Aspen Institute Report Calls for Stronger Role for Health Investment in Fiscal Policy in all Nations

October 4, 2023

Investing in sustainable, health-promoting programs and systems, and delivering high-quality services that are accessible to all, have direct impacts on economic productivity.

Contact: Jon Purves
The Aspen Institute

Washington, DC, October 4, 2023— Today, the Health, Medicine & Society Program (HMS) of the Aspen Institute is releasing a new report reinforcing the multidimensional ties between the economic health of a nation and the health of its citizenry. The report, entitled Dialogue on National Fiscal Policy and Health, offers ten key principles that build on the recognition that economic productivity is deeply influenced by health status, primary care capacities, the presence or absence of systemic inequities, and the availability of affordable healthcare. The dialogue, which was originally held on the margins of the 2022 World Bank/IMF fall meetings, provides important insights for policymakers, including those convening for discussions on economic resilience at the World Bank/IMF fall meetings in Marrakech this October.

The report is based on conversations among a group of former finance ministers and former health ministers from around the globe. John Lipsky, former first deputy managing director of the International Monetary Fund, and Donna E Shalala, 18th secretary of the US Department of Health and Human Services, co-chaired the Dialogue, which was supported by Pfizer. The countries represented include Colombia, Ecuador, Italy, Japan, Philippines, Rwanda, Vietnam and the United States.

Nothing has spotlighted the relationship between health and economic well-being more dramatically than COVID-19, which cost millions of lives, produced the second largest global recession in recent history, devastated national budgets and highlighted vast gaps in the health infrastructure of many nations and in global health financing mechanisms. At the same time, says Dialogue co-chair John Lipsky, “it created the political opening to consider health spending as an investment, not merely a tally of costs.”

Dialogue participants considered how nations could best construct their budgets to reflect the value of public sector spending on health for citizens and health systems, build political consensus for appropriate investments, and advance equity. Following their deliberations, they offered a strategic planning framework that laid a global foundation for action while respecting the tremendous diversity in national health systems and priorities, government structures, and available resources:

Principle 1: Health spending is an investment in a nation’s future. Demonstrating that a healthy population and strong commitments to health contribute to GDP growth and the stewardship of scarce public funds can generate the political will to increase those investments.

Principle 2: All ministries have a stake in fostering a healthy nation; it is not the exclusive provenance of the health ministry. Significant engagement by the finance ministry is particularly essential.

Principle 3: Many influences contribute to population health, including a strong health delivery system, a strong public health system, attention to social determinants, and policies designed to reduce poverty. Cost-effective budgetary decisions about investing in these realms recognize that many health-promoting activities take a long time to yield results.

Principle 4: Health spending has to be efficient and sustainable to garner political support, especially in the current environment of economic instability, inflationary pressure, and political uncertainty. Accountability is integral to health-promoting programs and health systems.

Principle 5: Trust fosters social cohesion and helps to build the consensus necessary to drive support for health sector investments. Community participation, inclusive engagement of public and private stakeholders, evidence-based decision-making, equity commitments, transparency, and dedicated efforts to root out corruption are core elements of trust.

Principle 6: A robust health information infrastructure enables optimal investments in health and informs priority-setting. That requires internet access and the capacity to collect, analyze, update, and share quality data, including on disease burden, treatment outcomes, cost-effectiveness of care, and the availability and allocation of clinical services, supplies, and other resources.

Principle 7: Technology improves the capacity to provide quality clinical services, enhances access to care, and generates actionable information that can be linked locally, nationally, regionally, and globally. The role of technology as an economic engine is further reason to support strategic budget decisions that will lead to its wider use.

Principle 8: Well-funded, readily accessible primary care and trained community health workers are essential ingredients of high-quality healthcare. Combined with an effective public health system, they are among the most sustainable ways to bolster population health.

Principle 9: Equity is at the core of strong healthcare systems in countries at every income level and the pathway to genuine global health security. Domestic, bilateral, and multilateral budget commitments can advance equity by reducing out-of-pocket costs, building local and regional capacity, and distributing resources on the basis of need, recognizing that all lives have equal value.

Principle 10: Existing global financial and health institutions can be more responsive to ongoing and emergent health challenges by framing action around commitments to global public goods, developing nimble financial instruments, and fostering country- specific and regional cross-sector partnerships.

The Dialogue report concludes by underscoring the need for all nations to promote effective interactions between health and finance policymakers. “We have an opportunity to view health issues through a fiscal lens, and fiscal issues through a health lens,” said Dialogue co-chair Donna Shalala. “Let’s act on that knowledge before the next crisis hits.”


The Health, Medicine & Society Program brings together influential groups of thought leaders, decisionmakers, and the informed public to consider health challenges facing the US in the 21st century and to identify practical solutions for addressing them. For more information, visit

The Aspen Institute is a global nonprofit organization whose purpose is to ignite human potential to build understanding and create new possibilities for a better world. Founded in 1949, the Institute drives change through dialogue, leadership, and action to help solve society’s greatest challenges. It is headquartered in Washington, DC and has a campus in Aspen, Colorado, as well as an international network of partners. For more information, visit

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