n 1865, the English economist William Stanley Jevons observed something that defied intuition: As coal–burning engines became more efficient, England’s total coal consumption did not decrease. It increased. Efficiency made coal more useful, which made it more widely adopted, which drove demand far beyond what the savings had offset. The pattern, now known as the Jevons Paradox, has repeated across industries and centuries. When a resource becomes cheaper to use, we use more of it. The ecosystem reorganizes around the new abundance.
A powerful version of this argument is now being applied to healthcare. The thesis is straightforward: Artificial intelligence is collapsing the marginal cost of clinical services—diagnostic reads, triage, monitoring, coaching, psychotherapy. Tasks once constrained by clinician cost and availability are becoming abundant. Pricing models will shift from fee–for–service to subscription and continuous access. Nations and systems that embrace this abundance will deliver more medical care to more people at lower cost.
The economic logic is sound. The pattern is real. But the paradox has been applied to the wrong resource. And the consequences of that misapplication, measured in trillions of dollars and hundreds of millions of lives, deserve examination at the level of global policy.
The Wrong Abundance
Medical care is intervention. It is what a person needs when something has already gone wrong or is at risk of going wrong. Making intervention more abundant does not make populations healthier. It makes the management of the absence of health more efficient.
The data confirm this at a national scale. The United States spends approximately $5.3 trillion annually on healthcare, 18% of GDP in 2024, on a trajectory toward 20%by 2033, according to the Centers for Medicare and Medicaid Services. It has built the most technologically advanced medical care system in history. Three in four American adults carry at least one chronic condition. Life expectancy trails peer nations by nearly four years, 79 years in the United States against an average of 82.7 among comparable OECD countries in 2024. The system has not failed at delivering care. It has succeeded at delivering care while the population it serves has grown steadily less healthy.
This is not an American problem. It is a structural one. The United States spends more on healthcare per capita than any other nation, yet ranks last or near–last among peer countries on most measures of population health, a pattern documented consistently in international comparisons. The correlation between health expenditure and health outcomes weakens as spending increases, because additional spending flows almost entirely into the service layer: more treatment, more diagnosis, more management of conditions that have already formed.
The pandemic made this visible in ways that were difficult to ignore. Nations mobilized extraordinary medical response capacity. Vaccines were developed at historic speed. Hospital systems expanded. What no nation had built was upstream infrastructure that reduced the population’s vulnerability before a health crisis arrived. The populations most affected were those already carrying the highest burden of chronic disease, the product of decades without investment in the conditions that produce health in the first place.
The lesson was noted. It was not structurally addressed.
The Right Resource
The Jevons Paradox works. But it matters enormously which resource you make abundant.
When you make medical intervention abundant, consumption of medical intervention increases. Systems reorganize around delivering more care, more efficiently. This is valuable. It saves lives. But it does not bend the cost curve, because the underlying demand for intervention continues to grow.
When you make the production of health itself more efficient, something structurally different happens. People flourish. Chronic disease burden diminishes. The need for medical intervention decreases rather than increases. And the economic ecosystem reorganizes around that abundance: models where value is created when populations are healthy, where markets grow when fewer people become patients, where public expenditure compounds as health becomes the default rather than the exception.
In one version of abundance, success means more consumption of medical care. In the other, success means less need for it. Both claim abundance. Only one permanently bends the cost curve.
The distinction between these two outcomes is not clinical but architectural. It depends on whether nations invest exclusively in the service layer, the delivery of care once needed, or also build the infrastructure layer beneath it: the civic systems, embedded in daily life, that reduce the probability of illness before clinical intervention becomes necessary.
Infrastructure, Not Advice
This is where the argument must be precise. Upstream health infrastructure is not wellness programming. It is not public health messaging. It is not advice.
Advice does not compound. Infrastructure does.
Roads do not get consumed by traffic. Electrical grids do not deplete when demand increases. Water systems do not erode when communities grow. Infrastructure shapes incentives, redirects capital, and alters long–horizon trajectories. It is the layer that simultaneously makes services more effective and less necessary.
What would health infrastructure look like if designed with the same durability and civic intent as the systems upon which nations already rely?
It would be embedded where people live, work, learn, and eat, not confined to clinical settings. It would carry context across environments, reflecting the whole person rather than isolated encounters. It would be private by default, consent–based, and governed with the same rigor as any public utility. It would generate signals that appreciate over time, deepening with use, rather than depreciating the moment they are captured.
And critically, it would not compete with medical care systems. It would instead make them more effective by reducing the volume and severity of what arrives at their door.
Services without infrastructure scale reaction. Infrastructure without services leaves gaps in acute need. Together, they constitute a complete architecture for population health. Separately, they produce the pattern we already observe: extraordinary medical capability presiding over populations that grow steadily less well.
A Question of National Strategy
The nations that recognize this distinction first will hold a structural economic advantage that compounds over decades. Not because they spend less on healthcare, but because their populations require less of it. The fiscal savings are significant. But the deeper advantage is in workforce productivity, economic resilience, and the long–horizon competitiveness that comes from a population that is genuinely flourishing rather than being managed.
This is not a technology problem. The tools exist. This is an architecture problem. No nation has yet built the upstream civic infrastructure that treats the production of health with the same seriousness as the production of medical care.
Three years ago, writing in these pages, I argued that transformation, not just resilience, must inform the creation of a true health ecosystem. The intervening years have only sharpened the case. The medical care system continues to advance. The population it serves continues to decline. The gap between these two realities is the architectural absence that defines our era.
The Jevons Paradox is not wrong. It is one of the most reliable patterns in economic history. The question for policymakers, health leaders, and the international community is whether we will continue applying it to intervention, producing ever more efficient management of illness, or whether we will apply it to the resource that actually matters.
Flourishing is the resource. Infrastructure is the mechanism. The nations that build it first will not just be healthier. They will be more competitive, more resilient, and more durable than those that do not.
The wealth and security of a nation is the health of its people.
a global affairs media network
The Jevons Paradox and the future of global health infrastructure
Ales Krivec via Unsplash+.
April 23, 2026
AI is making medical care more abundant, but in this case abundance may not be positive. The Jevons Paradox warns this may increase illness management rather than improve health, writes Robert Sundelius.
I
n 1865, the English economist William Stanley Jevons observed something that defied intuition: As coal–burning engines became more efficient, England’s total coal consumption did not decrease. It increased. Efficiency made coal more useful, which made it more widely adopted, which drove demand far beyond what the savings had offset. The pattern, now known as the Jevons Paradox, has repeated across industries and centuries. When a resource becomes cheaper to use, we use more of it. The ecosystem reorganizes around the new abundance.
A powerful version of this argument is now being applied to healthcare. The thesis is straightforward: Artificial intelligence is collapsing the marginal cost of clinical services—diagnostic reads, triage, monitoring, coaching, psychotherapy. Tasks once constrained by clinician cost and availability are becoming abundant. Pricing models will shift from fee–for–service to subscription and continuous access. Nations and systems that embrace this abundance will deliver more medical care to more people at lower cost.
The economic logic is sound. The pattern is real. But the paradox has been applied to the wrong resource. And the consequences of that misapplication, measured in trillions of dollars and hundreds of millions of lives, deserve examination at the level of global policy.
The Wrong Abundance
Medical care is intervention. It is what a person needs when something has already gone wrong or is at risk of going wrong. Making intervention more abundant does not make populations healthier. It makes the management of the absence of health more efficient.
The data confirm this at a national scale. The United States spends approximately $5.3 trillion annually on healthcare, 18% of GDP in 2024, on a trajectory toward 20%by 2033, according to the Centers for Medicare and Medicaid Services. It has built the most technologically advanced medical care system in history. Three in four American adults carry at least one chronic condition. Life expectancy trails peer nations by nearly four years, 79 years in the United States against an average of 82.7 among comparable OECD countries in 2024. The system has not failed at delivering care. It has succeeded at delivering care while the population it serves has grown steadily less healthy.
This is not an American problem. It is a structural one. The United States spends more on healthcare per capita than any other nation, yet ranks last or near–last among peer countries on most measures of population health, a pattern documented consistently in international comparisons. The correlation between health expenditure and health outcomes weakens as spending increases, because additional spending flows almost entirely into the service layer: more treatment, more diagnosis, more management of conditions that have already formed.
The pandemic made this visible in ways that were difficult to ignore. Nations mobilized extraordinary medical response capacity. Vaccines were developed at historic speed. Hospital systems expanded. What no nation had built was upstream infrastructure that reduced the population’s vulnerability before a health crisis arrived. The populations most affected were those already carrying the highest burden of chronic disease, the product of decades without investment in the conditions that produce health in the first place.
The lesson was noted. It was not structurally addressed.
The Right Resource
The Jevons Paradox works. But it matters enormously which resource you make abundant.
When you make medical intervention abundant, consumption of medical intervention increases. Systems reorganize around delivering more care, more efficiently. This is valuable. It saves lives. But it does not bend the cost curve, because the underlying demand for intervention continues to grow.
When you make the production of health itself more efficient, something structurally different happens. People flourish. Chronic disease burden diminishes. The need for medical intervention decreases rather than increases. And the economic ecosystem reorganizes around that abundance: models where value is created when populations are healthy, where markets grow when fewer people become patients, where public expenditure compounds as health becomes the default rather than the exception.
In one version of abundance, success means more consumption of medical care. In the other, success means less need for it. Both claim abundance. Only one permanently bends the cost curve.
The distinction between these two outcomes is not clinical but architectural. It depends on whether nations invest exclusively in the service layer, the delivery of care once needed, or also build the infrastructure layer beneath it: the civic systems, embedded in daily life, that reduce the probability of illness before clinical intervention becomes necessary.
Infrastructure, Not Advice
This is where the argument must be precise. Upstream health infrastructure is not wellness programming. It is not public health messaging. It is not advice.
Advice does not compound. Infrastructure does.
Roads do not get consumed by traffic. Electrical grids do not deplete when demand increases. Water systems do not erode when communities grow. Infrastructure shapes incentives, redirects capital, and alters long–horizon trajectories. It is the layer that simultaneously makes services more effective and less necessary.
What would health infrastructure look like if designed with the same durability and civic intent as the systems upon which nations already rely?
It would be embedded where people live, work, learn, and eat, not confined to clinical settings. It would carry context across environments, reflecting the whole person rather than isolated encounters. It would be private by default, consent–based, and governed with the same rigor as any public utility. It would generate signals that appreciate over time, deepening with use, rather than depreciating the moment they are captured.
And critically, it would not compete with medical care systems. It would instead make them more effective by reducing the volume and severity of what arrives at their door.
Services without infrastructure scale reaction. Infrastructure without services leaves gaps in acute need. Together, they constitute a complete architecture for population health. Separately, they produce the pattern we already observe: extraordinary medical capability presiding over populations that grow steadily less well.
A Question of National Strategy
The nations that recognize this distinction first will hold a structural economic advantage that compounds over decades. Not because they spend less on healthcare, but because their populations require less of it. The fiscal savings are significant. But the deeper advantage is in workforce productivity, economic resilience, and the long–horizon competitiveness that comes from a population that is genuinely flourishing rather than being managed.
This is not a technology problem. The tools exist. This is an architecture problem. No nation has yet built the upstream civic infrastructure that treats the production of health with the same seriousness as the production of medical care.
Three years ago, writing in these pages, I argued that transformation, not just resilience, must inform the creation of a true health ecosystem. The intervening years have only sharpened the case. The medical care system continues to advance. The population it serves continues to decline. The gap between these two realities is the architectural absence that defines our era.
The Jevons Paradox is not wrong. It is one of the most reliable patterns in economic history. The question for policymakers, health leaders, and the international community is whether we will continue applying it to intervention, producing ever more efficient management of illness, or whether we will apply it to the resource that actually matters.
Flourishing is the resource. Infrastructure is the mechanism. The nations that build it first will not just be healthier. They will be more competitive, more resilient, and more durable than those that do not.
The wealth and security of a nation is the health of its people.
