06 April 2018

Goals for health

Peter Jacobsen writes to the New Scientist:
One factor may be missed when comparing war severity between 1823 and 2003 using fatalities.... Recent wars have had fewer fatalities, but perhaps not because they were less severe. Weapons are increasingly potent but trauma care has improved a lot, and hence the lethality of war has decreased over time. A similar bias can be seen with the murder rate. Medical care means more survive modern war, Peter Jacobsen, 'New Scientist', 27 March
This points to the importance of choosing our social and environmental goals carefully. They need to be goals that are, or are inextricably linked to, what we actually want to achieve. Do we want to aim to reduce (for instance) deaths by violence, regardless of how much funding is to be spent on trauma care? Or would any additional funding be better spent on general health care with, perhaps, more lives saved per dollar spent? These questions need to be addressed for the operation of a Social Policy Bond regime, and they are not simple. But it's crucial to remember that they need to be asked too in our current policy regimes. They rarely are. Instead funding for healthcare is typically decided by people with little incentive or capacity to maximise improvements in health per dollar spent. Funding is often a function of history, or the charisma of medical specialists, or how newsworthy is a particular health problem. (See for instance this report from Australia: Men die earlier but women's health gets four times more funding.)

My suggestion is that we issue Health Bonds, which would explicitly and impartially target improvements in longevity, Quality Adjusted Life Years, infant mortality rates and other general population health indicators. Resources are always going to be limited but decisions our healthcare goals and - and the basis on which they are made - should be made clear to ordinary people, so that we can participate, if we want, in their formulation.

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