Brendan Shaw paints a concerning picture of global health priorities post-pandemic, highlighting the need for renewed focus and investment in healthcare systems to prevent further backsliding.
“There isn’t a financing gap. There is just money that is not moving towards the right things. There’s plenty of money out there”
Mariana Mazzucato, Chair, WHO Council on the Economics of Health for All, May 2024
“Improvements to health services coverage have stagnated since 2015”
World Health Organization, October 2023
So, it’s time to play Memory Bingo. You score 5 points for each one of these phrases you remember:
- Health system resilience (5 points)
- All in this together (5 points)
- Clap for carers (5 points)
- Peace dividend (5 points).
If you scored 20 points, you did better than many governments in the world today.
It seems that many of the lessons learned from the Covid-19 pandemic have already been forgotten.
Barely a few years after the pandemic and everything that everyone went through, it’s incredible how much we have all forgotten what it was like during the pandemic, and how we have forgotten all the lessons and sentiments we had back then. Health system resilience, the need to invest in health for all, broad recognition of the value of health care, health workers, health technologies and health systems – these were all common themes and accepted wisdoms a few short years ago.
In a bout of global-level collective amnesia, it all seems to have fallen by the wayside since then.
The mood in global health circles is grim as people realise that, despite just coming out of one of the worst global pandemics in 100 years, health is falling down the global political agenda. Health is being pushed off the priority list by issues like defence, energy security, geopolitical tensions and climate change.
There is an urgent need to get health systems and health spending back on the political agenda at a national and international level.
The many participants in the health sector need to work together to get health back on the political radar screen.
Health systems need reform and finance
There’s no doubt there are many problems in health systems worldwide that need more investment and policy attention today. Whether it’s the impending crisis in health workforces worldwide, the lack of updated health infrastructure that needs 21st century renewal, investment in new medical technologies to improve productivity and growth, sustainable financing to face the oncoming tsunami of non-communicable diseases, addressing antimicrobial resistance, or even just the investment in pandemic preparedness infrastructure to respond to the lessons from Covid, there is a wealth of areas that require new investment and priority by public and private sector funders.
With the 2030 deadline for achieving the United Nations Sustainable Development Goals fast approaching, on many indicators like universal health coverage and reducing premature mortality in non-communicable diseases the world is falling behind.
The World Health Organization’s 2023 report on global health spending shows that spending surged during 2020 and grew further in 2021 to US$ 9.8 trillion, or around 10.3 percent of total global gross domestic product (GDP). The report goes on to note:
“Sustaining government health spending and external aid at 2021 levels may be challenging given the deterioration in global economic conditions and the rise in debt-servicing obligations.” (p. vi).
As an example, after decades of health spending increasing as a share of national GDP in OECD countries, in the years since the Global Financial Crisis the health-to-GDP ratio has been flat.
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There was an understandable spike in health spending compared to GDP during the pandemic, but in many countries this ratio has fallen back to pre-pandemic levels any countries once the pandemic was over. In fact, in some countries the health spending to GDP ratio has fallen below its pre-pandemic level.
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Meanwhile, in many low- and lower-middle-income countries health spending ratios have fallen since the pandemic and not returned to their pre-pandemic levels.
Global health initiatives also need a reboot in political momentum. The delays in securing an agreed pandemic agreement at the recent World Health Assembly, so soon after a devastating global pandemic, is distressing.
It seems we are repeating history, yet again falling into the ‘panic and neglect’ cycles of managing past pandemics.
There have been good attempts to build momentum and discussion on the health financing challenge in recent weeks, including efforts at the World Health Assembly, the Health20 Summit in Geneva, and the 2nd International Dialogue on Sustainable Financing for Non-communicable Diseases and Mental Health in Washington DC. All these forums discussed how to progress health financing and priority in a global context.
Defence, wars and high debt levels crowd out health spending
In contrast to the delays, diversions and kicking-down-the-road we have seen in health spending in many countries today, there are other areas of spending which are having their time in the sun.
Part of the reason for de-prioritisation of health spending has been the combination of higher government debt levels and higher interest rates after the pandemic. With higher debt and governments having to pay higher interest rates on that debt, things like health have had to be put to one side in the budget.
Mauricio Cardenas, former finance minister of Colombia, recently warned that public finances worldwide are “under a lot of stress in different countries, mainly because of the high levels of debt and very high interest rates.”
Defence and military spending are another drain on resources.
A recent story in the Financial Times said it all. With the headline ‘Global defence groups hiring at fastest rate in decades amid record orders’, the story reports on the current boom time conditions in the defence industry as military equipment suppliers scramble to fill thousands of new positions on the back of a massive growth in government military spending on the back Russia’s invasion of Ukraine and rising geopolitical tensions around the world.
This must all seem incredible to the burnt-out health workers pushing for pay increases instead of applause from the streets. Was it really only four years ago that we all applauded our health workers from doorsteps and apartment balconies around the world as we realised how important they are?
In Europe, for example, surging defence spending is causing governments to redirect health and social policy spending to tanks and armaments. It’s causing political pressure in a range of EU countries, forcing them to choose between defence and social spending, while the AUKUS countries of the US, UK and Australia have committed hundreds of billions of dollars in new submarines and other high-tech military cooperation. Defence spending in Asian countries like China and Japan has outpaced European countries for years.
These involve investing in new capital equipment, skills development, workforce development and building whole defence industries in countries where they did not previously exist.
In 2023, global military spending rose by seven percent in one year, the largest increase in 15 years.
And the European Commission released a report earlier this year that even discusses the productivity benefits for the economy coming from defence spending.
Nurses and doctors in emergency medicine rooms, paramedics in ambulances, scientists in universities, and patients waiting for diagnoses, surgeries and treatments around the world must be shaking their heads in disbelief.
Implications for the pharmaceutical industry
So, what should pharmaceutical companies and the industry do about it?
The pharmaceutical industry could expand its work with partners across the health system in making the case for investing in health systems and health care. A coalition of stakeholders is perhaps needed across the health sector to put the case forward.
If the defence industry can keep a straight face while arguing that defence spending boosts productivity, surely the health sector can do a better job of it?
The strategy here for individual companies and the industry more generally should be to build national and international unity among health stakeholders, politicians, and the broader community to advocate for renewed investment and development of health systems in the 21st century.
We learned through the pandemic that we are all in this together. Ultimately, we are all just humans facing a range of global problems together.
Otherwise, we are just creating additional problems that are distracting us from working together to solve the more fundamental existential problems confronting us all.
Brendan Shaw is Principal of Shawview Consulting and Adjunct Professor at the Sydney Pharmacy School, Faculty of Medicine and Health, University of Sydney.
