That wealthy nations are healthier than less wealthy nations is supported by shed loads of data, even though the gradient has diminished sharply over the last three decades. But what about the reverse? Can improving health improve wealth at a population level? This is the topic of a recent article in the New England Journal of Medicine.[1] The prominent economist Jeffrey Sachs chaired a WHO commission in 2001 that argued that health is a major driver of population wealth.[2]
Empirical evidence for this thesis is hard to pin down – it is not something that can be trialled experimentally. Historical and cross-country comparisons are so confounded that cause and effect is hard to establish convincingly.
For the ARC WM Director, it is almost inconceivable that there is no positive relationship. This is because it is self-evident that someone with malaria or Tuberculosis will be more productive when they are cured than while suffering the disease. Moreover, there is evidence that good nutrition and hookworm treatment improve children’s attendance and concentration at school.[3, 4] The sum of the benefits of inexpensive gains must be positive. And then there are longer term benefits from improved child survival that encourage smaller families of better nurtured children – at least over a couple of generations before the dependency ratio becomes less favourable again.
Quantifying the effect of wealth on health at a population level is impossible – it can be modelled, but the parameter uncertainties are so broad that the model should only be used to explicate mechanisms, not to produce an unverifiable summary statistic.
In the meantime, investors in health services can be reassured that they can add wealth generation to the positive side of the balance sheet, and the above NEJM article is worth a read.
— Richard Lilford, ARC WM Director
References:
- Machado S, Kyriopoulos I, Orav EJ, Papanicolas I. Association between Wealth and Mortality in the United States and Europe. N Engl J Med. 2025; 392(13): 1310-9.
- Sachs JD. Macroeconomics and Health: Investing in Health for Economic Development. World Health Organization; 2001.
- Alaimo K, Olson CM, Frongillo EA. Food insufficiency and American school-aged children’s cognitive, academic, and psychosocial development. Pediatrics. 2001; 108: 44–53.
- Donkoh ET, Berkoh D, Fosu-Gyasi S, et al. Evidence of reduced academic performance among schoolchildren with helminth infection. Int Health. 2023; 15(3): 309-17.