The health of the state is a symbolic conceptualization of a collective entity that is made up of geographic territory, institutions, laws, and people. At the national level, health can intersect with concern for state and human security, macroeconomic performance and population health. Two dominant modes of state investment developed in the late twentieth century. One placed human development, with concern for health and education, at the forefront of policy concern; the second placed macroeconomic growth at the policy apex. Each approach entailed trade-offs which affect both short- and long-term outcomes and opportunities for the nation. Rapid, short-term economic growth can create monetary and material resources that can improve the availability of inputs to health but can also increase health inequalities. If the state does not intervene, these inequalities will cause long-term harm to the poorest, most vulnerable in society. Investment in human health and welfare can achieve equitable health coverage, access to care and gains in health outcomes. However, it can also lead to unsustainable and unsound budgetary practices that impact macroeconomic performance of the state. Chile and Sri Lanka demonstrate the strengths and weaknesses of the aforementioned approaches to health and development.
KeywordsForeign Direct Investment Moral Hazard Dominican Republic North American Free Trade Agreement Social Investment
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