Essay: The Economics of Health For All; Announcing the Geneva Health Files Summer Fellows
Newsletter Edition #63 [The Weekly Primer]
Originally published on June 15th, 2021 on Geneva Health Files.
I’m happy to present this newsletter to you.
My recovery is taking its own time, but on the other hand, my ambidexterity is growing leaps and bounds!
In today’s curated edition, we bring you an essay on health economics, and more.
Kaitlyn Green, my colleague who contributes to business development for Geneva Health Files, has written an essay for our readers sharing her perspectives on health financing — her current academic pursuit. Do not miss this rare peek into the views of a former American paramedic and how she grapples with the language and the questions in health economics.
It is also my honor to announce the first cohort of the Geneva Health Files Fellowship. When we sent out a call seeking support to scale this initiative, we never imagined post-doctoral researchers evincing interest in this exciting but small initiative. All of them have inter-disciplinary interests and backgrounds, much like our DNA if you will.
Join me in welcoming:
Meena Tafazzoli: A former strategy consultant from San Diego who has worked extensively in healthcare, and has an interest in the access to medicines. She is currently doing her thesis on The Changing Financial Incentives for Vaccines in a Post-COVID World, at the London School of Hygiene and Tropical Medicine.
Rithika Sangameshwaran: A foreign policy and global health geek based in Heidelberg, Germany, with rich field experience in Mumbai and elsewhere. She is a German Chancellor Fellow at Alexander von Humboldt Foundation.
Divya Venkatesh: Our pathogens expert with an interest in science communication and media entrepreneurship, based in Prague, Czech Republic. A former postdoctoral researcher at the University of Cambridge, she has co-authored several papers including Avian Influenza Viruses in Wild Birds: Virus Evolution in a Multihost Ecosystem.
Avinash Gupta: A doctoral candidate at National University of Singapore. He has extensively worked in Nepal across a range of disciplines from international development to banking, and is currently examining pharmaceutical supply chains in the developing world.
Over the summer, they will divide their time working on both the editorial and business operations at Geneva Health Files. They will join Kaitlyn who has been with us for a year now!
We are actively seeking resources to fund these fellowships. Please get in touch with us if you wish to support these talented global health professionals.
Also: later today I will be presenting at a social science workshop on Engineering Vaccine Equity & The Future of Global Health Innovation. Register here and check out my spectacular but uncomfortable cast. The event has been organised by University College of London, Sarah Parker Remond Centre and Institute of Advanced Studies, with the Department of Global Health and Social Medicine, King’s College London.
Last Friday, we mustered up a story on the update on the TRIPS Waiver discussions. Subscribe to read: Stage set for TRIPS Talks: An intense summer of negotiations for Geneva.
Hoping to return later this week with more!
Write to us. It is a shot in the arm, when I hear from readers.
Feel free to write to us: firstname.lastname@example.org or email@example.com; Follow us on Twitter: @filesgeneva
I. THE GENEVA HEALTH FILES ESSAY
While COVID-19 demands a reset of capitalism, nearly a year and a half into the pandemic, we are still tinkering at the edges of what is truly possible.
Despite the usual skepticism, the house view is that The WHO Council on the Economics of Health for All (set up in November 2020), will contribute to changing the conversation on health and economics, in global health and beyond. We agree that global health is too important to be left only to disciplinary experts, and there needs to be a fundamental rethink on our priorities to bring health front and center of economies.
Today we present a view from Kaitlyn Green, a former paramedic and an emerging expert on health financing as she grapples with the big questions in health economics.
“Global health: creating space at the table rather than wait for an invitation from finance ministers”
A year ago, I think I would have seen the announcement about the WHO Council on the Economics of Health For All and would have rolled my eyes. I believed that capitalism had got another win under its belt, further penetrating the world’s best chance at a global approach to health.
Around that time, I was six months into global health studies, learning about Structural Adjustment Programs by the World Bank, as something that was thought up 40 years ago, and was quietly decided to be a bad concept without proper restitution. I was learning how Bill Gates came into his role within global health governance (cut to: Gates making it rain à l’avenue Appia). Learning about the imperialistic, colonial need of global north donors setting their own global north priorities, creating vertical programmes built upon siphoned resources that could be destined for health system strengthening.
Also, a year ago, I was midway in a leap from my previous career as a paramedic in the United States.
As a paramedic there were a handful of times I had argued with dying patients about going to the hospital. I wanted them to come with me in an ambulance, they argued they could not afford it. I was on the abstract side of those arguments, as they hadn’t died before, but they knew what it was like to be crippled by medical debt. They were certain they would be more poor if they took an ambulance to the hospital, while there was a chance they wouldn’t die. And for a few, it was a gamble worth taking.
Conversations about money and healthcare resonate differently with those memories floating around. And although those experiences were incredibly defeating, they made me realize that I never wanted to be in a career where I was a cog in a machine that profited from the ill.
But as I started to scratch the surface of what global health governance is and how it exists, it started to seem that everything started and ended with money. Private-public partnerships and corporate charity and neoliberal foreign policy and humanitarian assistance was all reinforcing a system that, from my perspective, was built upon the continued exploitation and oppression of the historically exploited and oppressed.
Obviously, leaving the American healthcare system was not enough to escape this money-centered focus. I was naive to even consider that it could be it in the first place. It was high time I realized that there is no outrunning what existed before me and what will exist after me. I looked at financing healthcare and health economics as something that would remain an obstacle, one that if I learned enough about, I could potentially maneuver around it to participate in creating a system built upon health as a human right.
So, I changed course and started studying healthcare financing and health economics. I signed up for my courses at the London School of Economics thinking that I would hear nothing but capitalism works and here is how it helps overall.
As if I was walking into the belly of the beast, the source of the harmful wellspring of all academic economic justifications for free trade, I logged into my pandemic-era remote learning with a suspicion that I felt I would need to keep quiet.
The first lecture I attended completely subverted my expectation of the kind of values held by health economists. This instructor, a seasoned health economist, was making a passionate case for providing health via general taxation that didn’t disproportionately harm the poor (actually, where the poor more so benefited than the rich), talking about how the young today would be the ones paying for this pandemic and rejecting the headlines that the young were undermining the efforts of a benevolent government, and that efforts to privatize the UK’s NHS were misguided.
I was shocked.
I came to my beliefs about healthcare access because of my experiences: once I stole an oxygen tank for a patient (at the very real risk of being fired), because the only other option was sending her home without a supply. You know, the kind of experiences that I think would radicalize anyone.
Here is this man who had been neck-deep in economics for decades and was speaking about health in a way that meshed with seeing the suffering in a profit-driven health system. He came to these views in part because he is an individual with his own opinions and beliefs, but also because economic theory and studies supported his view. And he was one of several professors I encountered who spoke similarly. One of my professors co-wrote a paper in the eighties calling the assumptions that led to the neoliberal treatment of health based on bad statistics and that they were surprised that so many people foolishly followed suit in accepting such bad math.
That was when my interest in health economics shifted. I needed to understand this health economics conversation: what were its origins, where it was headed, who said what, why, and what was built from there.
As I read Arrow and Grossman I had statements like human nature cannot be explained by financial gains and losses and healthcare patients shouldn’t be called consumers and why are we quantifying human life revolving around my head. I realized, I needed time to learn this language of economics before I could argue about it.
It is a language of description — one where numbers and graphs are used to test understanding of how people behave and how health serves individuals and society. And it has limitations, but it certainly has plenty of applications. In my mind, health economics has shifted from a focus on the movement of wealth to evaluating how scarce resources can be effectively shared.
If I can grasp the essence of health through an economic lens, I think I will be able to take part in the conversations on the access to health.
I hope that the announcement of the WHO Council of Economics of Health for All represents a similar shift, where the global health community is creating space at the table rather than wait for an invitation from finance ministers.
Like this essay? Write to Kaitlyn Green: firstname.lastname@example.org
II. POLICY UPDATES
- G7 on the pandemic response:
- A missed opportunity in our view.
- See: G7 leaders made few concrete, strong, or deep health-related commitments at Carbis Bay — The BMJ Opinion
- But others have a different view for reasons we do not fully understand:
- The ACT Accelerator partnership welcomes commitment of 870 million vaccine doses and calls for more investment in all tools to end the pandemic.
- Biden administration to buy 500 million Pfizer coronavirus vaccine doses to donate to the world: The Washington Post
- WTO: Members approach text-based discussions for an urgent IP response to COVID-19
- Also see: WTO Members agree to text-based negotiations on revised TRIPS waiver
“…by clubbing together diametrically opposing proposals for discussions starting next week, the chances of confounding the discussions and undermining the waiver proposal remain very high.”: TWN
III. WHAT WE FOUND INTERESTING
My colleague Rithika has put this together for you:
- World Bank opposes vaccine intellectual property waiver as WTO talks resume: Reuters
- Despite the Headlines, the Gates Foundation Has Evaded Scrutiny: The Nation
- If vaccine apartheid exists, vaccine billionaires shouldn’t: STAT
- European Parliament backs patent waiver for coronavirus vaccines: Politico
- India’s Covid calamity exposes weakest link in US-led ‘Quad’ alliance: Financial Times
- A Top Virologist in China, at Center of a Pandemic Storm, Speaks Out: New York Times
- Covid lab-leak theory shows the ‘fact wars’ are still raging: Financial Times
- Biden-Putin summit: Why Geneva? : Swissinfo
FROM THE JOURNALS/REPORTS
- The constitutional determinants of health: The Lancet
IV. WHAT WE ARE WATCHING:
- WHO-WIPO-WTO meeting: June 15
- U.S.- Russia Summit: June 16
- WTO TRIPS WAIVER NEGOTIATIONS: Informal meeting among WTO members — June 17
- G20 3rd health working group meeting: June 17