Iâm a bit late to the party, but thank you for creating this post! Itâs gotten me interested in âlongtermist-styleâ global development interventions that seek to improve human well-being over timescales of 20 years or moreâand Iâd like to see even more research into this area.
That said, Iâm skeptical of your claim that growth causes health, but that health does not cause growth. You cite the âHealth and Economic Growthâ paper by David N. Weil in at least two places in your appendix entitled âHealth does not cause growth, but improving cognitive development mightâ.
First, you cite the paper as saying:
However, the evidence for health causing growth is weak and the effect is small.[55]
Footnote [55]: âIf improving health leads to growth, this would be a reason, beyond the welfare gain from better health itself, that governments might want to make such investments. However, the evidence for such an effect of health on growth is relatively weak. Cross-country empirical analyses that find large effects for this causal channel tend to have serious identification problems. The few studies that use better identification find small or even negative effects. Theoretical and empirical analyses of the individual causal channels by which health should raise growth find positive effects, but again these tend to be fairly small. Putting the different channels together into a simulation model shows that potential growth effects of better health are only modest, and arrive with a significant delay.â (p. 677)
Later on, you cite the paper again in your claim that âgrowth causes population healthâ. However, this paper does not seem to support the conclusion that growth increases population health. Instead, it says that the empirical effects of increases in income on health are mixed, with some studies showing a positive effect and others showing a negative effect. It also states that many of the studies have identification issues, and âalso suffer from the difficulty that feasibly identified estimates may only pick up a short-run effectâ (p. 649).
Later in the paper, Weil writes:
...over periods shorter than the âvery long run,â there indeed may be very little relationship between income growth and health improvement. Even in the most advanced countries, the stock of usable but non-applied health knowledge is so large that many decades of health improvement could take place without any new discoveries being made. Second, when one considers developing countries, the assumption that income growth will automatically lead to health improvement is unwarranted; and the assumption that income growth is the best way to achieve health improvement is even more unwarranted. As Deaton (2006) writes,âEconomic growth frequently needs help to guarantee an improvement in population health.â (p. 652)
To be fair, the paperâs conclusion does state:
...in the long run, improvements in health have indeed been the result of economic growth. It is not hard to identify the scientific discoveries, medical advances, and public health initiatives that have produced enormous health gains in the most advanced countries. These achievements seem unlikely to have occurred outside the context of industrialization. (p. 678)
This seems to support your conclusion that growth causes increases in population health. However, it only applies to the macrohistorical trend of growth in already industrialized countries coupled with the scientific and technological innovations that made improvements in health possible. It doesnât 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! To quote Weil again:
Regarding causality running from income to health, at least at the level of countries, there is also little evidence of much effect in the short run. For developing countries, there exists a large stock of health technologies that can be applied to great effect at low cost. Political will and institutional efficiency are more important than GDP in determining health. (p. 677)
Thus Iâm not convinced that altruists interested in longtermist global development ought to prioritize growth over health, especially because there is some evidence that people in developing countries prefer health improvements highly relative to poverty reduction (e.g. Stein, Redfern and Li 2021). Rather, 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).
Excellent commentâthanks! I agree with a lot of what you say- what I meant was that âeconomic development causes health improvements in the long-run, but not in the short-runâ 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 weâve all been sick and couldnât work. However, poor population health isnât generally the bottleneck for growth when a country is still poor, as thereâs an oversupply of labor (many subsistence farmers) competing for (fewer) manufacturing jobs and so it doesnât 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 doesnât 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 existâa lot of the health gains historically are due to old public health âtechnologyâ like WASH, better nutrition, basic vaccinations, reducing infectious disease. Rather the problem is that itâs 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 /â head/â y on health, rich countries like the US spend on the order of ~$1-10k/âhead/ây. With ~1bn people in extreme poverty, needing around ~$100/â head /â year to get maybe 80% of the health gains that we have in rich countries is still a lot of money (~$100bn - $1trn/â y ). Even the best âPolitical will and institutional efficiencyâ wonât help if you donât 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 senseâsee Alex Berger on the 80k podcast:
people sometimes underestimate the size of the opportunities when they think, âOh, we can make a leveraged play that could be ten times better.â 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. Weâre 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 itâs just theyâre 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 itâs 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:
âJust 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.â
Iâm a bit late to the party, but thank you for creating this post! Itâs gotten me interested in âlongtermist-styleâ global development interventions that seek to improve human well-being over timescales of 20 years or moreâand Iâd like to see even more research into this area.
That said, Iâm skeptical of your claim that growth causes health, but that health does not cause growth. You cite the âHealth and Economic Growthâ paper by David N. Weil in at least two places in your appendix entitled âHealth does not cause growth, but improving cognitive development mightâ.
First, you cite the paper as saying:
Later on, you cite the paper again in your claim that âgrowth causes population healthâ. However, this paper does not seem to support the conclusion that growth increases population health. Instead, it says that the empirical effects of increases in income on health are mixed, with some studies showing a positive effect and others showing a negative effect. It also states that many of the studies have identification issues, and âalso suffer from the difficulty that feasibly identified estimates may only pick up a short-run effectâ (p. 649).
Later in the paper, Weil writes:
To be fair, the paperâs conclusion does state:
This seems to support your conclusion that growth causes increases in population health. However, it only applies to the macrohistorical trend of growth in already industrialized countries coupled with the scientific and technological innovations that made improvements in health possible. It doesnât 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! To quote Weil again:
Thus Iâm not convinced that altruists interested in longtermist global development ought to prioritize growth over health, especially because there is some evidence that people in developing countries prefer health improvements highly relative to poverty reduction (e.g. Stein, Redfern and Li 2021). Rather, 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).
Excellent commentâthanks! I agree with a lot of what you say- what I meant was that âeconomic development causes health improvements in the long-run, but not in the short-runâ 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 weâve all been sick and couldnât work. However, poor population health isnât generally the bottleneck for growth when a country is still poor, as thereâs an oversupply of labor (many subsistence farmers) competing for (fewer) manufacturing jobs and so it doesnât 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 existâa lot of the health gains historically are due to old public health âtechnologyâ like WASH, better nutrition, basic vaccinations, reducing infectious disease. Rather the problem is that itâs 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 /â head/â y on health, rich countries like the US spend on the order of ~$1-10k/âhead/ây. With ~1bn people in extreme poverty, needing around ~$100/â head /â year to get maybe 80% of the health gains that we have in rich countries is still a lot of money (~$100bn - $1trn/â y ). Even the best âPolitical will and institutional efficiencyâ wonât help if you donât 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 senseâsee 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:
âJust 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.â