This introductory text provides a comprehensive overview of the World Health Organization’s (WHO) 2021 guidance document, “Financing common goods for health”, which critically addresses the systemic underinvestment in foundational public health functions worldwide.
The document emerges from the stark lessons learned during the COVID-19 pandemic, which unequivocally highlighted the interconnectedness of health security, disease risks, social determinants, and environmental degradation, and their disproportionate impact on vulnerable populations. It argues that the significant progress in health outcomes observed in recent decades is now jeopardized not just by the pandemic, but more fundamentally by chronic underinvestment in Common Goods for Health (CGH).
What are Common Goods for Health (CGH)? CGH are defined as population-based functions or interventions that are indispensable for the health and well-being of entire societies. Key examples include integrated disease surveillance systems, disease prevention strategies, public health policies, health and environmental regulations, and emergency management institutions. The core rationale for their public financing lies in their economic characteristics: they are either pure public goods (non-rival and non-exclusionary) or possess large social externalities, meaning their benefits extend far beyond any single individual.
Crucially, the report emphasizes that CGH will not naturally arise through market forces alone. This is due to specific market failures, such as the inability to charge a price to all users, which discourages private investment and limits optimal production. These market failures are compounded by collective action failures, wherein there is insufficient societal demand for governments to prioritize and invest in CGH. The invisible nature of many CGH benefits and the tendency for governments to prioritize more immediately visible issues (e.g., building infrastructure over long-term air quality standards) contribute to this underfunding.
The guidance document sets forth three primary objectives: to clearly define CGH, to discuss their connections with other vital health agendas for building more responsive and resilient health systems, and to address the complex financing issues associated with CGH at national, subnational, and community levels. It introduces a standardized nomenclature for CGH categories, subcategories, and functions, intended to facilitate policy discussions, budget dialogues, and health expenditure tracking for monitoring and accountability. The document targets a broad audience, including national and subnational finance and health authorities, government entities, global/regional organizations, civil society, and academic institutions.
Categories of Common Goods for Health: The document organizes CGH into five broad, yet interconnected, categories:
- Policy and coordination: Encompasses the formation of national policies, institutional capacities, and coordination mechanisms essential for effective health governance and emergency preparedness.
- Regulation and legislation: Involves the full spectrum of legal instruments, such as health laws, environmental regulations, and controls on products affecting health, crucial for imposing constraints and correcting market failures.
- Taxes and subsidies: Focuses on financial instruments designed to influence individual and market behavior, rather than merely revenue generation, through positive and negative incentives (e.g., taxes on unhealthy products, pro-environmental subsidies).
- Information collection, analysis and communication: Addresses the critical need for comprehensive surveillance systems, health management information systems (HMIS), research and development, and effective communication channels to monitor population-level health changes and inform policy.
- Population services: Includes fundamental services impacting all of society that markets often fail to provide or underprovide, such as water and sanitation, waste management, vector control, and emergency response operations.
Contextualizing CGH within the Broader Health Landscape: CGH are presented as the bedrock of both the health system and society, underpinning national and global health security, and acting as cross-cutting functions that extend beyond single disease areas or even the health sector itself. The report demonstrates their profound relevance to contemporary global challenges like climate change, inequalities, disaster preparedness, and environmental protection. It highlights the mutual reinforcement between CGH and various established health frameworks, including:
- Health systems strengthening: CGH provide the critical enabling environment for personal health services.
- Essential Public Health Functions (EPHF): CGH provide the economic rationale and collective foundations necessary to ensure EPHF are in place.
- Global health security: CGH underpin the capacities outlined in the WHO International Health Regulations (IHR).
- Universal Health Coverage (UHC) and Primary Health Care (PHC): CGH offer the economic justification for foundational functions and the enabling environment crucial for progress in PHC for UHC-related outcomes, emphasizing health promotion and disease prevention.
- One Health approach: Stresses the cross-sectoral coordination (e.g., between health, agriculture, environment) required for addressing emerging public health threats.
- Equity considerations: Investments in CGH inherently extend protections to all, including the poorest and most marginalized, thereby fostering collective identities.
Multifaceted Action and Financing: Effective implementation of CGH necessitates whole-of-government and whole-of-society approaches, requiring coordination and financing mechanisms that span various levels of government (subnational, national, regional, global) and multiple sectors. The document provides examples of how different levels of financing correspond to specific CGH functions, from local health promotion campaigns to global environmental agreements. It also details how responsibilities for CGH often fall across multiple sectors (e.g., health, finance, agriculture, environment, education), necessitating robust coordination and accountability mechanisms. Examples like Australia’s coordinated multisectoral budgeting and New Zealand’s cross-agency funding models illustrate effective approaches to financing these complex, shared initiatives.
The report strongly advocates for integrating CGH financing into annual and multiyear budget dialogues, as well as broader health financing and national budget reform discussions. It suggests public financial management (PFM) adjustments, such as moving away from input-based line-item budgeting to more flexible approaches, and utilizing direct or conditional transfers to support CGH functions, particularly in decentralized settings. Special attention is also given to the unique challenges of financing CGH in fragile and conflict-affected settings, where government capacity may be severely limited.
A Way Forward: The COVID-19 crisis has served as a painful reminder of the urgent need to invest in interconnected, population-based functions for health. The document positions this crisis as an unprecedented opportunity to overcome historical financing and governance challenges by reorienting global health efforts towards a system-building perspective. It calls for concerted actions from local, national, and global communities, emphasizing the need for multisectoral approaches, broad coalitions, and robust citizen and civil society engagement to ensure political and funding commitments translate into actual provision of CGH. By providing a detailed framework of what needs to be financed and how, this guidance document serves as a crucial first step in operationalizing the CGH agenda at both subnational and national levels, paving the way for strengthened health security and universal health coverage for generations to come.
Reference: World Health Organization. (2021). Financing common goods for health. Geneva: World Health Organization.