UK life expectancy and healthcare spend vs OECD. NHS success story?

UK life expectancy expanded - in line with the OECD average (more or less, there was a little catch up) until recently where (like in a few countries) it seems to be flattening. This is a blunt but well understood measure of a population’s health.

A similar type of trend can be seen in childhood mortality. Although experts can gripe with the data, the overall trend is likely robust. There is also some catch up from OECD average from a poorer start.

This is a good achievement by the UK given what the UK has spent on healthcare since the 1970s.

My general observation here is that the UK has underspend / invested less in healthcare but has managed to obtain an average to above average results.

The under spend as % GDP has been 2 to 4 percent points lower than OECD peers on average. This has been going on since the 1970s. (The World bank data is from 2000, sourced from WHO)

There are many factors that combine to impact life expectnacy and health. Correlation is not causation.

However, I think there is enough data and evidence to suggest that given the amount the UK has invested in health (and social care and education) that if the UK wants to continue the positive trends in health, it will likely have to spend more or at current levels of spend the health out comes will - in my view - likely to continue to tail off.

In this sense, the UK’s NHS has been a unique system that has enabled outsized gains in health outcomes for the amount of spend over the last 50 years.

OECD data.

OECD data.

I can’t make a nice graph widget, but I can show how this % spend on GDP goes back to the 1970s. so this is arguably about 50 years of under spend, at even the lower end of 2% of GDP that’s somewhere in the region of £500bn to £1,000 bn (yes 1 £trillion) in culmulative under spend compared to what would have been spent on the OECD average %.

(Now whether it would have been well spent or what else the UK spent the money on is another debate - maybe the OECD over spent given its outcomes… but given the UK is uniquely low (though Italy is close in some years and has slightly worse outcomes broadly) .

You can see how Germany is approx matching the UK since 1970 on life expectancy and trend (OK it did slowly gain beofre mathcing), but was spending much more of GDP to achieve that.

Small teams vs large teams and innovation effects

Large teams develop and small teams disrupt science and technology |  Nature

Analyses of the output produced by large versus small teams of researchers and innovators demonstrate that their work differs systematically in the extent to which it disrupts or develops existing science and technology.


Me: Large teams do more incremental innovation. Small teams do more break-through innovations (which last further into the future, when it works…). Ties in anecdotally to what we know about large company innovation vs smaller tech and biotech innovation (and the high risk, high reward nature of smaller teams / companies). But you need both for a healthy innovation ecosystem.  It seems to be that small teams (less than 8, and say, solo or duo teams) look at older, promising ideas that weren’t developed and take those forward, but also that combining ideas from several fields is effective between 1 and 8 team members, but then falls.


Nature letter here: https://www.nature.com/articles/s41586-019-0941-9


Full paper accessible here:  https://arxiv.org/ftp/arxiv/papers/1709/1709.02445.pdf

Univeral Basic Income, Finland experiment

A trio of articles looking at the Universal Basic Income idea and recent trial in Finland. Plus link to the Finiland page.

Tiny Indian state wants to pay its citizens a universal basic income | South China Morning Post / WaPo

If successful, the experiment by Sikkim, one of India’s most progressive states, would help alleviate poverty and address the challenge of job automation

https://www.scmp.com/news/asia/south-asia/article/2182595/tiny-state-india-wants-pay-its-610500-citizens-universal-basic

Universal basic income in India is a tantalisingly close prospect

Biometric ID cards and the squeeze on the rural poor are propelling the idea forward | Financial Times  

https://www.ft.com/content/a7ef07ec-2a00-11e9-9222-7024d72222bc



Finland's grand universal basic income experiment raises more questions than it answers | WIRED

Universal basic income might make people feel less stressed but doesn't necessarily fix unemployment

https://www.wired.co.uk/article/universal-basic-income-policy-universal-credit


Me: Along with a “job guarantee” idea, UBI started off as a fairly radical idea with now some significant small scale experiments behind it. I’m cautious as to how much other places can extrapolate from Finland, but overall it neither seems to help nor hinder your job prospects, but makes you feel happier. Maybe that’s enough given the highly admin intensive and relatively poor long-term outcomes for the current “job seeker” type benefits/sanctions, despite policy-maker backing.  


“In Britain, intensifying the use of sanctions and introducing harsher penalties associated with being sanctioned has been largely ineffective  at increasing flows from JSA into sustainable employment.” doi:10.1093/cje/bex088 Job Seeker’s Allowance (JSA) benefit sanctions and labour market outcomes in Britain, 2001–2014 Martin Taulbu et al. (2018)  https://academic.oup.com/cje/article/42/5/1417/4827894

Link to the Finland experiment here: https://www.kela.fi/web/en/basic-income-experiment-2017-2018

History of Start up failure, Washdoctors

A brief history of Wash Doctors – WashDoctors

History of a London based car wash start up from start to failure in 2 years. “As Founders of a business you need to be stable when things are going wrong, understated when things are going well.”

Me: We’ve used wash doctors. The business had some nice elements to it, some sustainable themes, possible better pay for workers. But the founders examine why the economics don’t work out for very human reasons (complaints, high variability of demand). Fascinating little glimpse into the very considered unfortunate end to a start-up. I hope they try some thing else.

https://medium.com/@washdoctorslondon/a-brief-history-of-wash-doctors-4e02f63ecd62