Health, development and governance Deborah Johnston (SOAS) MIF Residential School, Addis Ababa, March 2012 Does development improve health? The simple view At the micro level too? A wealth gradient for many health outcomes and healthy activities. (Data: Yazbeck 2009) Poorest have few resources Poorest have poor health information Poorest have worst incentives Simple policy menu for simple view Strong relationship between levels of health (life expectancy, child mortality) and levels of GDP per capita Causality running from wealth to health Historical evidence from now-rich countries World Bank Investing in Health: Promote income of the poor through liberalisation and economic growth Refocus public spending to most cost-effective health services Allow greater competition in health services Criticisms Anomalies Levels and changes? History Causality? The complexity of the relationship: social factors, governance ?? Data on child mortality in China and India from Deaton (2006) Criticisms Anomalies Levels and changes? History Causality? Health, Development and Governance? Role of public policy in health back at heart of the discussion Health inequalities may mirror economic inequalities, which also suggests that the policy focus must be wide Health inequalities may also reflect global factors, with particular challenges for policy (not only the obvious area of patents, but also entry of private medical services, and patterns of migration and economic activity) A CASE STUDY OF HIV/AIDS But.... At the regional level, patterns that do not match the income thesis neatly Also true at the micro level Simple policy menu? Promote income of the poor through liberalisation and economic growth But, evidence.. Refocus public spending to most cost-effective health services. Allow greater competition in health services Yes, but access, appropriateness (new dependency).. Narrowness? Using HIV to think of a wider health and governance agenda? Role of public policy in health back at heart of the discussion Health inequalities may mirror economic inequalities, which also suggests that the policy focus must be wide Health inequalities may also reflect global factors, with particular challenges for policy (not only the obvious area of patents, but also entry of private medical services, and patterns of migration and economic activity) Tailored HIV policy to meet specific needs: Know your epidemic (biomedical characteristics of disease and intersection with society) A broad view of health service provision to understand role for complementary health system changes: M2C, ARV, medical transmission risk, STIs, circumcision, nutrition Role for influencing social norms and practices both directly and through economic policy