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TWN Info Service
on Health Issues (May26/02) WHO: World Health Assembly to Adopt Strategy on Economics of Health for All Jakarta, 11 May (Dian Maria Blandina*) – The upcoming 79th World Health Assembly (WHA) is set to adopt a ten-year strategy on the economics of health for all. The 79th WHA is to take place in Geneva from 17 to 23 May. The WHA resolution 77.13 requested the Director-General to develop a strategy on how to implement an economics of health for all approach, including priority actions for Member States and other actors. Earlier, the 158th meeting of the World Health Organization (WHO) Executive Board unveiled a draft strategy on the Economics of Health for All (2026 -2030)] Moving beyond appeals for increased health financing within existing economic structures, the strategy proposes a fundamental reorientation of economic policy itself toward the attainment of universal health and wellbeing. The strategy successfully consolidates and legitimates a growing consensus around health as an economic investment rather than a social expenditure. Yet for all its ambition and foresight, the strategy leaves critical gaps unaddressed, chief among them the structural constraints facing Global South economies. The Normative Turn in Global Health Economics Document EB158/31 contains an ambitious proposition: that the global economy must be systematically reengineered to serve health, rather than the inverse. The draft strategy’s framing of health as a “foundational economic asset” and its repudiation of GDP maximization as an adequate metric of social progress signal what might be termed a normative inflection point in global health governance. The strategy is best understood not as a novel departure but as the latest iteration of a recurrent contestation within global health governance. Its intellectual antecedents include the 1978 Alma-Ata Declaration’s invocation of the 1974 UNGA resolution for a New International Economic Order. What distinguishes the current initiative is its institutional location and temporal conjuncture. Convened in November 2020, the WHO Council on the Economics of Health for All operated at the intersection of multiple crises: the COVID-19 pandemic’s demonstration of health system fragility, the inequitable distribution of vaccines underscoring intellectual property regimes’ extractive character, and mounting evidence of commercial determinants producing non-communicable disease epidemics. The Council's 2023 report articulated its recommendations across four pillars of action: 1. Valuing health for all by questioning the pursuit of economic growth and GDP maximization regardless of consequences; 2. Financing health for all by reforming how health is financed so funding becomes larger, more stable, and more effective over the long term; 3. Innovating for health for all by changing how patents work and how governments and companies relate to each other; and 4. Strengthening public sector capacity across all parts of government. Thus the Council’s recommendations to shift from “fixing market failures” to “shaping markets” represents more than a semantic adjustment. It signals a rejection of neoclassical economics’ assumption that markets can produce optimal allocations if only market failures are fixed to a position where the state should actively intervene in shaping (and limiting) the role of markets. . The Council rightly argues that markets are themselves political constructions, shaped by public investment, regulatory architecture, and intellectual property regimes. The state’s role is thus not supplemental but constitutive. This repositioning has profound implications for health policy by pointing to state-directed technological development and market restructuring as legitimate instruments of health governance. Draft strategy on the Economics of Health for All (EH4A) WHO’s draft strategy on the Economics of Health for All (EH4A) is organized around five strategic directions. The first directs economic policy toward health outcomes. It calls for reforming tax systems, integrating health impact assessments into trade agreements, and formulating labour policies that ensure decent work conditions. This strategy recommends addressing health workforce shortages, recognizes the contribution of unpaid care workers (predominantly women) and strengthens social protection systems. The second reframes how health is valued and invested in. It recommends adopting progress dashboards that monitor health equity, universal coverage, and community vitality, moving beyond GDP as the sole measure of success. It mandates health and equity impact assessments for all economic policies and establishes clear standards to guide private investments in health. The third focuses on financing. It aims to increase domestic health resources through progressive taxation, earmarked health taxes, and fair social insurance, in line with the 2023 UN political declaration on universal health coverage. It promotes outcome-focused budgeting and expenditure tracking systems that support accountability, and aligns external funding with domestic plans to support UHC. It also deploys tax credits, price caps, and intellectual property sharing to build local manufacturing and innovation ecosystems. The fourth builds capacity for implementation. It calls for audits and strengthened government expertise in health economics, integration of these competencies into medical and public health education and connecting expertise across sectors and governance levels through observatories. It recommends bringing together public institutions, academia, trade unions, and civil society, in support of public institutions to learn, coordinate, and respond swiftly to change. The fifth strategic direction secures evidence-informed implementation. It recommends long-term research into how economic policies affect health and fairness, positions the economics of health for all as a priority field, and protects science-informed policymaking through strengthened transparency. It supports independent research, manages conflicts of interest, and counters disinformation while building public trust through clear communication guidelines and civil society engagement. The agenda includes a specific task for WHO itself: to reserve budget for implementing this approach internally by generating evidence, guiding policy design, and supporting health-related macroeconomic policies and practices for sustainable health financing, as outlined in document EB158/31 Add.1. What Remains Absent There are also gaps in the strategy. Three omissions matter most. Sovereign Debt and Fiscal Austerity The 2023 Council report acknowledged that debt servicing obligations directly displace health expenditure in highly indebted states. The 2026 draft strategy, however, contains no substantive recommendations regarding sovereign debt restructuring and cancellation, despite its direct relevance to domestic resource mobilization. This omission is not accidental. Debt restructuring implicates international financial institutions, bilateral creditors, and private bondholders; actors with whom WHO possesses little leverage with which to engage. Yet the omission produces a peculiar discursive effect: the strategy pushes indebted states to increase domestic health financing while remaining silent regarding the debt service obligations that render such increases impossible. Financialization of Health The strategy’s treatment of private finance is ambivalent. It acknowledges that private sector engagement must be governed by clear standards on equity and universal access, yet it does not critically examine the structural transformation wrought by financialization, i.e. the increasing dominance of financial motives, markets, and actors in health systems and health governance. This transformation includes private equity acquisition of physician practices and nursing homes, hospital conversion to investor-owned entities prioritizing shareholder returns over community service, pharmaceutical firms’ financial engineering prioritizing share buybacks over research and development, and sovereign issuance of pandemic bonds whose payout triggers are constructed to protect investor capital rather than population health. The strategy’s framing of private investment as a health resource to be harnessed rather than a financial and commercial force obscures financialization’s role as a driver of both debt accumulation and health system fragmentation. Geopolitical Asymmetry and Imperial Power The third omission concerns the geopolitical architecture within which economic policy is formulated. Global North’s trade policies, currency regimes, technology transfer restrictions, and sanction authorities fundamentally structure the policy space available to the Global South – these are nowhere named. This depoliticized framing implicitly assumes a Westphalian universe of formally equal sovereign states, obscuring the substantive inequalities produced by colonialism, structural adjustment, and contemporary extractive integration into global value chains. The strategy advocates for health impact assessments of trade agreements without acknowledging that many developing countries face not choices about whether to enter trade agreements but which asymmetrical agreement to accept. It recommends intellectual property sharing without addressing the extra-territorial enforcement of intellectual property rights through bilateral trade agreements. It calls for progressive taxation without engaging capital mobility, tax competition, and the offshore wealth estimated at twelve percent of global GDP. Potential of Political Economic Transformation Fifty years after Alma-Ata declared health a fundamental human right whose realization required a New International Economic Order, the project of economic transformation for health remains unfinished. The EH4A strategy does not complete this project. It does, however, reopen questions that had been foreclosed, revive political lineages that had been suppressed, and create institutional footholds from which more ambitious transformations might be advanced. Whether those footholds prove sufficient will depend not on the strategy’s technical adequacy but on the political mobilization that its vision (however compromised, however incomplete) nonetheless invites. The strategy’s ultimate significance may lie less in whether it can be implemented immediately than in its reconstruction of the terrain upon which struggles over health, development, and economic justice are conducted. (* Faculty Member, United Nations University, International Institute for Global Health)
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