What If Our Economy Valued What Matters?

By Mariana Mazzucato

LONDON – Care is the life-giving force that sustains health and well-being, binding together societies and ecologies. But everyday forms of care, though essential, are systematically undervalued. Most care is provided by women, whose contributions are celebrated on International Women’s Day, even though they should be marked every day of the year.

The COVID-19 crisis has stretched our caring capabilities and highlighted the fundamental but underappreciated role that they play in our society. As we take stock of the pandemic’s wreckage, we must use this moment to overhaul how we measure value, and thus how we organize the global economy. The goal should be to create an economy that supports the health and well-being of every person on the planet, as well as the health of the planet itself. We currently have the inverse: a system that values health only as a means to the end of economic growth.

The World Health Organization’s all-woman Council on the Economics of Health for All was established to lead this paradigm shift. We believe that this year’s International Women’s Day is the perfect occasion for launching a radical revaluation of care and the economy. Even though the pandemic is still taking lives and creating a political impetus for transforming economic governance structures, the window of opportunity is closing. We are in grave danger of returning to the old siloed approach, whereby only “formal” economic sectors are said to create value.

This old system is perversely beholden to indicators like GDP, an indiscriminate measure of “progress” that ends up rewarding the destruction of people and the planet. The pathological obsession with GDP has undermined what we value most: life. In 2020, global GDP grew by $2.2 trillion as a result of governments increasing their military spending; meanwhile, the world still has not provided the mere $50 billion needed to vaccinate the global population.

A society that spends 44 times more on war and destruction than on ending a pandemic can hardly be considered sane. What if we based our decision-making on what we truly value? We would start with the primary goal of Health for All, and then work backward from that end to determine our means of achieving it.

In the WHO Council’s policy brief on valuing Health for All, we propose three principles for guiding this effort. The first is to value planetary health, by protecting the integrity of essential common goods such as water and air, and by respecting the ecological boundaries upon which human health and well-being ultimately depend. The second principle is to value the social foundations and activities that promote equity. This means championing diversity and investing in social and physical infrastructure to support those in need and enable communities to thrive. The third principle is to take human health seriously, by ensuring that every person can thrive both physically and emotionally, and by providing everyone with the tools to lead lives of dignity and opportunity in healthy communities.

What would it take to create an economy that served these objectives, and that measured what we really value? First, we must recognize that no single metric can encompass all the diverse components of Health for All, especially not a monolithic, highly distortive measure like GDP. We should move toward a global data-collection apparatus and analytical framework that abandon such simplistic indices.

Second, alternative metrics must fit together as part of a holistic approach that allows for information to be transparently debated and replicated across diverse local contexts. We don’t need to reinvent the wheel. The 17 United Nations Sustainable Development Goals provide a robust foundation for building better metrics and indicators. With a mission-oriented approach, we can start to redesign industrial and innovation policies to meet grand societal challenges – pursuing concrete targets and encouraging sectors to work together to deliver policy solutions such as carbon-neutral cities.

Another promising model is WHO Council member Kate Raworth’s Doughnut Economics framework, which is fast gaining traction in city governments around the world, from Amsterdam to Sydney. It encourages policymakers to aim for the sustainable ground between insufficiency (represented by the doughnut hole) and excess (represented by everything beyond the rim of the doughnut).

Any such framework will need to include detailed new metrics for valuing the goods and services that are indispensable to Health for All. Most of these are currently unaccounted for, from growing food, cooking, and cleaning to childcare and other unpaid household and neighborhood duties predominantly performed by women. As WHO Council member Marilyn Waring has long argued, time-use data can help reveal these underappreciated, unremunerated activities and begin to capture their true value.

Rethinking value is the critical first step. But for new metrics to produce saner perspectives, we also need to support strategic public finance and strengthen legal and economic policy levers across the public, private, and third sectors. As a previous WHO Council brief argued, this means broadening the tax base, introducing more progressive taxation, increasing financial literacy, broadening financial inclusion, expanding the public sector’s capacity to build equitable financial frameworks, and eliminating the financial obstacles to health services.

This “whole-of-society” approach to valuing Health for All would mean little if it didn’t start by empowering all stakeholders – especially the local communities most affected by health policies. Joint governance through public-private-common partnerships must be supported by a democratic process; only then will our new measures of progress be socially responsive and locally relevant.

Economics has hitherto measured the price of everything and the value of nothing. That must change. We need to measure the value of everything so that we can account for the things that truly matter. Health and well-being – and the care that sustains them – should become our principal measures of success.

Mariana Mazzucato, Professor in the Economics of Innovation and Public Value at University College London, is Founding Director of the UCL Institute for Innovation & Public Purpose.