The hidden fragility of preventive health spending

Global health spending is skewed towards treatment. As countries grow richer, curative health spending rises faster than preventive spending, and absorbs an increasing share of total health budgets. Hospital care, specialist services, and other treatment costs expand quickly. Spending on prevention rises too, but not nearly at the same pace.

At the same time, the data reveals a surprising pattern: lower-income countries tend to devote a larger share of their total health spending to prevention than higher-income countries.

At first glance this seems encouraging. Prevention delays the onset of disease, reduces its severity, and can avert illness altogether, often at a lower cost than treatment. And lower-income countries, working with constrained health budgets, appear to prioritise these high-value interventions.

Yet research shows that both households and policymakers systematically underinvest in prevention, particularly in lower-income settings, because the benefits are delayed, diffuse, and less visible.

So why is the share of prevention spending higher in lower-income countries? It’s not because of higher domestic prioritisation of prevention; rather, it’s due to the way in which health systems in those countries are financed.

Prevention in lower-income countries is largely financed by external sources. Donor-funded vaccine campaigns, disease control programs, and other preventive initiatives increase the amount spent on prevention, while budget-constrained domestic governments allocate less to prevention.

This creates a structural vulnerability. As countries grow and transition away from external assistance, or as global health aid recedes, domestic spending on prevention may not increase quickly enough to close the gap. At the same time, demand for costly curative care continues to rise. Without deliberate action, prevention risks being crowded out.

Both curative and preventive services are indispensable for strong health systems. The right balance will differ across contexts, but understanding the composition of health spending is essential to assessing whether countries are building systems that are resilient, equitable, and prepared for future health threats.