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For governments to step up in their leadership role as co-creator and co-shaper of health finance and health innovation for the common good, they need to provide investment to boost the capacity of the public sector, instead of over-relying on outsourcing and external consultancies.3 The covid-19 experience showed that capabilities around digital government, for example, were critical to counter misinformation. Indeed, places such as Kerala and Vietnam, for example, did better because of such investments.2 We need to focus on the governance of both public and private sectors as well as on how they can confidently work together. When government and business co-create value, both risks and rewards must be shared. Governments should specify conditions on the relationship between private and public organisations to steward the commercial determinants of health towards the common good. For example, drug companies increasingly prioritise financial gain over reinvesting in long term innovation.4 Although covid-19 vaccine development benefited from large public investments before and during the pandemic, this did not result in fair or equitable sharing of the benefits. Indeed, while around two billion vaccine doses were administered in the first 18 months of the pandemic, 75% of these were in just 10 countries.5

lthough covid-19 vaccine development benefited from large public investments before and during the pandemic, this did not result in fair or equitable sharing of the benefits. Indeed, while around two billion vaccine doses were administered in the first 18 months of the pandemic, 75% of these were in just 10 countries.5 Increasing countries’ fiscal flexibility is critical in realising the right to health. In terms of global finance, however, health expenditure can still be subordinated to debt repayments. More than three billion people live in countries where debt repayments exceed investments in health or education.6 Nationally and internationally, new approaches are needed, including abandoning the International Monetary Fund’s austerity ideology, which by its own admission has been ineffective as a response to the financial crisis.7 Governments must end the subsidisation of fossil fuel industries, which harm human and planetary health but received $7tr in 2022.8 Multilateral development banks are central to unlocking public and private finance to mobilise the capital needed.9

To steer the economy in an inclusive and sustainable direction, we must change the way we measure and monitor economic success. Growth in gross domestic product should not be the main goal—it’s an outcome rather than a direction.10 Instead, countries should take a dashboard approach that includes new and existing metrics for human and planetary health. The Living Standards Framework dashboard, developed by New Zealand in 2018, is one example.11 To create a holistic picture of life in the country, the framework captures 61 indicators from collective wellbeing to international connections, to natural environment and social cohesion. And there is no need to reinvent the wheel: the 169 targets of the 17 UN sustainable development goals provide an ideal starting point for ambitious goals against which our economies can be measured at the supranational, national, and subnational level. Ultimately, we need a reorientation of how we understand health, from seeing it as an expenditure—a bill to pay—to understanding it as a critical investment that underpins economic activity. Investment in health is an urgent political imperative if we are to ensure that basic conditions are met for humans to flourish, prepare for future risks, and provide a firm financial footing for long term leaps in medical innovation. Indeed, when health is treated as an investment, it encourages innovation in medical technologies and healthcare services.1 It is only through strong governance that governments can set a clear direction for economic development towards the goal of health for all.