How sustained economic growth influences health through nutrition and better living conditions
THE LAST WORD | ANDREW M. MWENDA | In this column last week I argued that economic growth, in spite of its many limitations, remains the most important driver of improved wellbeing. A key measure of wellbeing is increased life expectancy at birth. People who feed poorly and live in horrible conditions are prone to diseases and would, therefore, die young. Infant/child mortality has the biggest impact on life expectancy. For instance, life expectancy at birth in Uganda is about 65 years, compared to Japan at 84.5 years. But life expectancy at 15 years in Uganda could be nearer that of Japan. This shows that after overcoming the health challenges of early childhood, most people live longer.
There is a truly great book by Thomas McKoewn titled, The Role of Medicine: Dream, Mirage, or Nemesis? McKoewn is the founder of social medicine and argues that medicine is not very useful in improving health. In a series of famous diagrams, he demonstrates that for a whole range of diseases, mortality rates were falling long before the introduction of effective treatment, and (interestingly) continued to fall almost at the same rate after its introduction. A medical doctor himself, McKoewn argued that medicine is not very useful, even arguing that the more highly qualified a doctor is the more useless he or she was likely to be.
McKoewn argued that the roots of health improvement lay in economic and social progress particularly nutrition and better living conditions. Better-fed children have greater resistance to diseases than malnourished ones. The biggest, but certainly not the only, influence on both improved nutrition and improved living conditions is income. Of course education also plays an important part: better educated people are more likely to embrace modern living standards, eat a more balanced diet and know the germ theory of disease (like wash hands before they eat) than less educated ones. But without income some of these things are unaffordable – hence the centrality of economic growth to wellbeing.
This is why, recognising that his own professional efforts could do little to improve public health, McKoewn turned to more social ills such as poverty and deprivation, which he saw as fundamental causes of poor health. He felt that gradual improvement in the material conditions of life such as better food and better housing were much more important than either healthcare or public health measures. This goes against the official attitude of Uganda government health policy whose implicit assumption is that health is primarily determined by medical treatment hence our oversized investment in hospitals and doctors.
Last week, I gave statistics on the improvements in the quality of housing in Uganda, a good proxy for both improved incomes and education/exposure. When I walk through my village of Kanyandahi in Kabarole District, I meet many educated people living in better houses with better furniture than their neighbours who actually have higher incomes but are not educated. This has taught me that education/exposure are important, even more important, to improved wellbeing than income. However, I am acutely aware that even with a good education/exposure, one still needs better income to afford those things that improve the quality of living.