Minggu, 18 Januari 2009


The dramatic health improvements globally during the 20th century arguably contributed as much or more to improvements in overall well-being as did the equally dramatic innovation
in and expansion of the availability of material goods and services. To the substantial extent that appropriate investments in health can contribute to continued reductions in morbidity
and mortality, the economic welfare returns to health investments are likely to be exceptional and positive—with previously unrecognized implications for public sector resource
allocation. These returns go far beyond the contribution better health makes to per capita income, which itself appears substantial (see Bloom, Canning, and Jamison 2004; Lopez-
Casasnovas, Rivera, and Currais 2005). This section first summarizes the evidence concerning health’s effect on per capita income and then turns to more recent literature concerning the effect of health changes on a broader measure of economic well-being than per capita gross domestic product (GDP).
Health and Income
How does health influence GDP per person? Healthy workers are more productive than workers who are similar but not healthy. Supporting evidence for this plausible observation comes fromstudies that link investments in health and nutrition of the young to adult wages (Strauss and Thomas 1998). Better health also raises per capita income through a number of other channels. One involves altering decisions about expenditures and savings over the life cycle. The idea of planning for retirement occurs only when mortality rates become low enough for
retirement to be a realistic prospect. Rising longevity in developing countries has opened a new incentive for the current generation to save—an incentive that can dramatically affect
national saving rates. Although this saving boom lasts for only one generation and is offset by the needs of the elderly after population aging occurs, it can substantially boost investment
and economic growth rates while it lasts.
Encouraging foreign direct investment is another channel: investors shun environments in which the labor force suffers a heavy disease burden. Endemic diseases can also deny humans
access to land or other natural resources, as occurred in much of West Africa before the successful control of river blindness.
Boosting education is yet another channel. Healthier children attend school and learn more while they are there. A longer life span increases the returns on investment in education.
If better health improves the productive potential of individuals, good health should accompany higher levels of national income in the long run.Countries that have high levels of health but low levels of income tend to experience relatively faster economic growth as their income adjusts. How big an overall contribution does better health make to economic
growth? Evidence from cross-country growth regressions suggests the contribution is consistently substantial. Indeed, the initial health of a population has been identified as one of the
most robust and potent drivers of economic growth—among such well-established influences as the initial level of income per capita, geographic location, institutional environment, economic policy, initial level of education, and investments in education. Bloom, Canning, and Sevilla (2004) found that one extra year of life expectancy raises GDP per person by about 4 percent in the long run. Jamison, Lau, and Wang (2005) estimated that reductions in adult mortality explain 10 to
15 percent of the economic growth that occurred from 1960 to 1990. Not all countries benefit equally from this link. Bhargava and others (2001) found that better health matters more for income growth in low-income countries than in high-income ones. Although attribution of causality is never unequivocal in analyses like these, different types of evidence point consistently to a likely causal effect of health on growth.
Health declines can precipitate downward spirals, setting off impoverishment and further ill health. For example, the effect of HIV/AIDS on per capita GDP could prove devastating in the
long run. An enormous waste of human capital occurs as prime-age workers die. A high-mortality environment deters the next generation from investing in education and creating
human capital. The creation of a generation of orphans means that children may be forced to work to survive and may not get the education they need. High rates of mortality may reduce
investment. Saving rates are likely to fall, and retirement becomes less likely. A foreign company is less likely to invest in a country with a high HIV prevalence rate because of the threat
to the firm’s own workers, the prospect of high labor turnover, and the loss of workers who have gained specific skills by working for the firm. The International Monetary Fund recently published a collection of important studies of the multiple mechanisms through which a major AIDS epidemic can be expected to affect national economies (Haacker 2004).

Source: Jamison,DT, Breman,JG et al. Investing in Health. In Disease Control Priorities in Developing Countries SECOND EDITION. Oxford University Press,2006.

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