I have always been fascinated by the work of the doctor; perhaps because it was my father’s profession, or perhaps because doctors achieve tangible results, having the chance not only to treat and alleviate pain for many people, but also to save human lives. Even when economists provide the right “prescriptions,” and it is by no means certain that this will take place, it is difficult to attribute the saving of human lives to their actions. There are some important exceptions, with economists who have achieved this result by contributing towards improving the organisation of healthcare or facilitating the matching up of supply and demand for organs. These exceptions will be amply represented in this edition of the festival, starting from the inaugural lecture. Differences in people’s health and life expectancy are sometimes more marked than differences in income levels. In terms of purchasing power, the average income in Gabon is just over a third of the figure in the United States, but the mortality rate in Gabon for children under the age of one is 5 out of every 100 live births, while in the United States this figure goes down to 5 out every 1000. Life expectancy can vary considerably even within the United States: those born and residing in rural areas, the areas voting Donald Trump into office, live on average up to 30 years less than those living in large cities. Gender imbalances are also becoming increasingly pronounced: women live longer than men, yet they are more likely to suffer from diseases causing pain and invalidity. In developed countries, health inequality may experience a marked increase as a result of an ageing population, considering that recent estimates predict an increase of around 80% in spending on care for dependent elderly people who suffer from incipient dementia or Alzheimer’s disease. Health cover and the quality of available services represent an important, albeit limited part of these differences: introducing free and universal healthcare is not enough to redress the imbalance in life expectancy. Access to universal healthcare was established in the UK immediately after the Second World War, yet in the 40 years that followed the introduction of free medical care for all citizens there was an increase in the health gap for British families. Cultural, environmental, social and work-related factors have a profound impact on quality of life, nutrition and disease prevention, while the cost of targeted treatment for some diseases is often too steep for even the most generous national healthcare systems. When we talk about social mobility, the subject of debate in previous editions of the Festival, we tend to focus on people’s position on the income ladder and forget that the most important aspect of equal opportunities is the chance to live a healthy life and enjoy an active old age. Public action in this field would be particularly advantageous, as creating environmental conditions more conducive to healthy life can have major positive spin-offs. However, these benefits are not always pursued in the public sector, which tends to focus on the effects rather than the causes of many common diseases. Too little attention is often paid to the ways in which the results of bio-medical research can improve the quality of life for millions of people. Healthcare systems rarely take into account issues linked to moral hazard, namely the possibility of health insurance having a detrimental effect, by reducing the incentives for people to follow a healthy lifestyle, thus minimising the risk of frequent recourse to medical care. Moreover, public debate often does not deal adequately with the problem of selectivity within universalism, namely with the fact that even in a health service extending health insurance to all citizens, the provision of costly services can require a significant contribution on the part of those with a higher income. The differing health levels observable can sometimes be traced back to individuals’ varying degree of “health education”. Increased awareness of health risks and healthcare alternatives could encourage healthy living without additional costs and avoid the incidence of silent or discouraged patients who do not take full advantage of the healthcare and services available to them, because they are poorly informed about their rights and the range of services on offer. These are all examples of extremely relevant questions that economists can help to answer. As in previous editions, they will benefit from exchanges with experts in other fields, this time with an increased focus on so-called ‘hard’ science, to which after all we owe the extraordinary advances taking place in medicine in the last 50 years.
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