25 years on the "Good Health at Low Cost" countries are still improving beyond expectations.
In the developed world, debate rages on over whether a quality public health system can exist at reasonable cost. A recent Reuters report argued the problem with the Spanish healthcare system was that it was too good–that is to say, the Spanish people cannot actually afford the quality of care being delivered.
Emerging economies, however, have made significant progress over the last 25 years, many achieving leaps in public health at low cost. These include popular expat destinations such as Thailand and India. The authors of a 1985 report titled “Good Health at Low Cost” examined how developing countries such as Sri Lanka, Costa Rica, China and the Indian state of Kerala were achieving public health comparable to their western counterparts but at much lower cost.
Since then, researchers Dina Balabanova, Martin McKee and Anne Mills have identified some of the reasons for this progress. They include: leadership by individuals committed to health gains, capacity of individuals and institutions to implement health reform, stability to implement reform and taking the initiative to seize windows of opportunity.
To mark the 25th anniversary of the report the research team revisited the study countries. They found public health has continued to improve beyond what would be expected given those countries’ economic growth. Some highlights:
- Thailand has seen a steep reduction in maternal mortality.
- Ethiopia has gone from one of the worst performers in under-5 mortality to outperforming Uganda and Tanzania.
- Bangladesh has one of the highest life expectancies in South Asia.
- Both Thailand and Kyrgyzstan have implemented universal healthcare schemes unique among countries at their income level.
Indeed, of the countries surveyed Thailand has been particularly successful. Not only has the country achieved many of the UN’s Millennial Development Goals (MDGs)–such as reducing infant mortality by two-thirds and maternal mortality by three quarters–it has actually set new goals (identified as MDG+) to target specific regions and populations.
Researcher Dr. Dina Balabanova, of the London School of Hygiene & Tropical Medicine, commented:
Our study shows that the findings of the original 1985 report remain valid. However, strong health systems are becoming more important in improving health than ever before. New challenges, such as increasing urbanization, a growing private sector and an upsurge in non-communicable diseases, suggest that we need a combination of learning from the past and new thinking if we are to adapt health systems to the challenges of the 21st century.
They key lesson from these countries is that fixating on national income or economic growth as the drivers for improvement of public health is a mistake. Throwing money at problems, as this research has shown, is rarely (if ever) the most effective solution. Rather, government officials and healthcare providers the world over must embrace innovation across both the private and public sectors, in terms of both technology and structural improvement.
Otherwise there may well come a day when countries like the US and UK are setting development goals of their own.