Macroeconomics and Health (CMH)


The necessity of integrating health across sectors to create a viable development strategy was established by the findings of the CMH (December 2001). The Commission emphasised the central role of health in securing economic development, identifying the poorest populations as disproportionately affected by disease and the financial hardships caused by disease. The Report concluded that low- and middle-income countries must increase resource allocations to health, and high-income countries must increase their contribution to health in poor countries within a development framework. Equally important to increased health expenditures, the Commission recommended that countries examine their health systems and institutions to identify inefficiencies and limits to the capacity to absorb additional funds and to elucidate the inequities of health provision to the poor.

In parallel, WHO has stressed that Health for All and Primary Health Care (PHC) strategies cannot be successfully implemented without placing them within each country’s socioeconomic context. The result is the emergence of an international consensus: socioeconomic growth and development can be achieved only by rigorously promoting the implementation of pro-poor health policies within a developmental framework and financed through a massive scaling up of health investments.

Though health is accepted as an important goal of economic growth and development, economic development alone has not brought about the achievement of national and global health goals. The World Bank reports that though countries are spending one third of their budgets in the health and education sectors, the benefits are primarily experienced by the rich, not the poor (World Development Report, 2004). Several reasons are cited as to why public services are falling short, including the failure of funds to reach the peripheral service delivery level, weak incentives at the local level, and also lack of demand by the poor due to financial, logistical, cultural and educational barriers to access.

Over the last decade, several reports have supported a concerted international effort for scaling up essential interventions for health promotion, disease prevention, treatment, and risk-factor reduction through a coordinated sectorwide approach (World Development Report, 2003; World Health Report, 1999 and 2002). It is widely accepted that a range of interventions exist that, if efficiently and systematically applied, could reduce the burden of disease of the poor.

The CMH Report called for health investments to be placed centrally in countries’ development agendas through long-term macroeconomic policies, highlighting the links between health investment and poverty reduction. CMH Working Group 1 states that this “new thinking – that health enhances economic growth - supplements and, to a degree, realigns ideas of the justifications of spending on health, justifications that are based on humanitarian and equity arguments”.