Why We Can't Have It All

(Photo credit: John LeGear)

In last week's posting, I discussed commenter Catee Lalonde's first of three fundamental critiques of Dahlgren and Whitehead's definition of health inequities. You might want to look up the resulting further discussion in the comments: in the end, it comes down to another definition, viz. the definition of ‘global health'.

The second part of Catee's critique deals with what is called the political economy of health: how economic choices impact society's (and societies') health. In theory, Catee is obviously right: allocate sufficient resources, and all health inequalities could be resolved. However, reality is a bit different. There are three limits to resources for health:

1. The ‘hard' limit of what our ecology can bear. We already see the negative results of our over-exploitation around us, and there are hard limits to the resources available to humanity - including the resources for health. Within this limit, it is clear that we cannot improve health for all developing countries to the same level as developed countries (perhaps to its present level, but by the time we reach that level in the least-developed countries, health in developed countries will have progressed even further). Of course, it is possible to lower the level in developed countries to the same level as that of developing countries - but I don't think even the most diehard health equality advocate would propose that.
2. Within this limit, there is the realisation that allocating more resources to health can actually have negative results: in extremis, if we would allocate all resources to health we would have no resources left to generate new resources - in other words: health is dependent on its surroundings (e.g. the economy) and we cannot allocate every available dollar to current health efforts without seriously damaging our health in the long term.
3. A third limitation has to do with choices. Not all well-being arises from health, and as societies, we make certain choices concerning how we promote the well-being of the people. In this, societies are no different from people: you do not spend all your money on health, but buy the occasional book or DVD, drink a nice cappuccino instead of a glass of water, or (for those of us who are feel less secure at night) buy a can of mace. Similarly, societies spend resources on the arts, public security, and defence.  You might not agree with the exact allocation, but I don't think anybody would want to live in a world without e.g. any form of art. This puts a softer, but nevertheless very real limitation on what will be allocated to health.

These three limits mean that, both theoretically and practically, we will never be able to eliminate all health inequalities between societies. It all comes down to one of the basic axioms of economics: every possible direction of allocation competes for ‘scarce' resources (‘scarce' here has a rather technical meaning, but can be translated loosely as ‘limited'). Getting everybody everywhere to the highest imaginable health status is, sadly, no more than a pipe dream.