Trade, foreign policy, diplomacy and health

9. Global Public Goods for Health: Use and Limitations

Richard D Smith, David Woodward

4. Access goods

  • Health systems are key ‘access good’
  • Inadequate health systems limit ability of populations to benefit from GPGH
  • Health systems represent a critical constraint on GPGH provision
  • Support of development of adequate health systems in countries where they do not may be justified on GPG grounds

All case-studies highlighted the importance of those private goods and services required to produce the GPGH of their specific interest, especially health systems. The absence of functioning health systems in some countries renders production of some GPGH impossible, increasing the cost and/or reducing the benefits of others, increasing the likelihood of under-provision, or preventing benefits from being universal. The result is to reduce the number of GPGs that could be provided in two ways.

  • Inadequate health services severely limits the ability of populations to benefit from many potential GPGH if they were provided. This not only affects the cost-benefit calculus for their provision, but may also bring into serious question their status as GPGs in terms of the universality of benefits.
  • Accessible and effective health services are essential to the production of GPGH such as disease eradication and communicable disease control, and may thus represent a critical constraint on their provision. Their absence may thus limit the scope of GPGH whose provision is economically viable.

Support to the development or restoration of adequate health services in countries where they do not currently exist may therefore be justified on GPG grounds, particularly where universal or near-universal coverage is necessary to ensure GPGH production, as in the case of disease eradication. This represents a strong case for the provision of free health services as a public good at the national level, and for external subsidies to achieve this.