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Global Health Economics and
Sustainability
Innovating sustainable specialized healthcare

itself is characterized by persistent inequality, including in For decades, the marked and persistent inequalities in
healthcare and especially specialized care. healthcare on the island of Jamaica, to which the author
Inequality is, of course, not unique to Jamaica. By way has had to adjust his own practice and expectations of
of comparison, although Jamaica’s Gini Index is significant outcomes based on a patient’s ability to afford care, have
at 0.45, it is much lower than many other countries, such been of growing concern. As Martin Luther King said
as South Africa, whose Gini Index is 0.63, making it the many years ago, “Of all forms of inequality, inequality in
most unequal country in the world (Statista, 2022). This healthcare is the most shocking and inhumane.” Much
inequality is also apparent in the fairness of the Financial like the efforts being made in South Africa, developing
Contribution (FFC) Index, in which South Africa ranks a framework in Jamaica for a socially broad-based and
poorly, 143 in the world (WHO, 2000). The FFC was a sustainable solution to this persistent problem is the
rd
term created and included in the World Health Report ultimate goal of this work. At a fundamental level, it is also
2000 of the WHO (WHO, 2000), in which fairness was the recognition that societies are least unstable when they
defined as an equal burden where every household would perceive that genuine efforts to address inequalities are
contribute an equal share of its capacity to pay to the health being made. Jamaica’s at times turbulent social history over
system. In essence, it is an index of inequality in the burden the past 50 years is itself a testament to this.
of health costs across households in different countries. Thus, in this second of two articles, potential strategies
The principle here is that poor households should not pay to increase health-care funding are explored. This is done
a higher share of their discretionary expenditure on health in recognition of the worrisome fact that governments
than richer households and that all households should be of countries such as Jamaica will increasingly find it
protected against catastrophic financial losses related to ill difficult to meet the costs of specialized health care, such
health. as advanced cardiac and neurological care, in populations
Despite this, or perhaps because of it, South Africa that are steadily demographically aging.
has developed a strong culture of giving that has helped 2. Meeting current needs and growing
to offset this marked societal inequality. The importance
of charity and philanthropy is evident from the statistic expectations
that the bottom 60% of South Africa’s households depend As Jamaican and other Caribbean governments struggle to
more on social grants and less on income from the labor cope with global recessions, most recently caused by the
market to survive (Stats, 2015). Perhaps stark inequality global coronavirus disease 19 (COVID-19) pandemic, they
motivates charity and philanthropy in a way that might not are increasingly less capable of meeting expanding health-
have occurred otherwise if not for this visible disparity. In care needs. Over the past 40 years, this has led to a growing
this regard, it should be recalled that South Africa spends private health-care industry, as exemplified in Jamaica,
US$1091 per capita on health, despite a low national gross where 46.7% of health-care spending is privately sourced
domestic product (GDP), representing a large proportion, (Table 1). Different countries allocate varied percentages
8.9%, of their total GDP. It is noteworthy that external of their GDP to healthcare, resulting in wide per capita
resources contribute only 1.8% of health expenditure variations. Female lifespan is often used as a measure
in South Africa (Health Policy Project, 2016) (1.76% for of the impact of socioeconomic and health initiatives.
Jamaica). With the low dependency on external resources Health-care provision and access vary among countries,
for health as a percentage of total health expenditure, a with countries such as Canada, which have effective social
significant component of this relatively large per capita welfare programs, providing most healthcare through
expenditure on health must come from charitable and government-funded health-care systems (Table 1).
philanthropic sources, a substantial proportion of which Similar systems operate in other countries such as the
must support the health needs of the vast, impoverished UK, France, and Sweden. The previously mentioned
sector of South Africa’s population. Finally, a recent FFC is an important metric, serving as a safety net for
development, the imminent creation of the National Health individuals who fall ill and their families, who often bear
Insurance Bill, designed for all its citizens to equitably the financial burden of care. As seen in Table 1, Jamaica
access quality healthcare irrespective of social status, is a ranks quite poorly in FFC, indicating that a health-care
major step forward in health policy. It remains to be seen event can have potentially catastrophic socioeconomic
if this Bill will make it all the way to implementation in consequences. This underscores the need for new ways of
2024, but the implications for the health and, ultimately, funding specialized health care – where most of the costs of
economic welfare of those at the lower end of the social healthcare now lie – to protect its citizenry from such all-
ladder are profound (Roelf, 2024). too-common scenarios. This issue is prevalent throughout

Volume 2 Issue 3 (2024) 2 https://doi.org/10.36922/ghes.2717