Institute for Health and Human Development

Wellbeing and Globalisation

Project: Economic Growth and Health

Project Lead: Adrian Renton, Martin Wall

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A 1999 World Bank publication has claimed that technical progress between1960 and 1990 accounted for around half of the mortality reduction in developing countries over that period, and that growth in GDP accounted for one quarter or less of the change. This analysis has been repeatedly used in World Health Organisation (WHO) documents to support a shift in WHO thinking on the health-wealth relationship towards an emphasis on health as wealth-generating; rather than wealth as health-generating. We review the methods and findings of the original World Bank analysis, and update the analysis of the Bank’s current development data sets to provide a new assessment of the relative potential contribution of economic growth, education and technical progress to improvements in health

We reviewed the methods, analysis and findings presented in the World Bank paper; and cross-sectional time series regression analysis using a random-effects model to assess associations  of increasing GDP, education and technical progress with improved health outcomes

We found that the model used in the World Bank’s 1999 analysis does not allow the effect of GDP on health to vary over time. Our study suggests that there has been major variation and that the Bank analysis therefore underestimated by around fifty percent overall the effect of GDP growth on improvement in life expectancy. In our analysis “Technical progress” far from acting independently of GDP growth acts through it; by increasing the size of the effect of GDP on health.

We conclude that in the poorest countries where the current focus of international development efforts lies, social and economic change is likely to be a more important source of health improvement than technical progress. Technical progress, because it appears to operate through increasing the size of the effect of a unit of GDP effect on health is likely to continue to benefit richer countries more than poorer ones; thereby increasing global health inequalities.  Economic growth in poorer countries may be an absolute requirement if significant health improvements are to be achieved. The WHO needs to reconnect with its core values and focus on global development for well-being and equity as well as pursuing its crusade for health systems improvement

Read the discussion paper presenting the findings in detail.

View a powerpoint presentation on the subject.

For more information contact Adrian Renton, Martin Wall

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© 2010