- About HHR
By FXB Research Assistant Carrie Bronsther
On April 16, the Forum at Harvard School of Public Health, in collaboration with the GlobalPost, presented a panel discussion on The Cost of Inaction: The Consequences of Failing the World’s Children. The panel featured four expert participants: Countess Albina du Boisrouvray, Dean Julio Frenk, Professor Sudhir Anand, and Honorable Dr. Timothy Thahane, and was moderated by Samuel Loewenberg.
The participants discussed the implications of the landmark initiative launched by the FXB Center for Health and Human Rights on the “cost of inaction,” or the failure to respond appropriately to children’s needs. Directed by Professors Amartya Sen and Sudhir Anand, this project tackled two main questions: what are the costs of inaction, and is the cost of inaction greater than the cost of action? Inaction can lead to negative consequences, including financial, health, education, social, and labor-force functioning effects, for individuals, families, the community, the economy, and society as a whole. For this initiative, economists and public health researchers addressed the complex challenges of enumerating and quantifying the multiple social and economic costs that follow when societies fail to address the pressing needs of their most vulnerable members, in particular children.
The panel provided a dynamic discussion on the implications of the initiative and its potential to influence policy makers to think strategically and holistically when setting priorities. As a failure to act, an “inaction” represents a choice and demonstrates a commitment, or lack thereof. While the fact stands that decisions must be made given limited resources, the failure to invest in children creates limits on the viability and vitality of a society in the future.
It was argued that the costs of investing “upstream” in children can be much smaller than investing “downstream,” where the effects of the lack of investment can be irreversible or extremely costly to reverse. However, it was also noted that downstream costs, the costs of inaction, have less political clout as the benefits are less tangible and are therefore less likely to be taken into consideration for political reasons.
The “cost of inaction” is an essential initiative because it provides the economic evidence for the benefits of a long-term, comprehensive approach, which includes upstream investments. As Countess Boisrouvray discussed, an infrastructure to support children in all aspects of their lives, including access to health, education, water, sanitation, and support systems, is necessary to create productive citizens and a viable society in general. As Professor Anand pointed out, health systems must be considered as part of a larger system with interrelated components. Throughout the discussion, the panel highlighted the need to consider the consequences of inaction in one area as they relate to another area, such as applying the relationship between not investing in children’s health to ensuing poor education outcomes
Dean Frenk also highlighted the importance of evidence in creating political action, commenting that the initiative makes “what’s invisible visible” and emphasizing the need to create long-term commitments to improve the lives of children as part of a holistic approach. There was discussion on the nearly 7 million deaths of children under the age of five. In particular, the panelists pointed out that even though the number of deaths of children under the age of five has declined in recent years, most of these deaths could still be prevented or treated with access to simple, affordable interventions, such as ensuring a safer pregnancy. The need for investment in a functional health system in general and safe pregnancy in particular was noted as necessary to improve these outcomes. However, the lack of investments in neglected populations, such as children and women, is a barrier to progress. Social awareness of the cost of inaction is therefore essential to general political will and investments.
In their final remarks, the panel’s experts noted that the book provides a guide to influence policy decisions backed by economic evidence and can serve as tool to enhance dialogue between actors and beneficiaries. The initiative bridges gaps between those who generate knowledge and those who use knowledge to create actions, and can thereby help decision makers take a holistic approach to create viable societies.
The Cost of Inaction: Case studies from Rwanda and Angola
Sudhir Anand, Chris Desmond, Habtamu Fuje, and Nadejda Marques
Harvard University Press (June 2012)
Letter to the Editor: The Rule of Law as a Social Determinant of Health
O.B. K. Dingake
Letter to the Editor: Refusal to Treat Patients Does Not Work in Any Country – Even if Misleadingly Labelled Conscientious Objection
Christian Fiala and Joyce H. Arthur
Letter to the Editor Response: Much to Debate about Conscientious Objection
Wendy Chavkin, Laurel Swerdlow, and Jocelyn Fifield
Papers in Press
The Cholera Epidemic in Zimbabwe, 2008-2009; A Review and Critique of the Evidence
C. Nicholas Cuneo, Richard Sollom, and Chris Beyrer
Letter to the Editor: Human Rights, TB, Legislation and Jurisprudence
O. B. K. Dingake
UNstoppable: How Advocates Persevered in the Fight for Justice for Haitian Cholera Victims
HIV Criminalization Laws and the Right to Health
Canada’s Mining Industry in Guatemala and the Right to Health of Indigenous Peoples