Blog: Wealth and Health; Health and Wealth

The association between wealth and health has been known, at least, since the work of Friedrich Engels in the middle of the 19th century, and even earlier thanks to the work of the famous social statistician Adolphe Quetelet. Previously, your ARC West Midlands News Blog has reported on contemporary evidence of the strong association, whereby increasing wealth is associated with better health, even between the 98th and 99th centiles.[1]

But what about the reverse association, that improving health improves wealth? At a very coarse-grained level, some have drawn a causal association between greater health expenditure and improving economic performance in Thailand.[2]

At a more fine-grained level, a recent important modelling study in England finds that accumulating hospital waiting lists have resulted in negative consequences for the British economy.[3]

But what about studies at the individual level? A fascinating randomised trial published in JAMA,[4] showed that a lifestyle intervention was effective in improving the health of patients with diabetes. Long-term follow-up then showed that the intervention patients were also more likely to be employed over 15 years.

Health economics does not usually consider returns to the economy from treatments targeted at individual patients. To do so raises awkward ethical questions about fairness and discrimination against people who cannot enter the labour market. However, it is getting harder to defend not including the labour market benefits that might flow from treatment. Economic growth benefits all in society. The willingness-to-pay threshold for a new treatment should therefore take this into account. Including health benefits does not entail the necessity of focusing technology purely on people who can reap those benefits. However, it would put a premium on treatment for diseases common in younger age groups. For example, cancer and cardiovascular diseases may achieve a level of priority compared with dementia. Nevertheless, patients with dementia will benefit from a stronger economy in the longer term. Personally, I favour including potential productivity gains in health economic models, even though it will result in discrimination against older people (like the ARC WM director).

— Richard Lilford, ARC WM Director