Zahra Zarbakht Ali
A child who does not get enough to eat during her first thousand days will earn less throughout her life. Stunted growth leads to impaired cognitive development, which ultimately translates into lower lifetime earnings.
Pakistan has roughly 40 percent of its children living this reality today. Yet walk into any ministry briefing on nutrition or primary healthcare and the language is oddly upbeat: officials speak of a “health dividend” — the idea that money spent on health today will generate economic growth tomorrow.
It is a sound concept, grounded in economics. It is also, judging by the evidence of our own budgets, largely a slogan that dresses up policy failure as policy choice. A health dividend is the economic return a country gains from investing in its population’s health: better health leads to a more productive workforce, higher earnings, lower treatment costs and stronger GDP growth. It treats health expenditure as an investment with measurable returns rather than as a cost.
But a dividend implies prior investment. You cannot earn a return on capital that was never invested. Pakistan spent roughly 0.8 percent of its GDP on public health in FY2025–26, a figure that has barely changed in years and remains far below the 5 percent that many health economists consider necessary for achieving universal health coverage. Meanwhile, the Health Ministry’s budget was trimmed even as the country’s hunger score continued to worsen. Donors continue to promote the phrase because it aligns with cost-benefit frameworks and provides cover for loan conditionalities. Policymakers keep using it because it sounds forward-looking without requiring meaningful new fiscal commitments.
Earning a genuine health dividend would require treating stunting as a key economic indicator, protecting health budgets from cuts, removing taxes on essential medicines, capping unregulated diagnostic charges and narrowing the rural-urban healthcare gap.
These are baseline policy measures, not lofty aspirations. It is time the future tense stopped substituting for present-tense budgeting. A dividend belongs to those who make the investment. Right now, we are not.
—The writer is a psychologist and researcher focusing on child rights, education and mental health.
