Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has. (Attributed to Margaret Mead)
Recently I heard Professor David Taylor of UCL speak for fifteen minutes on the far from limitable topic of the ‘economy in health’. Choosing to break his exploration into a tripartite structure that: 1. considered economy as the driver of increased longevity and greater wealth 2. associated with the emergence of universal health care systems and 3. the knock-on threats to and opportunities for ongoing improvement in health and wellbeing, Taylor’s talk captured prescient ideas pertinent to us all.
The world’s economy is influenced by the demographic and epidemiological shift (shown below) popularised by sociologist Daniel Bell, which suggests a non-finite post-industrial future in which society has developed to a point at which the service sector generates more wealth than the manufacturing sector in an economy. In the UK, we have already arrived at this post-industrial stage, which is definable not only in terms of economy but also in relation to relatively low birth and death rates.
Demographic and Epidemiological Transition in Western Europe
As discussed in a recent MdM article on the Sustainable Development Goals which continue to prioritise reducing infant mortality, the social consequences of this and also of increased adult longevity (i.e. reduced mortality) are numerous. Indeed, Taylor linked this trend to more equal gender roles at home and in work, more intense patterns of child care, a rise in average IQ levels, the rise (and fall) of professionals such as pharmacists and doctors, changing international relationships, the evolution of universal health care systems and improved life opportunities for people with disabilities and for older people. Of course, the reality and feasibility of such consequences is material for a completely separate discussion, but such projected outcomes are useful in further exploring the role of economy in health, and vice versa.
While more children than ever before are surviving beyond 5 years of age, 2015 sees fewer children being born and national level introduction of incentives to revive something of the baby boomer generation. Indeed, as of earlier this year, China has lifted its one-child only policy in part to augment the fertility rate (births per woman) to support the ageing population the world over. For it is not problematic in terms of health related treatments and care that the population is ageing per se, but rather that there are insufficient working age individuals to carry out these services. Meanwhile, the graph below shows that in under 50 years, the percentage of the UK’s population aged over 65 doubled from 7 to 14%. More recent statistics from the United Nation’s 2003 report on World Population Ageing show that this process is accelerating.
Such trajectories demand questions of what drives health improvement, what are the most important threats and opportunities facing us today, and specifically relating to Kinsella’s graph, how well has the world done in achieving continued improvement in health and wealth or welfare since the 1940s?
There are many ways in which to address such questions, appropriating both post-modernist and historical ideas in particular the philosophical argument proposed by David Hume’s ideology of economic growth focusing on what we now term ‘demography’ and ageing. In Political Discourses (1752), Hume sets out a case for modern populations being larger and wealthier and refuted the idea of more powerful ancient governments and peoples. For Hume, the modern age and its peoples were better off, enabling more people to survive and exist with a better level of socio-economic wellbeing. Now considered iconic for being included in his volume of political-economic (Essays, Moral and Political) writings, his work pioneered demography as a factor in economic analyses, and is commonly incorporated in such work ever since, as Professor Roger Emerson notes.
Looking in more detail at the role of economy in health in 2015, it is apparent that globalisation is at a cross roads. While local trade talks are in confusion, multilateral talks gain ground (such as the Comprehensive and Economic Trade Agreement between Canada and the European Union), so threatening to introduce a further wave of privatisation in key sectors such as health and education as public services and government procurement contracts come under competition from transnational corporations. Liberalisation, deregulation and privatisation have caused disarray at the local level.
Meanwhile, trade agreements (such as the Transatlantic Trade and Investment Partnership), while positive in providing access to new markets for those products that can compete in the global economy such as commodities from China, Brazil, Thailand and South Africa, can have negative consequences on health. Indeed, as poorer producers are exposed to extraordinary competition from more efficient counterparts both locally and internationally, they are forced to restructure or fold which in turn erodes preferences in the the third market again with knock-on effects for health. For instance, intellectual property such as patents frequently conform to rules that favour corporations over patients which sees access to medicines under serious attack.
These challenges to health improvement and the economy of our age can be fundamentally addressed by what Mead calls ‘committed citizens’; able to critique data, assess projected trends and propose solutions. Some potential actions include transitioning from trade talks to a prioritisation of environment-centred policy with the complementary introduction of educational and training policies such as Mexico’s sugary drink tax.
Such measures, while new and therefore subject to future assessment, aim to manage the growing cost of dietary related disease which is one of the biggest changes happening globally with fluctuating prices (healthy items are costing more), changing availability and access, shifting food culture, corporate domination and impacted health services. Both at the delivery and ideological levels, one must always ask: who is in control of my health and economy? We must vote with our feet and actions, electing to create a sustainable and healthy economy for both the current and future generations.
Image Credit: AMISOM Public Information, Flickr.