shelf. However, there are aspects of the
Council’s recommendations which suggest an implicit theory of change.

The creation of the Council itself was strategic in the sense that putting
new ideas into public discourse and giving them the imprimatur of WHO might
in some degree change the discourse around policy formation at national and
global levels and contribute to change in that way. The calls for reform of
the intellectual property regulation in the Council’s report illustrate the
importance of authoritative statements as contributing to change.

However, new ideas need to find the constituencies whose action and
advocacy can change political realities on the ground. There is little in
this report which might link high level pronouncements about intellectual
property policy reform to successful domestic pressure in a sufficient
number of WTO member countries to effect change.

The proposal for a ‘Dashboard for a healthy economy’ may reflect the view
that new information can contribute to social and economic change. However,
as a theory of change, new information must change the distribution of
political forces; strengthen the agency of constituencies seeking to
achieve social and economic change. There is no indication in the Council’s
report of such consideration.

There are hints of an implicit theory of change in the discussion offered
in EB154/26 about how WHO could advance the Council’s agenda:

   1. WHO should expand its work in macroeconomics and health and ensure
   additional resources to enable comprehensive contributions by WHO in this
   area;
   2. WHO’s efforts to address the social and commercial determinants of
   health should be further strengthened and could include advocating for the
   transition to clean energy, more sustainable food systems and cleaner
   transportation systems;
   3. WHO could promote capacity-strengthening [..] in order to better
   equip country offices and health ministries to engage in dialogues with
   economic and finance sectors and to enhance overall public capacity to
   shape economic and fiscal policies and drive public-private collaborations;

The report suggests that deploying WHO’s technical expertise in providing
normative guidance and rigorous analysis on the economics of health for all
could also contribute to the achievement of the Council’s agenda. Barriers
to change There is no discussion (in the Council’s report or that of the
Secretariat) of the obstacles which have limited WHO’s capacity to move in
these directions, including the repeated (and bullying) denials by the USA
of the mandate or competence of WHO in these fields and the deliberate
policies of most of the high income countries to keep the Secretariat on a
tight leash through restricting the growth of assessed contributions and
insisting on tightly specifying voluntary contributions.

*PHM urges members of the Board to request further work by the Secretariat,
directed to:*

   1. analysing in more depth the genesis of the interlinked crises, in
   particular the crisis of inequality and alienation;
   2. identifying and exploring the barriers to the implementation of the
   13 recommendations;
   3. building the required consensus to operationalize international debt
   relief to sustain health finances and ensure health services in developing
   countries during periods of crisis;
   4. reorienting economics towards prioritizing health as a public good
   and therefore to build international alliances around exchanging knowledge
   and technology not driven by corporate profit requirements; and
   5. developing further recommendations to inform WHO action towards an
   economy for health for all.

*PHM urges the Board to:*

   1. request the Secretariat to design and undertake a survey of WHO
   member states directed to identifying and analysing the barriers to the
   implementation of the Council’s recommendations and identifying initiatives
   which have successfully overcome such barriers;
   2. request further work by the Secretariat directed to exploring the
   role of health systems such as healthcare facilities, public health units,
   and healthcare personnel in building political pressure for intersectoral
   action towards an economy for health for all;
   3. to request further work by the Secretariat to explore the scope for
   ‘meaningful public engagement’ and ‘community health partnerships’ working
   towards intersectoral action towards health for all.

The full PHM commentary on this item
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=3cf3a1d867&e=ade41a541f>
provides
more detail and references.

The WHO Tracker and PHM item commentaries are produced as part of *WHO
Watch* which is a project of the People's Health Movement
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=86e8fa537d&e=ade41a541f>
in association with Medicus Mundi International
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=52648877f6&e=ade41a541f>,
Third World Network
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democratising global health governance, through new alliances, new
information flows and by broadening the policy discourse.

See the WHO Tracker page for this EB154 session (here
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See PHM’s integrated commentary
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=d47728b693&e=ade41a541f>
on the full agenda of EB154 (or read the flipbook version
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=aa4b7fc4dc&e=ade41a541f>).
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