The COVID-19 pandemic has been an unwelcome reminder that health and the economy are inextricably linked. For this year alone, the estimated impact of the pandemic on the US economy is a 4 to 11 percent reduction in real GDP.
Yet prior to COVID-19, health was not typically part of economic growth discussions; the policy debate often focused on controlling healthcare costs.
We estimate that poor health costs the United States about 16 percent of real GDP annually from premature deaths and lost productive potential among the working-age population.
But it does not have to be that way. Rethinking health as an investment, not just a cost, holds the potential not only to improve the health of millions of Americans but to accelerate economic growth for decades to come.
In this article, we build on our global report Prioritizing health: A prescription for prosperity to look more closely at the United States and identify what it would take to improve the health of the population and what the benefits would be for individuals, the economy, and society. (For details of the analysis, see the sidebar “Our methodology.”)
1. The cost of poor health
We estimate that each year, poor health costs the US economy about $3.2 trillion from premature deaths and the lost productive potential associated with diseases. The five diseases with the biggest economic impact are, in order, musculoskeletal disorders, mental disorders, neurological disorders, substance use disorders, and diabetes and kidney disease.
Compared to its peers, the United States has a higher disease burden among younger and working-age populations. In the younger working-age population (20 to 40 years of age), where mental and substance use disorders are the biggest drivers of disease burden, Americans have a 46 to 50 percent higher disease burden rate than residents of other high-income countries. That gap narrows to a 17 to 33 percent higher disease burden in the older working-age population (40 to 70 years of age).
And this situation is expected to get worse. Over the next 20 years, the Institute for Health Metrics and Evaluation at the University of Washington forecasts that the US disease burden will increase by about 20 percent as age- and lifestyle-related diseases, such as cardiovascular diseases, cancers, and neurological disorders, rise (Exhibit 1).
Over the next 20 years, the US disease burden is expected to increase by ~20 percent as age- and lifestyle-related diseases rise.
|Disease, sorted by likelihood of incidence with age, high to low||Change in disease burden, % (DALYs1)||2020 disease burden DALYs, approximate relative size among the diseases|
|B Cardiovascular diseases||7||45|
|C Chronic respiratory diseases||-12||24|
|R Sense organ diseases||35||20|
|D Diabetes and kidney diseases||54||35|
|L Neurological disorders||51||35|
|E Digestive diseases||30||14|
|J Musculoskeletal disorders||21||38|
|V Unintentional injuries||12||23|
|S Skin and subcutaneous diseases||14||22|
|P Respiratory infections and tuberculosis||23||16|
|I Mental disorders||6||31|
|F Enteric infections||81||8|
|U Transport injuries||12||20|
|O Other noncommunicable diseases||17||35|
|T Substance-use disorders||37||30|
|Q Self-harm and interpersonal violence||-12||18|
|M Nutritional deficiencies||12||5|
|K Neglected tropical diseases and malaria||28||1|
|N Other infectious diseases||22||6|
|G HIV/AIDS and sexually-transmitted infections||-7||6|
|H Maternal and neonatal disorders||-15||12|
1DALY = disability-adjusted life year.
Source: Global Burden of Disease Database 2016, Institute for Health Metrics and Evaluation (IHME); McKinsey Global Institute analysis
McKinsey & Company
In the United States, no state is spared from this expected increase in disease burden, yet poor health is not borne equally. There are significant differences in health across states (Exhibit 2). Older populations and lower GDP per capita are associated, on average, with higher burdens of disease per capita. A disparity in disease burden per capita of almost 60 percent separates the states with the highest and lowest burden. In addition to state-level differences, there are disparities in disease burden and health outcomes within states as well as across age, gender, race, ethnicity, and socioeconomic status categories. To shed light on these disparities, McKinsey’s Center for Societal Benefit through Healthcare has developed an open-access dashboard for more than 80 measures at the county, state, and national levels. This data has highlighted, for example, the disproportionate impact of COVID-19 on communities of color as well as physical health and behavioral health vulnerability to COVID-19.
This variation in health outcomes does more than highlight disparity—it highlights an opportunity to improve the health of the US population through better delivery of known interventions.
2. The health improvement opportunity
By deploying existing approaches to improve health and prevent and treat diseases, we found that the United States could reduce its disease burden by as much as one-third by 2040.
That would have a significant impact on an individual’s health. For example, we found that the average 65-year-old American in 2040 would be as healthy as today’s average 55-year-old, and almost eight million more Americans would be alive.
The key to achieving these health benefits is prevention (Exhibit 3). We found that most of the health improvement would occur simply by ensuring access to interventions that are preventive in nature—environmental, behavioral, and preventive medical—like weight management, smoking cessation, preventive generic drugs, and routine vaccines. And a focus on prevention would help build resilience in the face of future pandemics; we are learning from COVID-19 that people with preexisting conditions such as obesity and heart disease are particularly vulnerable.
An example is low back pain. It can be addressed by preventive medical and health promotion interventions, like weight management and group-based multimodal programs consisting of different exercises, as well as therapeutic interventions like pain relief medicines. In 2040, if known interventions are implemented, it would be possible to reduce this disease burden by 55 percent, of which only 16 percent would be from pain relief medication and the majority from prevention and health promotion.
Another benefit of prevention is that it tends to be cost-effective. We found that 34 percent of the health improvements we calculated could be achieved at a cost of less than $100 for each additional healthy life year.
3. The role of innovation
While interventions known to us today can make a significant impact on the US disease burden, there remains a need for innovation, particularly to combat diseases that lack cures or scalable and sustainable treatments. They include some cancers, mental disorders, and neurological disorders as well as new health risks that may emerge.
Of course, progress is already being made in that regard, and potentially life-changing medical breakthroughs and technologies are in the pipeline. In our research, we identified ten innovations that could reach the market by 2040 and further reduce the remaining disease burden.
Unlike innovations from the past 30 years, which tend to reduce symptoms or delay disease progression but only rarely prevent or cure disease, many of today’s pipeline innovations have the potential to fully cure some diseases. Others tackle the underlying biology of aging, offering the potential to significantly extend healthy lifespan.
We calculate that these innovations could reduce the US disease burden by more than 20 percent by 2040—about twice the global rate, given the assumption of higher adoption rates in the United States.
4. The size of the economic prize
Achieving the health improvements described here would translate to tremendous economic growth—people who previously had a disability or needed to be full-time caregivers could join the labor force, older adults would be able to delay retirement, and employees with chronic conditions that interfered with employment would be able to focus more at work.
We calculate that these labor force impacts could add up to a 10 percent boost to US GDP in 2040, an increase of about $3 trillion (Exhibit 4).
To give a few examples of the degree of impact, the health improvements would translate to two million more people in the labor force whose death could be averted, about 5 percent greater workplace productivity for 25 million adults, and greater workplace potential for up to 13 million children and adolescents through avoided childhood disease.
And this opportunity to unlock economic growth is shared across the country, with all 50 states having the opportunity to boost GDP in 2040 by 8 to 13 percent by investing in better health (Exhibit 5).1 Differences between states depend on demographics and the health status of the population. To take just one example, compare Maine and Utah, which lie at the extremes of US age distribution: the median age in Maine is 45 years, compared to 31 years in Utah.2 It is not surprising that a larger share of Maine’s improvement opportunity comes from weight management, physical activity, and preventive medication for diabetes and heart conditions, which tend to increase with age. In Utah, the potential impact of psychological therapy for mental health conditions, which tend to have their highest burden among younger people, is much higher.
In all, the benefits far outweigh the costs. For every $1 invested in improving the health of the population, the United States stands to gain almost $4 in economic benefit. However, this does not mean additional funding for healthcare as currently delivered. The health benefits and the economic upside we calculate will not be possible without fundamental changes in not just where and how healthcare is delivered today, but also in how we build communities that help individuals grow up, work, and age in healthy ways.
While harder to measure, the societal benefits from these health improvements far exceed the economic benefits and may be as much as $4 trillion by 2040. Beyond working, better health would give people the freedom to spend their leisure time on what they want to do most. This includes older people, many of whom may choose to give back to society in other ways after retirement. In fact, through volunteering alone, we estimate that having a larger population of healthier people aged 65 and up could add $9 billion to $13 billion in societal value in 2040.
5. How to capture the opportunity
If one-third of the US disease burden could be prevented with known, cost-effective interventions, why haven’t these interventions been implemented? Simply put, it may be easier said than done. Realizing this opportunity will require significant changes, not just in the provision of healthcare but in society more broadly.
We identify four imperatives to capture this opportunity.
First, we must reframe the economic debate to include health as a growth lever and a critical component of economic and societal resilience—in other words, an investment, not a cost. This will enable us to make the right investments to drive long-term health, kickstarting the virtuous cycle of health and economic prosperity.
Second, we must pay as much attention to health as we do to illness. The health community has long been aware that an ounce of prevention is worth a pound of cure, yet in OECD countries, according to some estimates, only 2 to 3 percent of healthcare budgets goes toward prevention.3 The real question is how to shift from a focus on disease care to a mindset of disease prevention and health promotion while ensuring effective acute care services and sufficient capacity to deal with surges and crises. This shift involves ensuring that health promotion, preventive care, and early intervention are prioritized on a par with disease care and treatment. At the same time, it is critical to drive adoption of and adherence to effective therapies and to invest in public health preparedness.
Third, we must double down on innovation to accelerate the speed of response to public health crises and provide better solutions to the long-term challenges raised here. Scientific advances hold great promise to address many of the challenges we face with more effective, convenient, and acceptable interventions. which would improve the tool kit available to us today, provide new solutions for diseases we cannot yet cure or prevent, and combat new threats such as novel coronaviruses. To achieve this, we must work to ensure that potentially transformative innovations are scalable and sustainable.
Finally, we must maintain health as a priority for all. COVID-19 has put health on the agenda of every organization, large and small, including organizations that historically have not focused on health. Looking ahead, we must ensure that the health agenda remains a fundamental component of both the recovery and the “new normal.” Health, including mental health, should be top of mind in the decision-making process—for governments, companies, health institutions, investors, and societies. Long-term prevention and health promotion cannot simply be left to healthcare providers or public health systems. It is quite literally everybody’s business.
Different groups of stakeholders have specific opportunities. For example, governments could integrate the economic importance of health into decision making across all policy areas, support programs to encourage prevention, implement policies that promote healthy environments and communities, and rethink labor policies to enable an older and more inclusive labor force. Payors and providers could expand existing collaboration to innovate care delivery to promote self-care and prevention and to address social factors that play a role in health outcomes. They also can continue to move toward whole-person care models that place mental health and substance use on a par with physical health. Pharmaceutical and medical technology companies could invest in R&D for unmet needs and roll out known interventions efficiently to enable broader access. Companies could invest in both the short-term and long-term physical and mental health of their employees, foster inclusive work environments, and take broader responsibility for their health footprint, investing to promote the health of the communities and members they serve.
While we recognize that capturing the opportunity is no easy task, we find that it would be well worth the effort. Improving the health of Americans has the potential to be a societal and economic game changer. After all, few investments deliver against so many of today’s social needs, substantially improving well-being while also delivering an impressive shot in the arm to the economy. Let’s not miss the opportunity we have at hand.