Public Health
Public health measures how well a country keeps its people alive. It starts from a common baseline and rises with healthcare law and medical and food research; poor health drags population growth down, while good health adds a little through longer lives.
Public health is one of the five inputs of the demographic model. It stands for mortality: infant deaths, epidemics, hunger and life expectancy. It is measured for each province, but nearly all of it comes from national choices.
Where health comes from
Every country starts from a scenario baseline of 40%. Two things raise it, both through the Public Health modifier.
The Healthcare System law
The Healthcare System law spans both how care is delivered and how it is paid for. Each step costs more social spending:
| Option | Public health | Other effects |
|---|---|---|
| Uninsured Private Care | – | – |
| Employer-Based Insurance | +5 points | +1% tax efficiency, +1% stability |
| Social Health Insurance | +10 points | +2% stability, slight population growth |
| Universal Public Healthcare | +20 points | +3% stability, slight population growth, −1% tax efficiency |
| National Health Service | +25 points | +3% stability, slight population growth, −2% tax efficiency |
See Policies.
Research
Medical and food research raises health rather than population growth directly. In the Health & Welfare tree, Public Health and Sanitation Systems each add 10 points, and Mass Immunization Campaigns and Antibiotics Mass Synthesis add 5 more; later biomedical projects add further small gains. Food research, from mechanized agriculture and fertilizers to hybrid crops and later farm technology, also counts toward health. See Technology Trees.
What health does
Health has an asymmetric effect on growth, split at a midpoint of 50%:
- Below the midpoint it is a penalty. A country at the bottom of the scale loses up to 1 percentage point of annual growth; at the 40% baseline the loss is a fifth of a point.
- Above the midpoint it is a small bonus, at most 0.2 points a year at perfect health. This is not more births but fewer deaths.
The result is that medicine does the most where people die youngest. A poor, agrarian country that adopts basic public health and sanitation can see its growth jump, while a wealthy country gains comparatively little from the same investment.
Beyond growth, the Public Health research project also speeds Manpower recovery by 5%, and Antibiotics Mass Synthesis cuts casualties taken by 5%.
Famine
Famine is the other side of the same coin. Its risk and its severity are separate modifiers: Famine Risk Reduction lowers the monthly chance of a famine event, and Famine Loss Severity Reduction lowers the share of the population lost when one strikes. Precision Irrigation lowers famine risk by 10%; Cold Chain Distribution lowers the loss by 20%.
Trade-offs
Better healthcare is popular, adding Stability at every step, but each tier is a permanent line in the budget. In poor countries it is one of the most direct ways to grow the population; in rich ones it is mostly a matter of stability and welfare.