Building human capital starts with health

Health is a foundational investment in a country’s human capital.   Will a child live to celebrate her fifth birthday and be ready to attend school? Will she actually be able to learn and thrive in school? Will she grow to be an adult who can productively contribute to the society in which she lives?  All of this depends on robust health and nutrition, at every stage in her life.

Universal Health Coverage (UHC) —ensuring that all people have access to the quality health services they need at an affordable cost—underpins all of the Health Nutrition and Population (HNP) investments at the World Bank.  Last year, these reached $15 billion—our highest ever for HNP.  This is a good indication of how much demand there is from countries at all income levels to invest in health.
 
UHC Day, being celebrated today, is especially important this year because it is being marked officially for the first time by the UN and celebrated around the world. For the World Bank, it is doubly important because it closely follows the launch of our Human Capital Project (HCP) -- an ambitious effort to accelerate more and better investments in people. 
 
For too long, investing in people’s health and education has been seen as a consumption expense and an anchor on growth.   The HCP reverses this unsubstantiated view by placing investments in people at the epicentre of a country’s plans for sustained and inclusive economic growth.   It thus represents a huge opportunity to elevate country demand for investments in health even further.
 
A growing body of evidence shows that without a healthy, educated and resilient population, countries cannot compete effectively in the global economy.  When investments in health begin in the early years of life and are sustained through the life cycle, they lay a strong foundation for the growth and competitiveness of nations.  Investing in health systems that ensure that all people have access quality, affordable health services so that they are healthy and productive throughout their lives – the essence of Universal Health Coverage-- is thus a key human capital investment.
 
Nations need to ensure that their people are healthy so they can not only thrive in school and arrive at their jobs ready to work—but also continue to be skilled and able to perform those ‘jobs of the future’ over a lifetime. Poor health and nutrition hold people back from achieving their fullest potential at any point in life.  Investments in prenatal care for women, early nutrition and vaccination against common diseases can ensure the best possible start to life for children – but what’s equally needed is a focus on infectious and non-communicable diseases which hold adults back from leading full and productive lives.
 
UHC Day is a time to face up to some big basic deficits.

• Half the world’s population still lacks access to essential health services.  And as three global reports have emphasized this year, access to services is by no means a guarantee of quality care. For example, ten percent of patients in low income countries, and seven percent in high income countries, can expect to acquire an infection in a hospital. Our research in seven African countries, for example, has found that patients were being diagnosed correctly fewer than 75 percent of the time. 
• Unaffordable healthcare costs push 100 million people into extreme poverty every year. 
• 800 million people worldwide spend at least 10 percent of their household budget on health expenses—which means they are having to choose between their children’s health needs and other necessities like education, food or bus fares. 

A big reason for these startling shortfalls in UHC is the massive underinvestment in the health sector. A country that ensures essential health services for its people should be investing about $90 per person per year into health.    In 2015, 71 countries fell short of this level of investment. And in 41 nations with a combined population of 2.6 billion people, governments were investing just $25 per person per year in the health of their people—about a quarter of what is needed .

Moreover, across all health systems – poor and rich – endemic inefficiencies in expenditure estimated at between 20 to 40 percent plague the pursuit of better value for money.    Overcoming such inefficiencies – getting more health for the money --- is a top priority everywhere.   

The Human Capital Project drive to increase demand from countries forces us ask – how best to do that in the health sector? Here are three principles for more and better investments in health:

• Commit to universality: A truly universal system, with a commitment to equity so that all people are entitled to and receive quality healthcare, is non-negotiable. “Putting the last mile first” to prioritize the most vulnerable is not only right, it is the only way to ensure population-wide health and protect countries and economies from major disease outbreaks.   
• Ensure affordability: People cannot thrive as long as they are bankrupting themselves to pay for healthcare when they or their children are sick.  This is the most inequitable, expensive and inefficient way to pay for healthcare. Large scale systems that pre-pay and pool healthcare payments and cover the whole population are the best way to ensure affordability.  
• Mobilize a “whole of government” approach to health: UHC cannot be achieved with just the expertise and resources of the health sector. For example, clean water and sanitation are essential to good health and nutrition.  The Agriculture sector is key to safe and nutritious food, and to ensuring veterinary and animal health that secures us all against disease outbreaks. And investments in road safety are essential to reduce one of the highest causes of adult mortality globally – road traffic accidents.

The clarion call of the Human Capital Project is a chance to build the demand to drive broad, deep and accelerated UHC reforms across countries at all income levels.   And while there is no one-size-fits-all prescription, there is no doubt that common challenges can be overcome through collective ingenuity, scaled innovation and joint learning  On this UHC Day, let’s embrace this opportunity to make #Healthforall by 2030 a reality. There is no time to waste.