Healthy Health Systems,

Healthy Economies
Making the Case for Investment
6th APEC High-Level Meeting on Health & the Economy
Advancing in the Implementation of the Healthy Asia Pacific 2020 to Support the
2030 Sustainable Development Goals August 21, 2016 Lima, Peru

Dra. Felicia Marie Knaul

Instituto para las Amricas de la Universidad de Miami y Escuela

Healthy Economies: A duality

Productive investment in
health: Virtuous Circle
Equitable,
efficient, quality
services
+ economic
development

+ & Better
health

More equal
opportunity
+ Human
capital

Poverty
reduction

- health
Cost
explosion

Inequitable,
inefficient, poor
quality services
- economic
development

Less & poor

human
capital
Inequality of
opportunity

+ Poverty

+ productivity &
competitiveness

(Frenk, 1993)

Unproductive expenditure on
health: Vicious Circle

Lower
productivity &
competitiveness

Inflation

Returns can be huge.

Investments in health
have redefined our world and
continue to drive
economic growth,
poverty reduction and
improvements in well-being.

The impact of health on productivity,

education and economic growth is impressive
Economic growth:
Improved health and nutrition account for 30% of
Englands economic growth bw 1780 and 1980 (Fogel)
A 10% increase in life expectancy generates a 0.4%
increase in economic growth (Bloom, Canning D.)
Productivity: differences in levels of health explain 17%
of worker productivity (Bloom, Canning, Sevilla)
Educational attainment: Preventing parasitic infections
reduce school absenteeism by 25%. (Kremer)

Polio: vaccine 1953

Under 5 mortality
Global poliovirus cases, 1985 through 2014.

1950: 28/100
1990: <10/100
2013: 4/100

Source:
Stephen L. Cochi et al. J Infect Dis. 2014;210:S1-S4. Published by Oxford University Press on behalf of the Infectious Diseases Society of America 2014. This work is written
by (a) US Government employee(s) and is in the public domain in the US.
Haidong Wang*, Chelsea A Liddell, Matthew M Coates, 2014.Global, regional, and national levels of neonatal, infant, and under-5 mortality during 19902013: a systematic
analysis for the Global Burden of Disease Study 2013. Lancet 2014; Vol 384 September 13.

Investing in health is a necessary

but not sufficient condition for
producing health
and healthy economies.
Future health gains will require
more and better
investment in health

Non communicable and Chronic Disease:

Major risk for the global economy
Tobacco: - 3.6% of global GDP per year
World Economic Forum classifies NCDs representing 2/3 of deaths worldwide as
one of the biggest risks for global
economic welfare.

The most efficient health systems are not

necessarily the most costly
(APEC select countries, 2014)
Life expectancy (years)

Japan
China
Vietnam

Peru

alia
r
t
s
Canada Au

Mexico

Health spending per capita $US PPP (Log. Scale)

USA

Worldwive wave of UHC

transformation and reform

In the challenging context of

protracted and polarized
epidemiological transition,
while battling fragmented
health systems

Effective UHC requires an integrated response

along the continuum of care and within each
core health system function
Stage of Chronic Disease Life Cycle
Health System
Functions

Stewardship

Financing

Delivery
Resource
Generation and
evidence
building

Primary
Prevention

Secondary
prevention/
early
detection

Diagnosis

Treatment

Survivorship/
Rehabilitation

Palliation/
End-of-life care

Outline
1. Healthy Economies

Areas of opportunity
1.Chronic illness: cancer

2.

2. Healthy Women, healthy economies

Closing global cancer divides

is a necessary investment
for health and equity.
It is also much more
affordable,
development-appropriate and
feasible
than myth suggests.

Cancer: The Opportunity to Survive

is largely & unnecessarily defined by income
Children

Adults
Breast
Cervix

Leukemia

LOW
INCOME

HIGH
INCOME

LOW
INCOME

HIGH
INCOME

Almost 90% of Canadian

childhood leukemia patients survive
In the poorest countries only 10% survive.

Source: Knaul, Arreola, Mendez. estimates based on IARC, Globocan, 2010.

Survival inequality gap

100% die

The costs of inaction are huge:

Invest IN action
Total economic cost of cancer:
4% global GDP

2-

1/3-1/2 of cancer deaths are avoidable:

2.4-3.7 million deaths,
of which 80% are in LIMCs

Prevention and treatment offer

potential world savings of
$ US 130-940 billion

The costs to close cancer divides are

much lower than many fear:
The vast majority of key LMIC priority cancer chemo and
hormonal agents are inexpensive and off-patent
Prices drop: HepB and HPV vaccines
Delivery & financing innovations can aggregate
purchasing, stabilize procurement and be integral parts of
systemic health system strengthening
Global care networks harnessing ICTs
Expanded use of primary care
Benefits are spread across diseases and sectors, yet this is
not measured and remains invisible

The Diagonal Approach to

Health System Strengthening
Rather than focusing on either disease-specific
vertical or horizontal-systemic programs, harness
synergies that provide opportunities to tackle
disease-specific priorities while addressing systemic
gaps and optimize available resources
Diagonal strategies produce major benefits:
Avoid the false dilemmas between disease silos
that continue to plague global health;
Generate positive externalities.

Diagonalizing:
Implementation
Harness anti-poverty, maternal and
child health, SRH, HIV and other
large programs for cancer education,
prevention, treatment & survivorship
Integrate cancer care and control into
national health reform, insurance and
social security programs

Outline
1. Healthy Economies

2. Area of opportunity
Healthy Women, healthy economies

Women are
the motors of economic growth
who also
produce the majority of both
paid and unpaid health care.
Yet, health systems are disabling
instead of enabling women.

Economically Active Population growth rate in the period

0

Panama

Jamaica

Ecuador

United States

Argentina

Uruguay

Guyana

Canada

Men

Dominican Rep.

Source: ILO, 2013. ( http://www.ilo.org/ilostat/faces/home/statisticaldata/data_by_subject )

Paraguay

Trinidad & T.
El Salvador

Nicaragua

Colombia

300

Peru

Costa Rica

Guatemala

Honduras

Venezuela

Brazil

Mexico

Increased labor participation of women

(the Americas, 1970 - 2010)
Women
Average LAC

200

100

Women in Medicine
Women as % of all physicians 1980-2012, select countries
50
Australia

40

Canada
Czech
Republi
c
Denmark

30

Israel

20

Portugal

United
Kingdom
United States

2012

2010

2005

2000

1995

Source: OECD Statistics.

1990

1985

10

1980

Women physicians as % of total physicians

60

Medical under & unemployment: women

Peru: 2014

Mxico: 1990 - 2014

70
60

40

68%
49%

54%

43%

20

0
1990
Quantitative
unemployment (hours)

2000

2014

2014

Qualitative unemployment
(Other activities)

Inactivity and/or
unemployment

Source: Own estimates based on Labor force Surveys. Encuesta Nacional de Empleo, INEGI, 1990, 2000 & 2014: and
Encuesta Nacional de Hogares 2014, Peru.

Total value of women's

contributions to the health sector:
(Lancet, Women and Health, 2015)
TOTAL:
US$ 3.1 TRILLION
4.8% Global GDP

PAID:
51.2%
UNPAID:
48.8%

Exceeds total US+UK health budget

2.9 times Mexican economy
20% of the US economy

Each and every woman contributes

$1,200 to health annually

Mexico: the workweek

Men and women, based on a 168 hour week
Care giving

MEN

Domestic work
Work outside
of the home

20

R&R

12
hours/da
y
Source: Own estimates based on INEGI 2012 and CEPAL..

56

WOMEN
r?

&
t
s
e
6 /da
R
s
r
u
o
y
h

41

41

42

Not a Vicious Cycle, but rather

Less health for men,
women and children
Unhealthy women invest
time ineffectively in an
attempt to prevent disease
and loss of life

Reduced
economic
growth

Unhealthy children
learn less and adults
are less productive
Less
education
Inequality of
opportunities

Unhealthy, poor,
disenfranchised women
produce less health care
More
poverty
Less money to
invest in health and
human development

Poor health and less

education means reduced
economic growth

We aspire to a Virtuous Cycle

women, health and the economy
through gender-transformative policies
Healthy women invest time
effectively in producing
health and preventing
disease
Economic
growth
Healthy and more
educated women
produce more health
and health care

More equitable
opportunities
Poverty
reduction

More economic
growth means more
money to invest in
health and human
development

More health is
produced for men,
women and children

Children learn
better and adults
are more
productive

More health and

education mean more
economic growth

Health challenges
can be converted into
opportunities
to promote
economic and human
development.

Healthy Health Systems,

Healthy Economies
Making the Case for Investment
6th APEC High-Level Meeting on Health & the Economy
Advancing in the Implementation of the Healthy Asia Pacific 2020 to Support the
2030 Sustainable Development Goals August 21, 2016 Lima, Peru

Dra. Felicia Marie Knaul

Instituto para las Amricas de la Universidad de Miami y Escuela