Excellent comment—thanks! I agree with a lot of what you say- what I meant was that “economic development causes health improvements in the long-run, but not in the short-run” as per the Weil paper you quoted.
I wanted to push back on global health rhetoric arguing that health causes a lot of growth in poor countries, which has a lot of intuitive force as we’ve all been sick and couldn’t work. However, poor population health isn’t generally the bottleneck for growth when a country is still poor, as there’s an oversupply of labor (many subsistence farmers) competing for (fewer) manufacturing jobs and so it doesn’t matter if people get sick often, as workers can be replaced. Population health only becomes the bottleneck for growth at later stages of development.
It doesn’t apply to the context of catch-up growth in developing countries, as the healthcare innovations that these countries need to improve population health already exist
I disagree: the problem is not that the health innovations do not exist—a lot of the health gains historically are due to old public health “technology” like WASH, better nutrition, basic vaccinations, reducing infectious disease. Rather the problem is that it’s costly to role them out for large populations if GDP is low. Poor countries like the DRC often spend only on the order of ~$10 / head/ y on health, rich countries like the US spend on the order of ~$1-10k/head/y. With ~1bn people in extreme poverty, needing around ~$100/ head / year to get maybe 80% of the health gains that we have in rich countries is still a lot of money (~$100bn - $1trn/ y ). Even the best “Political will and institutional efficiency” won’t help if you don’t have the GDP to finance health yourself, and aid and philanthropy seems unlikely to adequately fund population health in poor countries. A good paper on this.
But if you want to give away many billions then global health interventions might make sense—see Alex Berger on the 80k podcast:
people sometimes underestimate the size of the opportunities when they think, “Oh, we can make a leveraged play that could be ten times better.” Maybe an individual donor could, but Open Phil will need to eventually be giving away a billion dollars a year, maybe more. That is actually not the relevant benchmark for us. We’re giving at a scale where it has to be able to absorb more resources.
Rob Wiblin: Okay, so there could be particularly good grants in science and politics that do this, but it’s just they’re not going to be able to absorb nearly as much money as you need to be able to give away. So you want to make those, but then it’s also going to be very important to find other things that can actually take billions.
Alexander Berger: Yep.
people in developing countries prefer health improvements highly relative to poverty reduction (e.g. Stein, Redfern and Li 2021).
Responds might not be aware that if growth might improve health more.
it might be better to look for interventions that can promote both health improvements and poverty reduction (such as institutional quality), or opportunities to reform health policy in developing countries so as to improve health outcomes over a long timeframe (such as LEEP).
I think increasing institutional quality to create growth via good economic policy is the way to go and perhaps more important than health policy, from my appendix:
“Just as one example, take the importance of trade liberalization on infant mortality (trade (liberalization) is usually consider to cause growth ). For instance, one natural experiment suggests that a US trade agreement with Sub-saharan Africa caused infant mortality to drop by ~9%. Another study found trade liberalization reduced child mortality in ~50% of developing countries they looked at and in most of those countries child mortality was reduced by more than 20%. This is big, if true.”
Excellent comment—thanks! I agree with a lot of what you say- what I meant was that “economic development causes health improvements in the long-run, but not in the short-run” as per the Weil paper you quoted.
I wanted to push back on global health rhetoric arguing that health causes a lot of growth in poor countries, which has a lot of intuitive force as we’ve all been sick and couldn’t work. However, poor population health isn’t generally the bottleneck for growth when a country is still poor, as there’s an oversupply of labor (many subsistence farmers) competing for (fewer) manufacturing jobs and so it doesn’t matter if people get sick often, as workers can be replaced. Population health only becomes the bottleneck for growth at later stages of development.
I disagree: the problem is not that the health innovations do not exist—a lot of the health gains historically are due to old public health “technology” like WASH, better nutrition, basic vaccinations, reducing infectious disease. Rather the problem is that it’s costly to role them out for large populations if GDP is low. Poor countries like the DRC often spend only on the order of ~$10 / head/ y on health, rich countries like the US spend on the order of ~$1-10k/head/y. With ~1bn people in extreme poverty, needing around ~$100/ head / year to get maybe 80% of the health gains that we have in rich countries is still a lot of money (~$100bn - $1trn/ y ). Even the best “Political will and institutional efficiency” won’t help if you don’t have the GDP to finance health yourself, and aid and philanthropy seems unlikely to adequately fund population health in poor countries. A good paper on this.
But if you want to give away many billions then global health interventions might make sense—see Alex Berger on the 80k podcast:
Responds might not be aware that if growth might improve health more.
I think increasing institutional quality to create growth via good economic policy is the way to go and perhaps more important than health policy, from my appendix:
“Just as one example, take the importance of trade liberalization on infant mortality (trade (liberalization) is usually consider to cause growth ). For instance, one natural experiment suggests that a US trade agreement with Sub-saharan Africa caused infant mortality to drop by ~9%. Another study found trade liberalization reduced child mortality in ~50% of developing countries they looked at and in most of those countries child mortality was reduced by more than 20%. This is big, if true.”