A COUNTRY IN POOR HEALTH

Dr Nthabiseng Legoete listened intently as the economics professor flicked health rankings drawn from The Global Competitiveness Report up onto the lecture room screen and began explaining the "Six Pack Model" of economic development to his class. The discussion soon turned to healthcare in South Africa, as students grappled with the grim picture painted by the data. The South African government was by no means a small spender on public healthcare. Despite this the country ranked poorly in terms of health outcomes. Of the 144 countries surveyed in the report, South Africa ranked in position 143 for cases of tuberculosis per 100,000 people. HIV prevalence, which stood at 17.9 percent of the adult population, translated into a ranking of 140 out of 144; and in measuring infant deaths per 1,000 live births the country ranked at 105 out of 144. In turn, the country's dismal state of health translated into poor socio-economic outcomes. South Africa's life expectancy stood at just 56.1 years. In actuarial terms this meant that, on average, South Africans died before they reached retirement age. In the same vein, the business impact of HIV/AIDS - a barometer for the relationship between health and economic growth - was a concerning story, with South Africa coming in at position 136 in The Global Competitiveness Report.

This focus on health in an economics class was important, as the physical and mental health of a country's population is one of Six Pack Model's critical components required to support and sustain economic growth and promote wellbeing in all economies.4 Alongside (i) healthcare, the other elements

in the "six pack" include (ii) an elevated savings rate that funds productive investments; (iii) access to functional and improving education; (iv) stable macroeconomic policies and capable institutions; (v) supporting demographic structures; and (vi) the ability to connect to others through the movement and flow of goods, services, people, capital, "know how" and, ultimately, "know why" across city, country and regional borders.

Equally difficult to reconcile was the fact that South Africa's spending on public sector healthcare stood at 4.2 percent of gross domestic product (GDP).6 A figure comparable to many middle-income economies, additionally, South Africa ranked 75th in the world in terms of public health spending as a percentage of GDP. By contrast, other countries with poor primary health outcomes - such as Chad, the Democratic Republic of Congo, Haiti, Mozambique, Sierra Leone and Timor-Leste mentioned above - spend on average just 2.0 percent of GDP on public healthcare.7 If one added in private spending on healthcare (4.1 percent of GDP, foreign aid and the non-governmental organization sector (0.2 percent of GDP), the country's total spending on healthcare makes up a total of 8.4 percent of the economy. By contrast, the World Health Organization (WHO) recommends that countries spend just five percent of GDP on health, and average expenditure for all middle income countries is 5.8 percent (Bernstein, 2011, 8-9). Based on these numbers, the level of healthcare spend did not appear to be South Africa's problem.

Question (20 marks)

1. Explain what is the Business Ethics Synergy Star Technique ?
2. In your view, is the public health crisis in South Africa an ethical issue?

Apply the Business Ethics Synergy Star Technique to explain why you say it is OR why it is not.