Passage 2
The medical community owes economists a great deal. Amartya Sen won a Nobel Prize for Economic Sciences in 1998. He has spent his entire career promulgating ideas of justice and freedom, with health rarely out of his gaze. Joseph Stiglitz won a Noble in 2001. In 1998, when he was chief economist at the (then) notoriously regressive World Bank, he famously challenged the Washington Consensus. And Jeff Sachs, a controversial figure to some critics, can fairly lay claim to the enormous achievement of putting health at the center of the Millennium Development Goals. His “Commission on Macroeconomics and Health” was a landmark report, providing explicit evidence to explain why attacking disease was absolutely necessary if poverty was to be eradicated. And I must offer my own personal gratitude to a very special group of economists- Larry Summers, Dean Jamison, Kenneth Arrow, David Evans, and Special Gupta. They were the economic team that drove the work of Global Health 2035.
But although we might be kind to economists, perhaps we should be tougher on the discipline of economics textbook, and you will see the priority given to markets and efficiency, price and utility, profit and competition. These words have chilling effects on our quest for better health. They seem to marginalize those qualities of our lives that we value most of all not our self-interest, but out humanity; not the costs and benefits of monetary exchange, but vision and ideals that guide our decisions. It was these issues that were addressed at last week’s Global Health Lab, held at London School of Hygiene & Tropical Medicine.
Anne Mills, Vice-Director of the school, fervently argued the case in favor of economists. It was they who contributed to understanding the idea of “best-buys” in global health. It was economists who challenged user fees. And it was economists who made the connection between health and economic growth, providing one of the most compelling political arguments for taking health seriously. Some economists might adore markets, but not health economists, she said. “Health care is different.” For her kind of economist, a health system is a “social institution that embodies the values of society”.
Although competition has a part to play in health, it should be used judiciously as a mechanism to improve the quality of care. Chris Whitty, Chief Scientific Adviser at the UK’s Department for International Developments, expressed his contempt for those who profess indifference to economics. Economic is about the efficient allocation of scarce resources. Anyone who backed the inefficient allocation of resources is “immoral”. He did criticize economists for their arrogance, though. Economists seemed to believe their ideas should be accepted simply because of the authority they held as economists. Economics, he said, is only one science among many that policy makers have to take into account. But Clare Chandler. A medical anthropologist, took a different view. She asked, what has neoliberal economics ever done for global health? Her answer, in one word, was “inequality”, Neoliberal economics frames the way we think and act. Her argument suggested that any economic philosophy that put a premium on free trade, privatization, minimal government, and reduced public spending on social and health sectors is a philosophy bereft of human virtue. The discussion that followed, led by Martin Mckee, posed difficult questions. Why do economists treat their theories like religions? Why are economists so silent on their own failures? Can economics ever be apolitical? There were few satisfactory answers to these questions.
