The Challenge of Producing Health in Modern Economies

Although health economics may be considered to be the application of economics as a way of thinking about questions regarding the production, maintenance and distribution of health, health economists have historically paid more attention to some production inputs than to others. Health economics has been mainly, even if not exclusively, health care economics. Relatively little attention has been paid by economists to the role of other (non-health-care) determinants of health, or to the nature of the production process underlying the health of populations. This has recently begun to change, however, as the attention of both researchers and policy-makers has shifted from the downstream question, “How do people get well once they are ill?”, to the upstream question, “How do people get ill?” A recent example of the interdisciplinary collaboration of health economists in questions related to the determinants of health is found in work from the Population Health Program of the Canadian Institute for Advanced Research. This group has been engaged for the past seven years in extracting from the international and cross-disciplinary literature a new understanding of “heterogeneities” in health status -- why some groups within populations are healthier than others. Many of the apparent underlying `causal’ factors -- genetic predisposition, culture, stress, control over one’s professional and personal environments, nurturing and enrichment in early childhood -- are not topics on which health economists generally have much to contribute. But others -- income; employment; economic growth; the distribution of income and wealth -- are rather closer to home. The key message from this work is the complex (and as yet far from completely understood) interplay between these myriad economic and other influences, and the equally complex biological interplay among immune, endocrine and cardiovascular systems (at least) in explaining how these influences get translated at the cellular level into ill health or premature death. This then raises several sets of challenges -- conceptual, methodologic, empirical, practical, and political -- for researchers attempting to push out the frontiers of understanding of the relative importance of various determinants, for policymakers attempting to act on new knowledge about determinants, and for health economists interested in participating in the collaborative cross-disciplinary efforts required for both research and policy development. Perhaps the biggest single challenge, for everyone concerned about the production of health in modern economies, is to find the proper balance between investment in the quality of the social fabric necessary to facilitate and sustain economic progress, and investment in the economic growth itself essential for providing the capacity to sustain the quality of social environments over long periods.