Who needs health care—the well or the sick?

Shifting drug spending from the worried well in developed countries to those with treatable disease in poorer nations will benefit the health of everyone

Introduction

Investment in health care, especially when it is driven by the interests of pharmaceutical companies, seems to produce a J curve. For most of the curve, the more money spent, the better the health outcomes, but after a certain point, the more spending and the more emphasis on health at the expense of other areas of human activity and achievement, the worse overall health becomes. Many poorer countries are trapped high on the long arm of the curve while richer countries seem intent on exploring the upper end of the short arm through the excessive self confidence of preventive medicine.1 The emphasis on preventive care damages patients in rich countries by tipping them towards misery. This process is built on a foundation of fear and is fanned by economic and political pressures.

A fraction of the spending on preventive medicine in rich countries could make a huge difference to the health of poorer nations