Abstract
Concerns have grown in recent decades that economic growth in many rich countries may, in fact, be uneconomic. Uneconomic growth occurs when expansion in economic activity causes environmental and social costs that are greater than the benefits of that additional activity. Health care has enjoyed a close historical relationship with economic growth, with health care spending consistently growing faster than GDP over the long term. This paper explores the possible relationship between health care and uneconomic growth. It summarises the rapidly growing evidence on the harms caused by poor quality health care and by the overuse of health care, and on the environmental harms caused by health care systems. Further, it develops a conceptual framework for considering the overconsumption of health care and the joint harms to human health and the natural environment that ensue. This framework illustrates how health-damaging overconsumption in the wider economy combines with unnecessary or low-quality health care to create a cycle of "failure demand" and defensive expenditure on health care services. Health care therefore provides important sectoral insights on the phenomenon of uneconomic growth. There are rich opportunities for interdisciplinary research to quantify the joint harms of overconsumption in health and health care, and to estimate the optimal scale of the health sector from novel perspectives that prioritise human and planetary health and well-being over GDP and profit.
Highlights
The idea that economic growth may not always improve human welfare has a long history (Ruskin, 1909 [1862]). Mishan (1967) decried the “growthmania” (p3-8) that simplistically collapsed the aims of economic policy and measurement to maximising growth in GNP, while ignoring the many “disamenities” that accompanied growth in already affluent societies
This paper explores the possible relationship between health care and uneconomic growth
The conceptual framework elabo rated in this paper provides a clearer picture of the ways in which health care systems are deeply embedded in a wider “consumptagenic system” and in the processes of uneconomic growth
Summary
The idea that economic growth may not always improve human welfare has a long history (Ruskin, 1909 [1862]). Mishan (1967) decried the “growthmania” (p3-8) that simplistically collapsed the aims of economic policy and measurement to maximising growth in GNP, while ignoring the many “disamenities” that accompanied growth in already affluent societies. Bringing together many of these themes at a macro level has been the work of Herman Daly on “uneconomic growth” (Daly, 1999, 2006) He noted that, after a certain point, continuing to increase the scale of the economy may cause the social and environmental costs of growth to outweigh its benefits. After a certain point, continuing to increase the scale of the economy may cause the social and environmental costs of growth to outweigh its benefits He argues (Daly, 2006) that population growth and expanding economic activity have moved humanity from inhabiting a historically “empty” world (in which economic growth could be absor bed without harm by the ecosystem), to an increasingly “full” world. This “full world” requires ever more remedial and defensive activity (Daly, 2014), as social and ecological limits increasingly convert eco nomic growth into uneconomic growth (Daly, 2002)
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