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My recent blog post on economics at WHO alongside Tony Culyer’s open letter to incoming Director-General Dr. Tedros generated great feedback and discussion. Below, you can find my views on some of the key points made, as well as WHO health economist Melanie Bertram’s response to the letter here.
As a new WHO Director-General—Dr. Tedros Adhanom Ghebreyesus—prepares to take office, many have called for clearer priorities, governance and organizational reforms, and funding expansions. All good, but there is one additional, grossly neglected issue that requires urgent action: WHO needs better economic advice. As I explain in this blogpost, that should come in the form of appointing WHO’s own chief economist.
In April, I attended a very hopeful event sponsored by the World Bank entitled, “Tobacco Taxation Win-Win for Public Health and Domestic Resources Mobilization.” My optimism was buoyed by seeing people from different ministries, disciplines, and perspectives all recognizing the need to raise tobacco taxes and sharing ideas on how to reduce the death toll from smoking. Then the bubble burst. I got home and saw a Wall Street Journal article about the increasing profitability of cigarette corporations in the US domestic market—a reminder that, unbelievably, we are still on the defensive against this large, growing, and completely avoidable disaster.
Why aren't tobacco taxes being addressed more forcefully and in more countries? Evidence suggests that tobacco taxes can be extremely effective—the cost is very low relative to the revenues and fully justified by the health gains.
Last month I attended a working group set up under the auspices of UHC2030 to look at the problems facing countries that lose external funding for their health programs. For many countries, the bad news is good news—their incomes and capacities have improved so much that donors no longer view them as needing the assistance.
We would argue that investing in global health, at least along certain dimensions, is entirely consistent with President Trump’s philosophy of America First—a real opportunity for his administration to improve the security of the American people by pushing through some much-needed reform. In that spirit, we’ve put together a proposal for a new executive initiative under the Trump Administration. We call it PAHAA: Protecting America’s Health at Home and Abroad.
Here in the US, the Congress is wrestling with proposals to replace the Obama-era health reform. One strategy on the table is to modify the benefits that are legally required to be included in health insurance policies; in her confirmation hearing, incoming CMS Administrator Seema Verma suggested that maternity care could be dropped from the list of essential benefits.
Cost-effectiveness analysis (CEA) can help countries attain and sustain universal health coverage (UHC), as long as it is context-specific and considered within deliberative processes at the country level. Institutionalising robust deliberative processes requires significant time and resources, however, and countries often begin by demanding evidence (including local CEA evidence as well as evidence about local values), whilst striving to strengthen the governance structures and technical capacities with which to generate, consider and act on such evidence. In low- and middle-income countries (LMICs), such capacities could be developed initially around a small technical unit in the health ministry or health insurer. The role of networks, development partners, and global norm setting organisations is crucial in supporting the necessary capacities.
Health technologies can reduce healthcare spending. On average, they don’t. Prominent examples—like the way polio vaccines eliminated the need for iron lungs—seem to drive a common faith in healthcare technology as a tool to “cure” costly health systems. But it actually works the other way around—health systems (policies, institutions, and markets) and human responses to them determine whether these tools will (or won’t) increase spending.