Health for all is a goal that almost every government says it shares, and was adopted as part of United Nations’ Sustainable Development Goal 3, ‘Good Health and Well-being’. Yet we still organise our economies as though health is a cost to contain rather than an outcome to shape. The problem is not a shortage of good intentions. It is that we rely on an economic framework built on correcting failures. So long as public investment is justified only by what the private sector is not doing, we have no theory of the public good, only a theory of what markets are missing. A framework built on failures is reactive by definition, and will keep failing us.
The consequences are visible in every health budget. On average, the countries in the Organisation for Economic Co-operation and Development direct only 2.8% of health spending to promotion and prevention, against around 80% to curative and rehabilitative care. Even in countries with a commitment to universal health coverage, we see a decline in health budgets: in England, the public health grant to local authorities was cut by 26% per person in real terms between 2015/16 and 2025/26. We pay after people fall ill and underinvest in what keeps them well: secure housing, education, decent work and community.
Public investment in well-being matters enormously: the most radical health innovations, from foundational research to the mRNA platforms behind the Covid-19 vaccines, rest on decades of public funding. But I have come to see its limits. A state that absorbs risk without governing direction and the distribution of rewards simply socialises risk and privatises reward. Missions give the economy direction, but direction alone does not settle who benefits. We need not only an entrepreneurial state and mission-oriented policies but also a new economics of collective action based on a ‘common good economy’: getting economic relationships right from the start rather than picking up the pieces afterwards.
Shaping innovation for the common good
When I chaired the World Health Organization’s Council on the Economics of Health for All, we learned to reverse the question: Not what health costs the economy, but if health for all is the goal, what does it mean for how we value health workers, design partnerships with business, finance innovation and build the capacity to govern it? Conditions attached to public money are the most direct answer available. During the pandemic, the United Kingdom embedded conditionalities in the Vaxzevria supply agreement requiring doses at cost, strengthening its ability to guarantee access. And the WHO mRNA Vaccine Technology Transfer Programme makes early-stage public funding conditional on knowledge sharing and equitable access, so Global South countries can produce their own vaccines rather than wait for handouts. Companies benefiting from publicly financed health research should keep prices affordable and avoid patents so wide or so evergreen they cannot be licensed. This is not anti-business. It is how partnerships become equitable: symbiotic rather than parasitic.
Achieving goals on health goes beyond the health ministry. We must regulate and shape industries in all sectors to achieve health for all. This includes implementing actions aligned with environmental and climate strategies to achieve near- and long-term health co-benefits, as the Lancet Pathfinder Commission found – another area where investing now brings better health outcomes (and costs less) than delayed remedial action.
Investing where health is created
It also means investing in the places where health is produced and designing them with the people who use them. Housing, community centres, parks and youth clubs are treated as discretionary costs because their benefits are diffuse and hard to measure. Yet building 90,000 social homes in the UK is estimated to generate £51.2 billion in economic value once reduced homelessness, lower healthcare costs and higher tax receipts are counted, while in London, where 30% of youth clubs closed over the decade, teenagers who lost their nearest club became 14% more likely to commit a crime within six years. Bogotá’s manzanas del cuidado or ‘care blocks’ bring child care, health care, legal advice and psychological support within a 30-minute walk of caregivers’ homes, on the principle that those who care also deserve care. Neglecting such places is not only unjust, but also fiscally reckless.
The political choices follow. Treat health as a mission cutting across housing, food, energy and education rather than a line in one ministry’s budget. Distinguish investment from day-to-day spending in fiscal rules, so prevention is not the first casualty of consolidation or austerity. Attach conditions to public money. Measure what matters, because gross domestic product will never tell us whether a society is getting healthier. When we build a clinic, a home or a youth centre, the question must not be “What is the cheapest way to deliver it?” but “What kind of society do we want to build?”
