Why should we invest in health? Evidence from the lens of second-order benefits of health | Published in Journal of Global Health Reports

The World Health Organization (WHO) and the Sustainable Development Goals (SDGs)

The World Health Organization (WHO) states that a healthcare system should improve population health, prevent healthcare costs, and meet health expectations. Risk sharing and financial protection are crucial since health care is expensive and uncertain.¹ Responding to people’s expectations shows respect for dignity, autonomy, and information confidentiality. Improving health means increasing the population’s average health and reducing health disparities.² Life expectancy and health care access have improved worldwide in recent decades.³ These advancements have greatly increased wellbeing.⁴ The microeconomic studies on health and worker productivity, education, and savings suggest that improved health boosts economic growth.⁵ However, some macroeconomic research shows a big and meaningful influence.^6,7 Hence, health reforms are more and more becoming a key priority in all countries to address/ improve the accessibility, affordability, and availability of quality services along with improved efficiencies in spending.⁸

Secondary Benefits of Health Systems

By definition, secondary benefits are any additional effects that may arise from a project’s economic ties.⁹ When pertaining to health – secondary health benefits are the additional benefits received by an individual or community apart from the original objective as a result of the presence of a project in a specific geographical area.¹⁰ Second-order health benefits may include:

• An increase in equity, employment, literacy level, women’s education and empowerment, income, productivity, local wealth and lifestyle.
• A decrease in out-of-pocket expenditure, poverty, socio-economic, geographic and gender inequalities.
• Fostering local partnerships with communities, innovations and implementation of technology, upscaling of human resources and infrastructure development, and opportunities for advancement and career development.

However, second-order benefits of Health systems are little researched and not discussed in mainstream policies and practice. This report explains the rationale, evidence, and methods for understanding the health schemes’ significant potential socio-economic impacts and linking the indirect impacts/association by health systems in other facets. The work aims to support broader efforts to see health systems as critical in promoting equitable and inclusive development in benefiting the entire community, particularly those who are frequently left behind.

Employment Generation and Infrastructure Development

The health sector has always been a source of employment generation, directly for the healthcare workers and indirectly for all those involved in medical infrastructure, supply chain, medical technology, pharmaceuticals, logistics, etc. Total private infrastructure accounts for nearly 62% of all of India’s health infrastructure with 43,486 private hospitals¹¹ and linked with this growth is the exponential increase in the jobs in the fields of medicine, nursing, allied and other healthcare workers, medical technology manufacturing drugs and maintenance, diagnostics and vaccines; infrastructure creation and maintenance, healthcare management, etc.

The concerted efforts towards health system strengthening under National Health Mission (NHM)¹² have also seen an exponential growth of human resources and health institutions. From 2006 to 2022, the number of Accredited Social Health Activist (ASHA) has risen to approximately 1.04 Million, Auxiliary nurse midwives (ANMs) to 207,587 from 133,194, Allopathy Doctors to 30,640 from 20,308, specialist Doctors to 4,485 from 3,550 and Community Health Centres to 5,649 from 3,346.^13,14 Overall, 0.26 Million contractual healthcare workers have been employed under NHM and recently more than 0.125 Million Community Health Officers (CHO) have also been added.

Healthcare financing has increased, which led to infrastructure development and increased employment opportunities. In the Union Budget 2023-24, the health sector has been allocated INR 891,550 Million¹⁵ as against INR 739,320 Million allocated in 2021-22 and INR 102,800 Million in 2005-06. Healthcare financing also helped the growth of healthcare training institutions, the 15th Finance Commission has recommended allocating more than INR 130,000 Million for the training of allied healthcare

SDGs, Targets, and Indicators

SDGs, Targets, and Indicators mentioned or implied in the article:

1. SDG 3: Good Health and Well-being
   • Target 3.8: Achieve universal health coverage, including financial risk protection, access to quality essential health-care services, and access to safe, effective, quality, and affordable essential medicines and vaccines for all.
   • Indicator 3.8.1: Coverage of essential health services (defined as the average coverage of essential services based on tracer interventions that include reproductive, maternal, newborn and child health, infectious diseases, non-communicable diseases, and service capacity and access).
   • Indicator 3.8.2: Proportion of the population with large household expenditures on health as a share of total household expenditure or income.
2. SDG 4: Quality Education
   • Target 4.1: By 2030, ensure that all girls and boys complete free, equitable, and quality primary and secondary education leading to relevant and effective learning outcomes.
   • Indicator 4.1.1: Proportion of children and young people (a) in grades 2/3; (b) at the end of primary; and (c) at the end of lower secondary achieving at least a minimum proficiency level in (i) reading and (ii) mathematics, by sex.
   • Indicator 4.1.2: Participation rate of youth and adults in formal and non-formal education and training in the previous 12 months, by sex.
3. SDG 5: Gender Equality
   • Target 5.1: End all forms of discrimination against all women and girls everywhere.
   • Indicator 5.1.1: Whether or not legal frameworks are in place to promote, enforce, and monitor equality and non-discrimination on the basis of sex.
   • Indicator 5.1.2: Proportion of ever-partnered women and girls aged 15 years and older subjected to physical, sexual, or psychological violence by a current or former intimate partner in the previous 12 months, by form of violence and by age group.
4. SDG 8: Decent Work and Economic Growth
   • Target 8.2: Achieve higher levels of economic productivity through diversification, technological upgrading, and innovation, including through a focus on high-value-added and labor-intensive sectors.
   • Indicator 8.2.1: Annual growth rate of real GDP per employed person.
   • Indicator 8.2.2: Proportion of youth (aged 15-24 years) not in education, employment, or training.
5. SDG 10: Reduced Inequalities
   • Target 10.2: By 2030, empower and promote the social, economic, and political inclusion of all, irrespective of age, sex, disability, race, ethnicity, origin, religion, or economic or other status.
   • Indicator 10.2.1: Proportion of people living below 50 percent of median income, by age, sex, and persons with disabilities.
   • Indicator 10.2.2: Proportion of men, women, and children of all ages living in poverty in all its dimensions according to national definitions.
6. SDG 11: Sustainable Cities and Communities
   • Target 11.3: By 2030, enhance inclusive and sustainable urbanization and capacity for participatory, integrated, and sustainable human settlement planning and management in all countries.
   • Indicator 11.3.1: Ratio of land consumption rate to population growth rate.
   • Indicator 11.3.2: Proportion of cities with a direct participation structure of civil society in urban planning and management that operate regularly and democratically.
7. SDG 16: Peace, Justice, and Strong Institutions
   • Target 16.5: Substantially reduce corruption and bribery in all their forms.
   • Indicator 16.5.1: Proportion of persons who had at least one contact with a public official and who paid a bribe to a public official, or were asked for a bribe by those public officials, during the previous 12 months.

Table: SDGs, Targets, and Indicators