Why Do Societies Ever Produce Common Goods for Health?

CONTENTS References The world, and we human beings who live in it, would be better off if we were to invest more resources and attention in producing common goods for health (CGH), such as antipollution and safety regulations, epidemiological surveillance that facilitates rapid response to infectious outbreaks, and taxes levied on harmful products like carbon emissions and tobacco. The logical reasons and the highly favorable benefit-cost ratios that should compel countries to allocate more public resources for such things are laid out clearly in the articles in this special issue of Health Systems & Reform. The papers also explain why logic and evidence are not adequate to convince people and their leaders to dedicate sufficient resources and attention to CGH. As the papers show, before societies will fund CGH, they need to solve a range of collective action problems. The papers argue that societies underinvest in CGH for behavioral reasons, such as underestimating risk and shortterm thinking; as well as economic reasons, such as externalities and free-riding (which create incentives for people to act without regard to the full social costs and benefits of their decisions). With all of these factors conspiring against the production of CGH, it is a wonder that they are produced at all. In this commentary, I argue that we need to be clear-eyed about the history and motivations that led societies to invest in the CGH that we take for granted today. Studying the past may help us identify the political strategies that could create, expand and sustain CGH in the future. So why do societies ever produce CGH? The answer is essentially historical and political, not conceptual and technical. Bump and colleagues address the proximate political factors that explain public investments in CGH. In addition to those insights, I contend that historical analysis demonstrates that broader political factors related to collective identity and power are fundamental, with significant implications for the strategies required to realize investments in CGH. In particular, I argue that investing in CGH requires that: