has fallen in many European countries: according to World Bank data from
US$3,760 in 2008 to US$3,609 in 2011 in the UK, US$3,314 to US$2,864 in
Greece and US$5,241 to US$4,542 in Ireland (World Development Indicators,
2014). Wider comparative perspectives are lost amid the heated debate and
discussion. If there is a crisis it is only in relation to the recent history of devel-
oped countries and the expectation that incomes and social spending would
rise rapidly, year after year.
Stepping back from a narrow domestic debate confined to the wealthiest
countries in the world and thinking in global and comparative terms can help
put this ‘crisis’ into perspective. In China, for example, spending per person on
health between 2008 and 2012 increased from $157 to $278, in India from $
to $59, and in the South Sudan declined slightly, from $34 to $32.
It is not just in spending but also in terms of access that there are glaring
global inequalities in health provision. The UK National Health Service may
be squeezed but it remains free at the point of use. In India recent estimates
show that more than 30 million people drop into absolute poverty every year
(not earning enough income to eat enough to properly exist as a human being)
as a result of having to divert household income to emergency health care. In
Ethiopia 30 per cent of children under five are malnourished and in Sweden
virtually 0 per cent. Healthy nourishment in children is associated with better
school performance,being healthier later in life and earning higher lifetime
incomes.
In Somalia only 7 per cent of the population have access to improved water
supplies and in Austria virtually 100 per cent. Poor water quality is linked to
the deaths of three million children per year. In Niger only 50 per cent of the
relevant age group complete primary school and in Hungary nearly 100 per
cent. Primary education is associated with better health care, more employ-
ment and higher incomes later in life.
The world’s media may headline growth rates but it is often forgotten just
how large are global inequalities and how long they will take to close. Were
Burundi to experience 10 per cent annual GDP (gross domestic product)
growth for the next decade (an economic boom equivalent to the best ever
recorded in any country) its per capita incomes would rise to about $400 and
its living standards to 0.60 per cent of those in contemporary Norway. Or alter-
natively, per capita growth of only 1 per cent in Norway would raise incomes
there by $666 per person, more than four times the 2012 level of GDP in
Burundi. This crude calculation shows that even if health expenditure in India
continues to increase by $5 per person per year, it will take over 700 years to
reach current UK levels and over 1,700 years to reach current US levels.
The vast inequalities in global incomes generate a massive discrepancy in
the availability of resources. A small proportion of the world’s population,
whether in their own countries they count as rich or poor, students or
employed, young or old,will be able to consume, travel and get better health
care than the vast majority of the world’s population, regardless of how rich-
country governments prioritize their budgets or how long the current global
2 Introduction