At the World Congress of Psychiatry last fall, a coalition of psychiatric associations signed on to the Prague Agreement, an initiative advancing an economic case for mental healthcare. The central proposition of the initiative is that governments and financiers should regard mental healthcare spending as an investment to spur economic growth, leading to a favorable rate of return. Investing in mental healthcare, the agreement states, “reduces demand for physical health services and improves productivity.”
It’s an alluring proposition that I once championed. After working several years in health policy, noting the primacy policymakers placed on economic matters, I decided to pursue joint training in medicine and economics. I was convinced there was an economic case to be made for policies that promoted population health.
Today, after several years of clinical training and policy research, I have come to see that the focus we place on economic growth is the source of, rather than the answer to, many public health ills. Amid the frenzy to sustain favorable economic measures, we have long stopped asking why these measures matter — who and what are they for?
Economic growth is most often measured as growth in a country’s gross domestic product (GDP), broadly speaking the sum of spending by households, government, and investments. Economic theory posits that people spend money on things they value, so if spending increases, people must be leading more valuable, more worthwhile, lives.
Despite what economic theory suggests, there is a vast body of literature demonstrating that GDP is a poor proxy for population health, well-being, or satisfaction. That’s in part because GDP is indifferent to what we spend on. Recent drivers of GDP growth include military spending and disaster recovery efforts, both of which portend human calamity.
The particularities of economic measurement may seem far removed from the mental health arena. But psychiatrists and other physicians should be thoughtfully engaged in how human well-being is thought of and measured on global and national scales.
The disconnect between GDP growth and population well-being will not surprise American doctors. Despite decades of unrelenting economic expansion, the U.S. is contending with mounting mental health crises, from overdoses to suicides to loneliness.
While GDP is indifferent to what we spend on, it fails to capture what people consistently report is most precious to them: relationships. GDP falls when someone decreases their work hours to spend more time with family, when they join a community garden rather than buying their produce, or when they go to religious services instead of a shopping mall.
Presenting mental health care as a growth opportunity may appeal to financiers, but it legitimizes a misguided approach to human well-being. It’s an argument that flips humanistic values on their head — economies should benefit people, not the other way around.
In the service of economic growth, governments have slashed welfare services, rolled back environmental protections, and gutted regulatory frameworks. People have been squeezed beyond their limits by raising costs, stagnant wages, and diminishing opportunities for meaning and connection. The drive for growth is making us sick.
The growth fixation is understandable in a sense. Without continuous growth, modern economies falter — jobs are lost and businesses close — putting people’s means of survival at risk. But more growth does not mean people’s lives are improving; it just means our economic system continues trudging ahead.
How much longer economies can continue to grow is hotly debated by economists. As economies grow, their rate of growth slows — a phenomenon termed secular stagnation — and never-ending economic growth is a dubious proposition on a finite planet.
Rather than participating in the logic of economic growth, physicians should challenge the foundations of an economic system that puts increasing spending ahead of fulfilling human potential.
