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
References:
- Lilford RJ. Wellbeing and Income: New Evidence That There is No Asymptote Where Further Wealth Causes No Further Gain in Wellbeing. NIHR ARC West Midlands News Blog. 27 January 2023; 5(1): 8.
- Limwattananon S, et al. Universal coverage with supply-side reform: the impact on medical expenditure risk and utilisation in Thailand. J Public Econ. 2015; 121: 79-94.
- Williamson A & Patel P; on behalf of The Commission on Health and Policy. Waiting for Prosperity Modelling: The Economic Benefits of Reducing Elective Waiting Lists in the NHS. London: Institute for Public Policy Research; 2023.
- Huckfeldt PJ, et al. Association of Intensive Lifestyle Intervention for Type 2 Diabetes With Labor Market Outcomes. JAMA Intern Med. 2023; 183(10):1071-9.