ECONOMISTS’ DECLARATION

  •  CONVENED BY 

More than 360 economists in 53 countries have now signed the Economists’ Declaration on Universal Health Coverage. This historic document, led by Lawrence H. Summers of Harvard University, calls on global policymakers to prioritize a pro-poor pathway to universal health coverage as an essential pillar of sustainable development. Because investing in health makes economic sense.

The Economists’ Declaration was originally launched in September 2015 with 267 signatories in 44 countries. It was published in The Lancet and publicized in The New York Times.

ECONOMISTS’ DECLARATION ON UNIVERSAL HEALTH COVERAGE

Published 18 September 2015 in The Lancet
Lead Signatory: Lawrence H. Summers, Harvard University
Convened by The Rockefeller Foundation


With the United Nations launching the bold sustainable development agenda, this is a crucial moment for global leaders to reflect on the financial investments needed to maximize progress by 2030. As an input into deliberations around those investments, the signatories to this declaration, 267 economists from 44 countries, call on global policymakers to prioritize a pro-poor pathway to universal health coverage as an essential pillar of development.

Universal health coverage means ensuring that everyone can obtain essential health services at high quality without suffering financial hardship. Resource constraints require individual countries to determine their own definition of “essential” – while recognizing, in the words of former World Health Organization Director-General Gro Harlem Brundtland, that “… if services are to be provided for all, not all services can be provided. The most cost-effective services should be provided first.”

Even granted this recognition of resource constraints, our generation has a historic opportunity to achieve a “grand convergence” in global health, reducing preventable maternal, child, and infectious disease deaths to universally low levels by 2035. In its report, Global Health 2035, the Lancet Commission on Investing in Health showed that with today’s powerful tools for improving health, and the prospect for continued improvement in those tools, financially feasible universal health coverage in every country could lead to grand convergence with its accompanying benefits in both health and in protection from health-related financial risks. (1)

We amplify these points below.

Our global society has a vested interest in investing in health to transform lives and livelihoods.

  • Health is essential to eradicating extreme poverty and promoting growth of well-being. (2,3) Over the past decade, health improvements – measured by the value of life-years gained – constituted 24% of full income growth in low- and middle-income countries. (1)
  • Health systems oriented toward universal health coverage, immensely valuable in their own right, produce an array of benefits: in times of crisis, they mitigate the impact of shocks on communities; in times of calm, they foster more cohesive societies and productive economies.
  • The economic benefits of investment in grand convergence are estimated to be more than 10 times greater than costs – meaning that early stages on the pathway to universal health coverage, focused on high-payoff convergence interventions, will have high value relative to the cost of raising revenue, including the deadweight (or welfare) cost of taxation, or (in most cases) to the value of its use in other sectors. (4)

The success of the next development chapter hinges on the ability to actually deliver proven health solutions to the poorest and most marginalized populations.

  • There is a strong record of public sector and development assistance success in the finance and delivery of transformative health interventions – immunizations, treatment of HIV/AIDS, tuberculosis and childhood infections, and eradication or near eradication of major communicable diseases. At the same time most countries have experienced difficulties with delivering primary and secondary care in both the public and private sectors. Continued progress toward universal health coverage will require addressing these delivery problems.
  • 150 million people fall into poverty every year paying for health out-of-pocket. (5) By pooling funding and providing early access to health services, universal health coverage reduces reliance on out-of-pocket payments, thereby protecting households from impoverishing financial risks.
  • The Ebola virus disease epidemic has reminded us that we are only as strong as our weakest links. The debilitating effect of Ebola could have been mitigated by building up public health systems in Guinea, Liberia and Sierra Leone at one third the cost of the Ebola response so far. (6)

Every country has the opportunity to achieve universal health coverage.

  • More than 100 countries across the development spectrum have begun working toward universal health coverage – testing and increasingly demonstrating its feasibility.
  • Countries will find greatest value for money by financing for everyone convergence-related services that are high-quality and free or low cost at the point of delivery. As their domestic resources increase, countries would expand the package of essential services that are publicly financed for all.
  • Most countries have the capacity to raise more domestic funds for health through improved tax systems and innovative financing mechanisms. And given anticipated economic growth across low- and lower-middle-income counties, most countries will have additional financial means to invest more in health services and delivery. When allocated efficiently, greater investments in health can result in lower overall costs to the system. (1)

Development assistance for health will play an essential part in achievement of a grand convergence in global health and universal health coverage.

  • Domestic funding alone will not be enough for many low-income countries to provide even the convergence-related health services. Focusing the available country-specific health aid on the convergence interventions in low-income (but committed) countries can provide invaluable help.
  • A grand convergence in global health will be greatly helped by substantial investments from donors in the neglected global functions of development assistance for health: providing global public goods such as health research and development, dealing with cross-border externalities such as pandemics and antimicrobial resistance, and supporting leadership and stewardship of global institutions. Adequate finance of these global functions is likely to prove the most efficient path to improving conditions of the poor in middle-income countries. (7)

We, the undersigned, therefore urge that:

  • Heads of government increase domestic funds for global health convergence and provide vocal political leadership to implement policy reforms toward pro-poor universal health coverage;
  • Donor countries meet their pledges for international development assistance and commit to investing in the global functions of development assistance for health, particularly research and development for diseases of poverty;
  • Development financing discussions explicitly address equity, including who pays domestically and who benefits;
  • National policymakers embrace universal health coverage, as defined above, as an integrated approach for measuring progress toward health targets in the post-2015 global development framework.

• • •

Even with substantial rates of economic growth, resources for health (and other sectors) will remain highly constrained. The intrinsic value of improved health – and the demonstrated potential of governments and aid agencies to deliver key health interventions – points to maintaining and expanding commitment to health through investing in pro-poor pathways to universal health coverage. Amartya Sen has labeled this opportunity “the affordable dream.” (8)

ECONOMISTS’ DECLARATION SIGNATORIES


Australia

Nejat Anbarci

Hristos Doucouliagos

Stephen Duckett

Simon Eckermann

Mark McGillivray

Barbara McPake

Jorida Zeneli

Argentina

Juan Ignacio Altuna

Silvia Juncos

Alejandro Sonis

Alberto Testa

Bangladesh

Syed Abdul Hamid

Mohammad A. Jabbar

Atonu Rabbani

Belgium

Claude d’Aspremont Lynden

Michel Huybrechts

Andre Sapir

Reinhilde Veugelers

Belize

Ignez Tristao

Bolivia

Luis Tejerina

Botswana

Linah K. Mohohlo

Brazil

Denizar Vianna Araujo

Tania Maria Beume

Marcia Cristina Gomes da Rocha

Vera Martins Da Silva

Marcella Distrutti

Luiz Alberto Esteves

Alexandre Chiavegatto Filho

Naercio Menezes Filho

Bruno Cara Giovannetti

Andre Medici

Marcelo J. Moreira

Rodrigo Soares

Mario Ramos Ribeiro

Cameroon

Zakariaou Njoumemi

Canada

Matilde Bombardini

Timothy Evans

Alan Freeman

Prabhat Jha

Steve Morgan

M. Kent Ranson

Alan Whiteside

Chile

Camilo Cid

Manuel Llorca-Jaña

Miguel Quiroga-Suazo

Christian Hernandez Valenzuela

China

Jikun Huang

Justin Yifu Lin

Ding Liu

Gordon G. Liu

Colombia

Pedro Buitrago

Giancarlo Romano G

Carlos Ernesto Escobar Vargas

Costa Rica

James Cercone

Luis Elizondo Vidaurre

Côte d’Ivoire

Ibrahim Magazi

Cyprus

Christopher Pissarides

Denmark

Bjørn Lomborg

Ecuador

Ruth Lucio

Egypt

Ahmed Kouchouk

Ethiopia

Degnet Abebaw

Assefa Abebe

Tadele Feree Agaje

Joseph Atta-Mensah

Alemayehu Geda

Netsanet Walelign Workie

France

Jerome Creel

Alan Kirman

Brouillet Pascal

Jean-Jacques Paul

Thomas Piketty

Eric de Roodenbeke

Germany

John Komlos

Dalia Marin

Ghana

Philip Kofi Adom

Frank Adu

Moses Aikins

Genevieve Cecilia Aryeetey

Francis Mensah Asenso-Boadi

Chris Atim

Richmond Commodore

Selassi Amah d’Almeida

Augustin Kwasi Fosu

Edward Nketiah-Amponsah

Justice Nonvignon

Peter Quartey

Daniel Sakyi

Nii Kwaku Sowa

Henry Telli

Ebo Turkson

George Tweneboah

Timothy O. Williams

India

Vinod B. Annigeri

Kishor Hari Badatya

Sugata Bag

Aditya Bhattacharjea

Pratap Singh Birthal

Satya R. Chakravarty

Sarbajit Chaudhuri

Mausumi Das

Nimai Das

Indraneel Dasgupta

S. Mahendra Dev

Chetan Ghate

Ashima Goyal

K. S. James

Somdeb Lahiri

Ramanan Laxminarayan

Srijit Mishra

Diganta Mukherjee

Subrata Mukherjee

Anjan Mukherji

Arnab Mukherji

Soumyanetra Munshi

Amarendu Nandy

Pulin B. Nayak

Rupayan Pal

Durgesh C. Pathak

M. Govinda Rao

Ayanendu Sanyal

Subrata Sarkar

Anindya Sen

Soumyen Sikdar

Charan Singh

Anup Sinha

Pankaj Sinha

Uday Bhanu Sinha

E. Somanathan

Krishnamurthy Subramanian (Subbu)

Aviral Tiwari

Beena Varghese

Indonesia

Teguh Dartanto

Djoni Hartono

Athia Yumna

Arief Anshory Yusuf

Israel

Sergiu Hart

Italy

Ferdinando Regalia

Japan

Masahiro Kawai

Alistair Munro

Takashi Oshio

Kenichi Ueda

Akihito Watabe

Kenya

Japheth Awiti

Joy Mueni Kiiru

Diana Kimani

George Kosimbei

Dianah Mukwate

Joseph Muchai Muniu

Mwenda Mwilaria

Jennifer Njaramba

Martine Odhiambo Oleche

Perez Onono

Apurva Sanghi

Malaysia

Syed Mohamed Aljunid

Mexico

Esteban Colla

Javier Dorantes Aguilar

Pablo Ibarraran

Matthew Kovach

Alejandro Figueroa Lara

David Mayer-Foulkes

Isidro Soloaga

Carlos M. Urzúa

Morocco

Rachid M. Aourraz

Driss M. Zine-Eddine El-Idrissi

Myanmar

Alex Ergo

Nicaragua

Carlos Herrera U

Nigeria

Kehinde Akeem Adegoke

Ayodeji Ajiboye

Shehu Rano Aliyu

Elaine Baruwa

Nkata Chuku

Sampson Ezikeanyi

Musa Ibrahim Jega

Kenneth Ojo

Olumide Okunola

Olubajo Olalekan

Adesoji Ologun

Obinna Onwujekwe

Chibuzo Opara

Afees Adebare Salisu

Francis Nwachukwu Ukwuije

Norway

Halvor Mehlum

Kjetil Storesletten

Howard White

Pakistan

Suleman Abdiah

Hasan M. Mohsin

Peru

Sandro Parodi

Singapore

Antonio Fatas

Kai Hong Phua

South Africa

Haroon Bhorat

Stan du Plessis

J. Paul Dunne

Jaya Josie

Patrizio Piraino

Nicola Viegi

Nick Vink

Martin Wittenberg

Ingrid Woolard

South Korea

Cheolsu Kim

Spain

Maria Blanco

Irma Clots-Figueras

Guillem Lopez-Casasnovas

Andreu Mas-Colell

Rafael Luque Muñoz

Ángel López Nicolás

Bienvenido Ortega

Julio Segura

Sweden

Justice Mensah

Thomas Sterner

Switzerland

David B. Evans

Michael Gerfin

Alberto Holly

Jürgen Maurer

Xenia Scheil-Adlung

Simon Wieser

Thailand

Viroj NaRanong

Ammar Siamwalla

Siripen Supakankunti

Chalongphob Sussangkarn

Nualnoi Treerat

The Netherlands

Rob Baltussen

Hengky Kurniawan

J.L. (Hans) Severens

Eddy van Doorslaer

The Philippines

Karl Kendrick Chua

Turkey

Bilin Neyapti

Ilhan Can Ozen

Ilhan Ozturk

Ali C. Tasiran

Erol Taymaz

Ebru Voyvoda

A. Erinc Yeldan

Uganda

Mugisha David

Willy Rwamparagi Kagarura

Norbert Mubiru

Jean-Pascal N. Nganou

United Kingdom

Tony Atkinson

Nicholas Barr

Andrew Briggs

Karl Claxton

Paul Collier

Joan Costa-Font

Anthony J. Culyer

Tim Ensor

Eric French

Stephany Griffith-Jones

Andrew Hughes Hallett

Kara Hanson

Jenni Hislop

Mireia Jofre-Bonet

Andrew M. Jones

Richard Layard

Paul Levine

Anil Markandya

Marisa Miraldo

Alistair McGuire

Giovanni Melina

Anne Mills

Patrick V. Moore

Lucia Fiestas Navarrete

Joseph Pearlman

Zahidul Quayyum

Lucrezia Reichlin

Paul Revill

Bibhas Saha

Mark Sculpher

Peter C. Smith

Richard D. Smith

Nicholas Stern

Frances Stewart

Marc Suhrcke

Adair Turner

Anna Vassal

Sophie Witter

Olivia Wu

Robert Yates

Winnie Yip

United States

M. Caridad Araujo

Suchit Arora

Kenneth Arrow

Dean Baker

Kaushik Basu

Peter Berman

Stefano M. Bertozzi

David Blanchflower

Jacob Bor

Rebekah Heinzen Borse

Jeremy Bulow

Robert J. Camfield

Jim Campen

Karen Cavanaugh

Cheryl Cashin

Frank J. Chaloupka

Menzie D. Chinn

Daniel Cotlear

Janet Currie

David Cutler

Patricia Danzon

Brad DeLong

Asif Ud Dowla

Pascaline Dupas

Anthony Elson

James Fearon

Brandon Fenley

Carolyn Fischer

Victor R. Fuchs

Fabio Ghironi

Amanda Glassman

Alexander Gleason

Rachel Glennerster

Nora Gordon

Karen A. Grépin

Michael Grossman

Jonathan Gruber

Robert Haveman

Peter Heller

Rebecca Henderson

Christopher Hollenbeak

William Hsiao

Wenke Hwang

John Irons

Paul Isenman

Dean Jamison

Seema Jayachandran

Arjun Jayadev

Geoffrey Joyce

Ted Joyce

Dean Karlan

Robert Klitgaard

Eric Kramer

Sanjeev Kumar

Mattias Lundberg

Caroline Ly

Sara Machado

Carlos Martins-Filho

Keith E. Maskus

Deborah McFarland

Bruce Mizrach

Akbar Noman

Rachel Nugent

Nikolas Papavlassopulos

Germain Pichop

Anne Morrison Piehl

Steve Radelet

Lakshmi K. Raut

Alvin Roth

Bernard Salanie

Will Semmler

Jason Shogren

Lara Shore-Sheppard

Vernon L. Smith

Agnes Soucat

Joseph E. Stiglitz

Lawrence H. Summers

Anita A. Summers

Daria Taglioni

Frank Thompson

Nathan W. Tefft

David J. Vanness

Nicholas Wilson

Barbara L. Wolfe

Tetsuji Yamada

Harry Zhang

Venezuela

Luis Zambrano Sequin

ADD YOUR SIGNATURE


If you are a professional economist and would like to add your signature to the Declaration:


References

1. Jamison, DT, Summers, LH, Alleyne, G et al. Global health 2035: a world converging within a generation. The Lancet. 2013; 382: 1898–1955

2. WHO Commission on Macroeconomics and Health. Macroeconomics and health: investing in health for economic development. World Health Organization, Geneva; 2001

3. WHO Commission on Macroeconomics and Health and Working Group 1. Health, economic growth and poverty reduction. World Health Organization, Geneva; 2002

4. Kydland, FE, Mundell, R, Schelling, T, Smith, V and Stokey, N. Expert panel ranking. in: B Lomberg (Ed.) Global problems, smart solutions: costs and benefits. Cambridge University Press, Cambridge; 2013: 701–716

5. Xu, K, Evans, DB, Carrin, G, Aguilar-Rivera, AM, Musgrove, P and Evans, T. Protecting households from catastrophic health spending. Health Affairs. 2007; 26: 972–983

6. Save the Children. A wake-up call: lessons from Ebola for the world’s health systems. Save the Children, London; 2015

7. Schäferhoff, M, Fewer, S, Kraus, J et al. How much donor financing for health is channelled to global versus country-specific aid functions? The Lancet. 2015 (published online 13 July)

8. Sen, A. Universal healthcare: the affordable dream. The Guardian (London); 6 January 2015