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Is wealth good for your health?

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£$¥

Is wealth good for your health?

Technology

Environment

Employment

Education

Revolutions in England since 1500: industrial, health, economic

20

30

40

50

60

70

80

90

1500 1600 1700 1800 1900 2000

Lif

e ex

pec

tan

cy a

t b

irth

(yr

)

0

5000

10000

15000

20000

25000

GD

P/c

apit

a (1

990

I$)

The Preston curve (1975)

Samuel H Preston

University of Pennsylvania

0 10,000 20,000 30,000 40,000

40

50

60

70

80

life

exp

ecta

ncy

, 200

0

gdp per capita, 2000, current PPP $

USA

Japan

Germany

FranceItaly

UK

Spain

Korea

Argentina

South Africa

Equatorial Guinea

Mexico

Russia

Brazil

Botswana

Namibia

Gabon

China

India

Indonesia

Pakistan

Bangladesh

Nigeria

The Millennium Preston Curve

Source: Deaton, 2006

HANS ROSLING

Karolinska Institut, Stockholm

GAPMINDER FOUNDATION

"Bring me my sword!"

"The grievous truth is that… the bottom billion will not—and cannot—be freed from poverty in

our lifetimes."

Wealth is good for health?

"Wealthier is healthier"Pritchett & Summers 1993

58 countries with GDP/capita <$6000, 1960-85

5% increase in income

1% reduction in infant mortality

Africa: +1.5% growth in 1980s saves 0.5m lives in 1990

Public spending on health $$ x 1000 = U5M/10

1

10

100

1000

1 10 100 1000 10000

Total $$ spent on health per person

Un

de

r 5

mo

rta

lity

Health is good for wealth?

WHO Commission on Macroeconomics and Health

-0.08

-0.04

0

0.04

0.08

0.12

0 5 10 15 20 25

Months of treatment

Sc

ho

ol p

art

icip

ati

on

(c

om

pa

rati

ve

)

tre

atm

en

t p

eri

od

s

REDUCES ABSENTEEISM BY ONE QUARTER IN KENYA

One third economic growth from

"demographic gift"

0.5

0.55

0.6

0.65

0.7

0.75

1950 1960 1970 1980 1990 2000 2010 2020 2030 2040 2050

Sh

are

po

pu

lati

on

of

wo

rkin

g a

ge

East Asia

Sub-Saharan Africa

"Demographic dividends" and "economic miracles"From health to wealth?

educationeconomicsgovernance

public healthfamily planning

0

10

20

30

40

50

60

East Asia Sub-Saharan Africa

% li

vin

g o

n <

$1

pe

r d

ay

Africa awaits the economic miracle

1990 2008 2015

Ireland, the Celtic tiger

…growing workforce

1.2

1.7

2.2

1950 2000 2050

Wo

rkin

g/n

on

-wo

rkin

g p

op

ula

tio

nIreland

UK

Asia

Falling fertility...

1.5

2.5

3.5

4.5

1960 1980 2000

Ch

ild

ren

/wo

man Ireland

UK

And the Irish get wealthier...

-3

-2

-1

0

1

2

3

4

5

6

7

1950 1960 1970 1980 1990

Gro

wth

GD

P/c

apit

a (%

/yr)

HIV/AIDS cuts the productivity of tea pickers in Kenya

30

32

34

36

38

40

42

44

46

0123

Years before death

Kg

s p

luck

ed d

aily

HIV+

HIV-

"To your health"More than a toast to economists

D Malakoff (Science 2000)

Price tag on productivity in USA, 1970-90

A year of life gained for 35-44 year-olds worth:

Men $170,000

Women $120,000

Fiscal health: saving for retirement

Wealth is bad for health?

USA: wealthier but not healthierGDP #7 Life expectancy #42

30

32

34

36

38

40

42

44

46

48

1986 1991 1996 2001 2006

Nu

mb

er u

nin

sure

d (

m)

10

11

12

13

14

15

16

17

Per

cen

t u

nin

sure

d

Health in a sweeter world

0

100

200

300

400

500

poorest 1 2 3 4 richest 5

GDP/person -- country groups

Kca

l su

gar

/per

son

/day

19622000

Health in a sweeter world

0

5

10

15

20

25

30

35

Pe

rce

nt

ob

es

eRising obesity in rich countries

serial surveys OECD, 1980-2002

Falling wealth, failing

health?

Cycles: virtuous vicious

wealthhealthsickness poverty

One million “excess” deathsin developing world since 1980 due to

contractions in economies

Infa

nt m

orta

lity

One million “excess” deathsin developing world since 1980 due to

contractions in economies

Children die when GDP falls

Relative risks higher for vulnerable children born:

To low-education mothers +68%

Young/old mothers +23%

In rural areas +72%

If boys +11%

Wealth is mostly good for health, but…

Microeconomics• Money buys health, and 1o health is cheap• Money buys health directly (medicines) and indirectly

(education for prevention and cure)• Health underpins prosperity -- individual, family, businessMacroeconomics• Health is linked to wealth across countries and

generations…• The cause? Social? Cultural? Educational?

Technological? All? A minimum set? Buying health• Microeconomic argument often enough?