This year’s G20 Summit is over, and the German government should be commended, among other things, for raising health as a core concern. What is more pleasing to hear is Argentinian G20 Sherpa mentioning at the last G20 Summit that her country would have a strong people-centric orientation in its upcoming G20 Presidency. While Germany did put health on the G20 high table, it remained stuck to an institutionalist approach to health, which was in sync with its prioritisation of ‘building resilience, improving sustainability, assuming responsibility’, but clearly out of sync with the growing disenchantment among people. In sync with its own focus, Argentina should move beyond and adopt a people-centric orientation as far as health is concerned. Directly addressing issues that affect people on a daily basis. In the G20 as well as in other international forums, we often hear about the risks that terrorism poses to us collectively and how we need to work together to tackle it. During Germany’s G20 Presidency, we also heard about the risk that health issues like pandemics and anti-microbial resistance (AMR) pose to health systems and how we need to make them resilient against such threats. However, there has not been any discussion of addressing health risks that confront individuals at a more direct level.
The top-5 risk factors that are killing citizens of G20 are—high blood pressure, smoking, high blood glucose, high sodium and high cholesterol (Institute for Health Metrics and Evaluation 2015). Mass screening for their prevalence is highly economic, the economic benefits of tackling them high, given that they affect the economically active population in the age group of 30-64 years particularly. The death of an earning citizen is not just a loss to the national economy, but more so to the particular household and community that he or she belongs to, often pushing families into hardship and leaving them with fewer resources to invest in future generation, contributing to intergenerational inequality.
G20 countries, especially Germany, have been doing a lot to address such health risk factors in their national capacities. Elevating them at the G20 level would sharpen the policy focus. Beyond addressing the people disconnect, focusing on these health risks also does not cost too much and the measures needed to address them are widely documented. There is a whole literature (goo.gl/pXGh5a and goo.gl/kJdtxp) available on monitoring and tackling these risk factors.
Let me highlight one area on which relatively little research has been done, and almost no policy focus exists. Again, this is highly cost-effective and seems to be the best bet to contain the burden of death, disease and disability which is rapidly consuming citizens and families in both the developed as well as developing societies, within and beyond the G20.
We often talk about skill formation in the context of jobs—one of the most central issues worldwide —but we rarely recognize its significance for addressing individual health risks, despite appreciating the importance of behavioral change in this regard, and even telling schools to instruct their students on adopting healthy habits and consuming healthy food. Schools can play a central role in soft skill development which develops healthy mindsets and attitudes. Developing healthy behaviors among grown-ups is way more difficult than doing so at the level of small children.
Nevertheless, if one were to adopt a population-wise approach to tackling these health risks they could do so:
i. for the 0 to 29 year segment, focus on soft skill development and culture of health;
ii. for 30 to 64 year segment, proactive screening / monitoring/treatment of these risk factors and a mix of incentives and disincentives for promoting healthy behaviors;
iii. for the 65 plus, depending on availability of resources, screening and treatment of those who happen to visit a health facility.
We need to begin appreciating the role of skill formation, especially at the early levels, in the context of health as well.