Where Capability Concentrates, Valuation Compounds.

The Capability Economy: Health Resilience as the Next Investable Infrastructure Class.

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Abstract

Bank of America spends more than $250 million annually on GLP-1 medicines for its employees. Chief Executive Officer Brian Moynihan has described the expenditure as a good investment, placing the decision within a broader corporate assessment of employee health, healthcare expenditure and long-term value. Contemporary reporting places the expenditure within Bank of America's approximately $2 billion annual employee healthcare budget.

This paper examines the economic meaning of that expenditure through established health-capital, human-capital and organisational-capability theory, while applying the Architecture of Capability Economics as the paper's integrating analytical contribution.

The paper establishes a distinction between health expenditure, health-capital investment and capability infrastructure. Grossman's health-capital model establishes the first theoretical step: health is a durable capital stock into which resources can be invested. Becker's human-capital framework establishes the wider economic basis for investment in productive human attributes. Dynamic-capabilities and absorptive-capacity theory establish the institutional mechanism through which resources are converted into organisational outcomes.

The paper advances the next analytical step. Health capital becomes capability infrastructure when the preservation of health is connected to the preservation of functional capacity, participation, resilience and productive continuity. The resulting economic pathway is:

self-care → capability → resilience → reduced future liabilities → productive capacity → economic value.

This framework changes the interpretation of employer health expenditure. The relevant economic return is not restricted to immediate productivity. It includes the preservation of future productive capacity and the reduction, avoidance or postponement of liabilities associated with capability deterioration, including healthcare expenditure, disability, absenteeism, workforce replacement, loss of institutional knowledge and reduced participation.

The paper distinguishes this proposition from the broader workplace-wellness literature.

The 2019 JAMA randomised clinical trial of a comprehensive workplace wellness programme found improvements in some self-reported behaviours but no significant effects on clinical health measures, healthcare spending and utilisation, absenteeism, tenure or job performance after 18 months. This establishes that employer health expenditure does not automatically constitute productive investment.

GLP-1 medicines constitute a different empirical category. The SELECT trial enrolled 17,604 adults with overweight or obesity and established cardiovascular disease without diabetes and found a 20 per cent reduction in major adverse cardiovascular events with semaglutide relative to placebo. The clinical evidence therefore establishes a health effect, while the institutional question remains whether that effect is converted into lower liabilities, greater workforce continuity and preserved productive capacity.

The paper's central proposition is consequently precise:

Health expenditure becomes capability infrastructure when it preserves the functional capacity required for continued participation and productive activity and thereby alters the future liability and productive-capacity profile of the economic system.

Bank of America's GLP-1 expenditure provides a significant institutional case through which this proposition can be examined.

Authorial and Scholarly Position

This paper is an independent scholarly analysis of employer health expenditure as a form of human-capital and capability investment. It applies established economic and management theories, including health-capital theory, human-capital theory, dynamic-capabilities theory and absorptive-capacity theory, to the Bank of America GLP-1 case.

The paper also develops the author's concept of capability infrastructure as an integrative analytical framework connecting health capital, organisational capability, resilience, future liabilities and productive capacity. The concept forms part of the Architecture of Capability Economics developed by the author and is identified as such throughout the paper.

The paper distinguishes between established peer-reviewed scholarship and the author's prior conceptual work. Established scholarship provides the principal theoretical and empirical foundation. The author's prior work provides the interpretive framework through which the case is analysed.

The paper is analytical rather than political and does not represent the position of Bank of America, any pharmaceutical company, healthcare provider, political organisation or public authority. No commercial endorsement is implied.

The paper does not claim that Bank of America's expenditure has already generated a quantified economic return. Its purpose is to specify the economic mechanism through which employer-financed health interventions can preserve human capability, strengthen resilience, reduce exposure to future liabilities and protect productive capacity, and to identify the empirical outcomes through which that proposition can be evaluated.

1. Introduction

In August 2026, Bank of America disclosed annual expenditure of more than $250 million on GLP-1 medicines for its employees. Chief Executive Officer Brian Moynihan described the expenditure as a good investment and connected it with the health effects observed among employees. Contemporary reporting also places the expenditure within the bank's approximately $2 billion annual employee healthcare budget.

The economic significance of the decision lies in the classification of the expenditure.

Healthcare expenditure is conventionally treated as consumption or as an employee benefit.

Capital expenditure is treated differently because capital creates or preserves an asset capable of generating future economic value.

The Bank of America case therefore raises a fundamental economic question:

When does expenditure on health become investment in productive capacity?

The answer cannot rest upon the existence of expenditure alone.

Employer expenditure on wellness does not automatically produce measurable economic returns. The evidence from workplace-wellness research establishes this clearly. Song and Baicker's large randomised clinical trial found significant improvements in some self-reported health behaviours but no significant differences in clinical health measures, healthcare spending and utilisation, absenteeism, tenure or job performance after 18 months.

The analytical problem is therefore more precise than the proposition that healthy employees are more productive.

The relevant question is whether an intervention preserves a form of human capability that has economic consequences over time.

This paper develops that proposition by connecting four established fields:

1.  health-capital theory;

2.  human-capital theory;

3.  organisational-capability theory;

4.  empirical evidence concerning employer health expenditure.

The paper then introduces the Architecture of Capability Economics as an integrating framework.

The conceptual foundation for this integration is established in the author's prior work on self-care, capability, resilience, affordability and productive capacity. A Message from the Founder sets out the underlying proposition that self-care can operate as infrastructure where it contributes to the preservation and development of human capability, resilience and future economic capacity.

Global Structure Network, A Message from the Founder.
https://theglobalstructurenetwork.com/message-from-the-founder

The present paper develops that proposition through established economic and organisational theory and applies it to employer health expenditure. The Founder source therefore provides the doctrinal and authorial foundation for the integrating framework; Grossman, Becker, Teece, Cohen and Levinthal and the empirical health literature provide the established theoretical and evidential foundations through which the proposition is specified and tested.

The resulting analytical sequence is:

self-care → capability → resilience → reduced future liabilities → productive capacity → economic value.

This sequence introduces an intertemporal dimension into the analysis of health expenditure.

The economic value of health preservation does not arise solely from what happens today. It also arises from what does not happen tomorrow.

Preserved capability sustains participation. It reduces exposure to future healthcare and disability liabilities. It reduces workforce replacement. It preserves institutional knowledge. It maintains workforce continuity. It preserves the productive capacity upon which future output depends.

The economic object is therefore not simply health.

It is future productive capacity preserved through health-related capability.

This establishes the paper's central intervention: health expenditure acquires an investment function where it preserves or increases productive capability and where that preserved capability generates future economic value through participation, resilience, reduced liabilities and productive capacity.

The intervention does not assert that all healthcare expenditure constitutes productive investment. It identifies the economic function through which particular health expenditures acquire investment characteristics.

The Bank of America case provides a contemporary institutional setting in which this proposition is examined. The bank is allocating substantial corporate resources to a health intervention and publicly characterising that expenditure as an investment. The economic question is whether the expenditure is connected through identifiable mechanisms to preserved capability, reduced future liabilities and sustained productive capacity.

The paper therefore moves from the conventional classification of healthcare expenditure towards an analysis of its productive economic function.

The central analytical question is:

When does employer expenditure on health preserve sufficient future productive capacity to constitute human-capital investment?

The remainder of the paper establishes the health-capital foundation, develops the institutional and organisational mechanisms through which health capital generates firm-level value, examines the empirical evidence concerning employer health expenditure, evaluates the specific GLP-1 evidence and identifies the conditions under which the investment proposition is demonstrated.

2. From Health Consumption to Health Capital

The theoretical foundation begins with Michael Grossman's health-capital model.

Grossman's 1972 model treats health as a durable capital stock. Individuals possess a stock of health that depreciates over time and can invest in that stock through medical care and other inputs. Health produces a flow of healthy time that enters household production and labour-market activity.

Grossman, M. (1972), On the Concept of Health Capital and the Demand for Health, Journal of Political Economy, 80(2), 223–255.

Full URL:

https://doi.org/10.1086/259880

Grossman's framework is important because it rejects the idea that medical expenditure is economically exhausted at the moment of consumption.

Medical care can constitute investment where it alters the future stock of health.

That provides the first analytical distinction:

health expenditure is not necessarily equivalent to health consumption.

Some expenditure changes the future condition of the individual.

The distinction becomes particularly important when the economic agent making the expenditure is not the same as the individual receiving the intervention.

An employee consumes the healthcare intervention.

An employer finances it.

The employer therefore occupies a different economic position from the patient.

The employer internalises a portion of the consequences through healthcare costs, absenteeism, disability, workforce continuity, retention and productive capacity.

The institutional question consequently becomes:

Can an employer capture sufficient economic value from improved employee health to justify treating health expenditure as investment?

Grossman's model establishes the health-capital side of the question.

It does not provide the complete institutional answer.

3. Human Capital and Productive Capacity

The second theoretical foundation comes from human-capital economics.

Becker established the wider proposition that investments in human attributes can generate future productive returns.

Becker, G. S. (1964), Human Capital: A Theoretical and Empirical Analysis, with Special Reference to Education, National Bureau of Economic Research.

Health occupies a distinctive position within this framework because it affects the capacity of individuals to participate in economic activity.

The relationship is not limited to output per hour.

Health can influence:

• labour-force participation;
• days available for work;
• disability;
• employment continuity;
• physical functioning;
• household production;
• longevity;
• future healthcare requirements.

This distinction is essential to the present argument.

A rigorous health-capital analysis does not require the proposition that healthcare expenditure produces a universal productivity multiplier.

The economically relevant outcome can be the preservation of the capacity to participate.

That is already economically material.

A worker who remains capable of participating in employment possesses productive capacity that would otherwise have been impaired or lost.

The correct unit of analysis is therefore not simply productivity per hour.

It is the stock and continuity of productive capability.

4. The Capability Extension

The Architecture of Capability Economics extends this established framework by placing capability between health capital and economic production.

The relevant distinction is:

Health capital is the underlying stock.

Capability is the functional capacity produced and maintained by that stock.

Participation is the deployment of that capability.

Productive capacity is the economic potential created through participation.

The Network's broader architecture develops this proposition through its work on capability infrastructure and the Capability Economy.

Capability as Productive Infrastructure:

Macroeconomic Theory: Why Capability Is Becoming the World's Most Valuable Productive Asset - (SSRN, 2026)
https://papers.ssrn.com/sol3/papers.cfm?abstract_id=7086180

https://theglobalstructurenetwork.com/f/capability-as-productive-infrastructure

The Capability Infrastructure Field:

https://www.gsdiandadvocacy.co.uk/the-capability-infrastructure-field

The ACE Extension — System Architecture:

https://www.gsdiandadvocacy.co.uk/the-ace-extension--system-architecture

The important analytical move is therefore not to replace health-capital economics.

It is to extend it.

Health capital describes the asset.

Capability describes what that asset enables.

Productive capacity describes the economic significance of what it enables.

5. Self-Care as Capability Formation

Self-care is frequently placed within the consumer or wellness economy.

That classification is incomplete where self-care affects the preservation of functional capacity.

The economic sequence becomes:

self-care → capability formation → resilience → participation.

The Message from the Founder expresses this broader proposition by treating long-term self-care as the construction of a capability architecture rather than as lifestyle consumption.

Full URL:

https://theglobalstructurenetwork.com/message-from-the-founder

The economic significance of this proposition lies in its temporal structure.

An individual who invests in health today is not simply purchasing present wellbeing.

The intervention affects the future condition of the individual.

This produces an intertemporal economic relationship:

present expenditure → preserved capability → altered future condition.

The paper therefore treats modern self-care as one component of capability formation rather than as an undifferentiated category of consumption.

This does not mean that all self-care expenditure constitutes investment.

The economic function of the expenditure must be established.

Where the expenditure preserves or expands functional capacity relevant to participation, the expenditure has a capability-preserving function.

6. Capability, Resilience and Future Liabilities

This is the central extension of the paper.

Capability has an economic value not only because it supports current participation, but because it changes the probability and scale of future liabilities.

Capability deterioration can generate liabilities across several balance sheets.

For households, these can include:

• higher healthcare expenditure;
• reduced earnings;
• disability;
• reduced labour participation;
• reduced financial resilience.

For employers, they can include:

• higher healthcare expenditure;
• absenteeism;
• disability claims;
• recruitment costs;
• employee replacement;
• loss of institutional knowledge;
• reduced continuity;
• reduced productive capacity.

For insurers, they can include:

• increased claims;
• longer-duration liabilities;
• higher risk exposure.

For governments, they can include:

• higher healthcare expenditure;
• disability expenditure;
• lower tax receipts;
• reduced labour-force participation;
• increased social expenditure.

This establishes the economic significance of prevention and capability preservation.

The value of an intervention is not confined to the benefit recorded at the moment of treatment.

It also includes liabilities that are reduced, postponed or avoided.

The central relationship is therefore:

capability preservation → resilience → reduced future liabilities.

This is a different economic proposition from the claim that every health intervention produces immediate financial savings.

It concerns the preservation of the future economic state.

7. Capability Infrastructure

Infrastructure is normally understood as a system that enables economic activity.

Roads enable movement.

Energy systems enable production.

Telecommunications enable communication.

Financial infrastructure enables transactions.

Digital infrastructure enables information processing.

Capability infrastructure performs an analogous function at the level of human productive capacity.

It preserves the conditions under which economic agents can participate.

Capability as Productive Infrastructure:

https://theglobalstructurenetwork.com/f/capability-as-productive-infrastructure

The concept therefore does not classify every health intervention as infrastructure.

It identifies a functional category.

An intervention becomes capability infrastructure where its economic function includes preserving the capability required for sustained participation and production.

This distinction is decisive.

A healthcare transaction describes what was purchased.

Capability infrastructure describes what economic function the expenditure performs.

8. The Institutional Conversion Problem

Grossman's model operates primarily at individual level.

The Bank of America case operates at institutional level.

The firm does not possess the employee's health stock in the same sense as the individual.

The firm nevertheless bears economic consequences associated with changes in that stock.

This creates an institutional conversion problem.

The firm must convert a health intervention into an organisational outcome.

This is where dynamic-capabilities theory becomes relevant.

Teece, Pisano and Shuen define dynamic capabilities in terms of a firm's ability to integrate, build and reconfigure competences in changing environments.

Teece, D. J., Pisano, G. and Shuen, A. (1997), 'Dynamic Capabilities and Strategic Management', Strategic Management Journal, 18(7), 509–533.

Cohen and Levinthal's absorptive-capacity framework provides a related proposition: organisations differ in their capacity to recognise, assimilate and apply valuable knowledge.

Cohen, W. M. and Levinthal, D. A. (1990), 'Absorptive Capacity: A New Perspective on Learning and Innovation', Administrative Science Quarterly, 35(1), 128–152.

The relevance is direct.

A firm can purchase a resource without possessing the organisational capacity required to convert that resource into an economic outcome.

This establishes a second distinction:

health capital is not equivalent to organisational capability.

An employer can fund healthcare.

The economic return depends upon the pathways through which that healthcare affects workforce capability.

9. Complementary Infrastructure

The Bank of America case is particularly relevant because reporting indicates that GLP-1 access is accompanied by health coaching and related support.

That matters analytically.

A pharmaceutical intervention constitutes one component.

The organisational systems surrounding it constitute another.

The resulting architecture is:

intervention → adherence → health improvement → capability preservation → resilience → reduced liabilities → productive capacity.

The organisational system is therefore not ancillary to the investment proposition.

It forms part of the mechanism.

This gives rise to a testable proposition:

Employers that combine effective health interventions with complementary systems for adherence, monitoring and behavioural support will produce different economic outcomes from employers that provide the intervention without those systems.

The distinction allows the capability proposition to be tested independently of the existence of healthcare expenditure itself.

10. What the Workplace-Wellness Evidence Establishes

The workplace-wellness literature provides an essential empirical boundary.

Baicker, Cutler and Song's 2010 Health Affairs analysis reported substantial financial returns from workplace wellness programmes.

Baicker, K., Cutler, D. and Song, Z. (2010), 'Workplace Wellness Programs Can Generate Savings', Health Affairs, 29(2), 304–311.

Full URL:

https://doi.org/10.1377/hlthaff.2009.0626

The later randomised clinical evidence produced a substantially different result.

Song and Baicker's 2019 JAMA trial covered a large workforce across 160 worksites. The intervention improved some self-reported health behaviours but produced no significant differences in clinical health measures, healthcare spending and utilisation, absenteeism, tenure or job performance after 18 months.

Full URL:

https://doi.org/10.1001/jama.2019.3307

This evidence is central to the present paper because it establishes a necessary boundary:

Employer health expenditure does not constitute productive investment merely because its stated purpose is employee health.

The economic mechanism must be demonstrated.

The JAMA evidence therefore strengthens rather than weakens the capability argument.

It demonstrates that wellness expenditure must be distinguished according to intervention quality, mechanism, effectiveness and economic transmission.

The paper consequently does not treat the entire workplace-wellness sector as evidence for employer health investment.

11. Why GLP-1s Constitute a Different Empirical Case

GLP-1 medicines occupy a different evidentiary position from generic workplace wellness programmes.

The SELECT trial enrolled 17,604 adults with a BMI of at least 27 and established cardiovascular disease but without diabetes.

Semaglutide reduced the risk of the composite cardiovascular endpoint by 20 per cent relative to placebo.

Full URL:

https://www.nejm.org/doi/full/10.1056/NEJMoa2307563

The trial therefore establishes a clinically meaningful effect.

The economic question remains separate.

Clinical benefit does not itself establish employer return.

The following transmission mechanisms must be established:

clinical benefit → functional benefit → reduced future health burden → reduced liability exposure → preserved workforce capacity → economic value.

The distinction is important because the paper does not convert clinical evidence into an unsupported claim about productivity.

The clinical evidence establishes the first part of the chain.

The institutional evidence must establish the remainder.

12. The Bank of America Case

Bank of America's expenditure provides an unusually clear institutional case because the employer itself has classified the expenditure as investment.

Contemporary reporting states that the bank spends $250 million or more annually on GLP-1 medicines for its employees and that Moynihan has described the expenditure in positive investment terms.

Fortune also reports that GLP-1 coverage has become an increasingly important employee benefit and that almost one-third of workers surveyed would consider changing jobs to obtain such coverage.

Full URL:

https://fortune.com/2026/08/07/bank-of-america-splashing-out-250-million-a-year-on-weight-loss-drugs-for-staff-great-impact-ceo-says/

The case therefore contains two distinct economic mechanisms.

First: capability preservation

GLP-1 treatment can affect health outcomes relevant to future functional capacity.

Secondly: labour-market value

GLP-1 coverage can affect employee attraction and retention.

These mechanisms must not be conflated.

A benefit can create value through retention without producing measurable health-related productivity effects.

It can also create health-related value without materially affecting retention.

The Bank of America expenditure can therefore be analysed across both channels.

13. Future Liabilities as the Missing Economic Variable

The conventional ROI analysis asks:

How much does the intervention cost, and how much money does it save?

The capability framework asks a broader question:

How does the intervention alter the future economic condition of the institution?

That condition includes liabilities.

Suppose deterioration in employee health produces a future sequence involving:

health deterioration → higher medical expenditure → disability → absence → replacement → lost experience → reduced productive capacity.

An intervention that interrupts that sequence changes the future liability profile.

The resulting value does not necessarily appear immediately as a cash saving.

It can appear as:

• fewer disability events;
• fewer lost working days;
• longer workforce continuity;
• lower replacement expenditure;
• lower future medical expenditure;
• preserved institutional knowledge;
• greater labour participation.

This is why future liabilities must be included in the investment analysis.

The economic value of capability is partly the value of capacity that remains available.

14. The Capability Balance Sheet

The conventional corporate balance sheet records financial assets and liabilities.

The capability framework introduces an additional analytical layer.

An institution possesses productive capacity that depends upon human capability.

That capability is affected by:

• health;
• skills;
• resilience;
• participation;
• organisational systems;
• affordability;
• continuity.

The resulting concept can be represented as a capability balance sheet.

Capability assets

• preserved workforce health;
• functional capacity;
• workforce continuity;
• institutional knowledge;
• resilience;
• participation;
• productive capacity.

Capability liabilities

• avoidable disability;
• preventable absenteeism;
• health-related turnover;
• workforce replacement;
• loss of institutional knowledge;
• future healthcare expenditure;
• reduced participation.

The economic significance of health expenditure therefore depends partly upon whether it changes the relationship between these assets and liabilities.

This provides a more complete framework than a narrow healthcare-cost calculation.

15. Affordability and the Reach of Capability Infrastructure

Capability infrastructure cannot operate without access.

Affordability therefore enters the architecture as a condition of capability formation.

The Network's work on affordability establishes this proposition across household and institutional contexts.

Affordability as Economic Freedom:

https://theglobalstructurenetwork.com/f/affordability-as-economic-freedom

SSRN:

https://papers.ssrn.com/sol3/papers.cfm?abstract_id=6470839

The Cost-Stack Economy:

https://theglobalstructurenetwork.com/f/the-cost%E2%80%91stack-economy

SSRN:

https://papers.ssrn.com/sol3/papers.cfm?abstract_id=6471040

The Architecture of Affordability:

https://theglobalstructurenetwork.com/f/the-architecture-of-affordability

SSRN:

https://papers.ssrn.com/sol3/papers.cfm?abstract_id=6545658

The relationship is:

affordability → access → capability formation → participation.

This means that capability infrastructure has two separate economic dimensions.

Efficacy determines whether the intervention produces the intended capability effect.

Affordability determines who can access that intervention.

A high-efficacy intervention with restricted access produces concentrated capability gains.

A scalable intervention with broad affordability produces wider capability diffusion.

This distinction connects capability economics with distributional economics without reducing capability to distribution.

16. The Capability Consumer

The individual receiving the intervention is not merely a consumer.

The Capability Consumer is an economic agent whose consumption decisions influence the condition of his or her productive capability.

The Capability Consumer:

https://theglobalstructurenetwork.com/f/the-capability-consumer

The Consumer-to-Thrive Manifesto:

https://theglobalstructurenetwork.com/f/the-consumer-to-thrive-manifesto

The GLP-1 case demonstrates the principle.

The employee is not simply purchasing a pharmaceutical product.

The employee is participating in an economic system in which health expenditure affects future capability.

Where an employer finances that expenditure, the same capability becomes an institutional economic variable.

The consumer and the employer therefore occupy different positions within the same capability system.

17. Household Capability and Firm Capability

Capability exists at multiple levels.

The household is a principal site of capability formation.

The firm is a principal site of capability deployment.

The two are economically connected.

Household capability affects labour participation.

Firm capability affects productive capacity.

Institutional expenditure can influence household capability.

Household capability can therefore become an input into firm performance.

This is why health expenditure cannot be analysed exclusively inside the healthcare sector.

Its consequences cross institutional boundaries.

The same individual can simultaneously be:

• a patient;
• a consumer;
• a household member;
• an employee;
• a capability-bearing economic agent.

The Capability Economy recognises these roles as economically interconnected.

18. From Capability to Economic Value

The complete architecture can now be stated.

Stage 1: Self-care

Individuals and institutions allocate resources towards health preservation.

Stage 2: Capability

Health preservation maintains functional capacity.

Stage 3: Resilience

Maintained capability increases the capacity to withstand disruption and continue functioning.

Stage 4: Reduced future liabilities

Preserved resilience reduces exposure to future health, disability, participation and workforce liabilities.

Stage 5: Productive capacity

Preserved capability sustains the capacity to participate in productive activity.

Stage 6: Economic value

Productive capacity contributes to output, continuity, income, fiscal capacity and institutional value.

The resulting equation is:

Self-care → capability → resilience → reduced future liabilities → productive capacity → economic value.

This is the central contribution of the paper.

19. A More Precise Definition of Capability Infrastructure

The analysis permits a formal definition.

Capability infrastructure is the set of systems, expenditures and institutional arrangements that preserve, develop or deploy the functional capacities required for sustained economic participation and productive activity.

This definition deliberately excludes a simple equivalence between expenditure and infrastructure.

An expenditure qualifies according to function.

The function must involve capability.

The capability must have relevance to participation or productive activity.

The preservation or development of that capability must have economic consequences.

This provides an analytical test.

A health intervention is capability infrastructure where:

1.  it changes a relevant health or functional condition;

2.  that condition affects capability;

3.  capability affects participation or productive capacity;

4.  the resulting change has economic consequences.

20. Falsifiable Predictions

The framework produces testable predictions.

Prediction 1: Labour participation

Employers providing effective GLP-1 coverage should experience lower rates of health-related absenteeism and disability among relevant covered populations than comparable employers without equivalent access, after controlling for population differences.

Prediction 2: Future healthcare liabilities

Where GLP-1 treatment produces sustained clinical benefits, total healthcare expenditure should be evaluated over a sufficiently long period to capture downstream cardiovascular and related events rather than through pharmaceutical expenditure alone.

Prediction 3: Workforce continuity

Where capability preservation affects workforce continuity, employers providing effective access should demonstrate measurable differences in health-related turnover and workforce retention.

Prediction 4: Complementary organisational infrastructure

Employers combining pharmaceutical access with structured support, monitoring and adherence systems should demonstrate stronger capability outcomes than employers providing pharmaceutical access without equivalent complementary infrastructure.

Prediction 5: Capability-adjusted investment

The strongest economic case will arise where intervention cost is assessed against the combined value of:

current health benefit + reduced future liabilities + preserved participation + workforce continuity + productive capacity.

These predictions convert the capability proposition into an empirical research programme.

21. Countervailing Explanations

The investment interpretation must be distinguished from alternative explanations.

21.1 Retention

GLP-1 coverage can function as an employee benefit that improves retention.

That creates economic value even without a measurable health-related productivity effect.

21.2 Competitive benefits

Employers can adopt coverage because competing employers provide it.

The resulting expenditure reflects labour-market competition rather than calculated health ROI.

21.3 Employee preference

Employees can value access to GLP-1 treatment independently of employer productivity.

The benefit therefore possesses utility value even where institutional returns are absent.

21.4 Clinical benefit without institutional return

A treatment can improve health without producing an employer-level financial return.

The employee captures part of the benefit.

The employer captures another part.

The distribution of those returns determines the investment case.

21.5 Institutional conversion failure

An employer can finance an effective intervention without possessing the systems required to translate the intervention into sustained capability.

These explanations do not invalidate the capability framework.

They define the empirical questions that determine whether capability infrastructure produces institutional value.

22. The JAMA Boundary Condition

The 2019 JAMA evidence should therefore be understood as a boundary condition on the framework.

It demonstrates:

health programme → expenditure

does not necessarily produce:

health programme → capability → economic return.

The missing variables are intervention efficacy, participation, persistence, capability effect, institutional conversion and time horizon.

The distinction is fundamental.

The capability framework does not state that every workplace health programme generates financial value.

It states that where health expenditure preserves economically relevant capability, the expenditure has a productive infrastructural function.

The JAMA result is therefore compatible with the framework.

Indeed, it makes the framework more discriminating.

23. The Intertemporal Investment Problem

The Bank of America case also illustrates the central difficulty of human-capital investment.

Costs occur today.

Returns can occur years later.

The employee can leave.

The health outcome can take time.

The liability avoided may never appear in the accounts.

The economic return is therefore partly counterfactual.

This creates an intertemporal investment problem.

The employer must compare:

current expenditure

against

future health benefits + reduced liabilities + workforce continuity + preserved productive capacity.

This is structurally different from a conventional short-term ROI calculation.

The appropriate analytical horizon must therefore correspond to the time over which the intervention affects the relevant capability stock and associated liabilities.

24. The Bank of America Case as an Institutional Experiment

Bank of America's expenditure creates an observable institutional allocation decision.

The firm has committed substantial resources to a health intervention.

The intervention has established clinical evidence.

The firm has publicly described the expenditure as investment.

The case therefore creates a natural research question:

Does the institutional deployment of a clinically effective health intervention produce measurable changes in workforce capability, future liabilities and productive capacity?

That question is stronger than asking whether GLP-1s are good for employees.

It is also stronger than asking whether the expenditure produces immediate healthcare savings.

It asks whether health capital becomes economically productive when embedded within institutional capability infrastructure.

25. From the Experience Economy to the Capability Economy

The broader economic transition can be expressed as a shift in the object of consumption.

The Experience Economy emphasises the experience produced through consumption.

The Capability Economy emphasises the capacity produced, preserved or expanded through consumption.

From the Experience Economy to the Capability Economy:

https://www.gsdiandadvocacy.co.uk/from-the-experience-economy-to-the-capability-economy

This distinction becomes particularly important in health.

The consumer does not simply consume a treatment.

The treatment can alter the individual's future capability.

That capability affects participation.

Participation affects economic activity.

The economic object therefore moves beyond immediate consumption.

26. The Commercial Architecture of Modern Self-Care

The modern self-care economy sits within this transition.

When Capability Becomes Infrastructure: The Commercial Architecture of the Modern Self-Care Economy:

https://www.gsdiandadvocacy.co.uk/when-capability-becomes-infrastructure-the-commercial-architecture-of-the-modern-self-care-economy

The commercial significance of this architecture lies in the convergence of:

• consumers;
• employers;
• healthcare systems;
• insurers;
• governments;
• technology;
• pharmaceutical companies;
• institutional capital.

Each actor interacts with capability differently.

Consumers seek capability.

Employers seek workforce continuity.

Insurers manage liabilities.

Governments manage population capability and fiscal exposure.

Capital seeks scalable infrastructure.

The market therefore develops around the economic consequences of preserved capability rather than around healthcare expenditure alone.

27. Capability as a Productive Asset

The central economic proposition can now be stated without reference to any particular pharmaceutical product.

Capability is a productive asset.

An economy requires people capable of participating in it.

A firm requires employees capable of performing their functions.

Households require members capable of generating income and managing economic activity.

Institutions require continuity.

Capital requires capable agents through whom it can be deployed.

Technology requires capable users and operators.

Capability therefore sits upstream of multiple forms of economic production.

The economic value of capability does not reside solely in the individual.

It propagates through the systems in which the individual participates.

28. Future Liabilities and Economic Resilience

Resilience is the bridge between capability and future liabilities.

A resilient economic agent retains the capacity to function under changing conditions.

At individual level, this means preserved functional capacity.

At household level, it means preserved participation and financial continuity.

At firm level, it means workforce continuity and reduced disruption.

At system level, it means greater productive resilience.

Health therefore enters resilience economics through capability.

The sequence is:

health → capability → resilience → continuity.

Continuity then affects liabilities.

continuity → fewer disruptions → fewer replacement requirements → preserved productive capacity.

This is the economic mechanism through which health expenditure can become infrastructure.

29. Capital Allocation

Once capability infrastructure is recognised, capital allocation changes.

The relevant investment question becomes:

What infrastructure preserves productive capacity and reduces future liabilities?

This includes physical infrastructure.

It also includes human capability infrastructure.

The Network's wider capital architecture addresses this relationship.

The Capital-Raising and Execution Architecture for Capability Infrastructure:

https://www.gsdiandadvocacy.co.uk/appendix-the-capitalraising-and-execution-architecture-for-capability-infrastructure

Why We Are Catalytic Capital:

https://theglobalstructurenetwork.com/f/why-we-are-catalytic-capital

This paper does not reproduce that capital architecture.

Its purpose is narrower.

It establishes the economic rationale for treating capability-preserving systems as a potential field of productive infrastructure.

30. The Intervention

The paper advances one specific analytical intervention.

Health expenditure should be evaluated according to economic function, not merely expenditure category.

The classification should distinguish:

Consumption

Expenditure producing immediate utility.

Health investment

Expenditure increasing or preserving health capital.

Capability infrastructure

Expenditure that preserves or expands the functional capacity required for participation and production.

These categories can overlap.

A single intervention can simultaneously be consumption, health investment and capability infrastructure.

The categories describe different analytical dimensions.

This avoids the false choice between consumption and investment.

31. The Economic Architecture

The full architecture can now be stated:

Self-care preserves health.

Health preserves capability.

Capability produces resilience.

Resilience reduces exposure to future liabilities.

Reduced liabilities preserve productive capacity.

Productive capacity generates economic value.

Affordability determines access to the architecture.

Institutions determine how effectively capability is converted into productive outcomes.

Capital determines whether the infrastructure can scale.

The resulting system is:

Affordability → access → capability → resilience → liability reduction → productive capacity → economic value.

This is the core architecture applied to the Bank of America case.

32. Conclusion

Bank of America's more than $250 million annual expenditure on GLP-1 medicines provides a significant contemporary case of an employer treating health expenditure as investment.

The economic significance of the case does not depend upon accepting the CEO's classification at face value.

It depends upon identifying the mechanism through which health expenditure becomes economically productive.

Grossman's health-capital model provides the foundation.

Becker's human-capital framework establishes the broader economic significance of investment in human attributes.

Teece, Pisano and Shuen establish the organisational capability required to convert resources into institutional outcomes.

Cohen and Levinthal establish the organisational capacity required to recognise, assimilate and exploit valuable resources.

The workplace-wellness literature establishes an essential boundary: health expenditure does not automatically generate economic returns. The JAMA randomised trial found no significant effects on clinical health measures, healthcare spending and utilisation, absenteeism, tenure or job performance after 18 months.

The GLP-1 evidence establishes a different empirical foundation. SELECT demonstrated a 20 per cent reduction in major adverse cardiovascular events among its study population receiving semaglutide.

The remaining economic question is institutional.

Does preservation of health capital preserve capability?

Does preserved capability increase resilience?

Does increased resilience reduce future liabilities?

Do reduced liabilities preserve productive capacity?

Does preserved productive capacity generate economic value?

The Architecture of Capability Economics connects these questions through a single economic sequence:

self-care → capability → resilience → reduced future liabilities → productive capacity → economic value.

This sequence provides the paper's principal contribution.

It changes the analytical object from healthcare expenditure to capability preservation.

It changes the investment question from immediate cost reduction to intertemporal preservation of productive capacity.

It changes the understanding of resilience from a general organisational characteristic to an economic consequence of preserved capability.

It changes the understanding of future liabilities by recognising that economic value exists not only in additional output but also in liabilities that are reduced, postponed or avoided.

It changes the interpretation of the employee from recipient of a benefit to bearer of productive capability.

It changes the interpretation of the employer from purchaser of healthcare to potential investor in workforce capability.

The resulting proposition is precise:

Health expenditure constitutes capability infrastructure where it preserves the functional capacity required for sustained participation and productive activity and thereby changes the future liability and productive-capacity profile of the economic system.

Bank of America's GLP-1 expenditure is therefore an appropriate institutional case through which this proposition can be tested.

The case does not establish the proposition by itself.

The proposition establishes the economic framework through which the case can be understood and empirically evaluated.

The wider implication extends beyond GLP-1 medicines.

Modern self-care, preventive health, health technology, employer benefits and human-capability systems increasingly operate across the boundary between consumption and infrastructure.

The economic question is consequently no longer limited to:

What does health expenditure cost?

It becomes:

What productive capability does the expenditure preserve, what future liabilities does it alter, and what economic capacity remains available as a result?

That is the transition from health capital to capability infrastructure.

Authorial and Doctrinal Position

This paper forms part of the author's wider Architecture of Capability Economics.

The paper does not present the Architecture of Capability Economics as a substitute for established economic theory.

It applies established health-capital, human-capital and organisational-capability theory and introduces capability infrastructure as the integrating analytical category.

The author's broader conceptual architecture is documented through the Global Structure Network.

Message from the Founder:

https://theglobalstructurenetwork.com/message-from-the-founder

The Founder message establishes the wider proposition that self-care can be treated as an architecture of capability, with capability, resilience, participation and long-duration economic value connected across time.

The present paper uses that architecture selectively.

It does not reproduce the full operating system of the Architecture of Capability Economics.

It does not reproduce its measurement system.

It does not reproduce its institutional implementation methodology.

It does not reproduce its capital execution framework.

The public contribution is narrower and more rigorous:

It identifies the economic pathway through which health-preserving expenditure can become capability infrastructure and through which preserved capability can affect future liabilities and productive capacity.

References

Established Academic Literature

Becker, G. S. (1964). Human Capital: A Theoretical and Empirical Analysis, with Special Reference to Education. National Bureau of Economic Research.

Becker, G. S. (1965). 'A Theory of the Allocation of Time'. The Economic Journal, 75(299), 493–517.

Cohen, W. M. and Levinthal, D. A. (1990). 'Absorptive Capacity: A New Perspective on Learning and Innovation'. Administrative Science Quarterly, 35(1), 128–152.

Grossman, M. (1972). 'On the Concept of Health Capital and the Demand for Health'. Journal of Political Economy, 80(2), 223–255.

Full URL:

https://doi.org/10.1086/259880

Grossman, M. (1972). The Demand for Health: A Theoretical and Empirical Investigation. National Bureau of Economic Research.

Grossman, M. (2000). 'The Human Capital Model'. In A. J. Culyer and J. P. Newhouse (eds), Handbook of Health Economics, Vol. 1A, pp. 347–408. Elsevier.

Teece, D. J., Pisano, G. and Shuen, A. (1997). 'Dynamic Capabilities and Strategic Management'. Strategic Management Journal, 18(7), 509–533.

Workplace Health and Wellness Evidence

Baicker, K., Cutler, D. and Song, Z. (2010). 'Workplace Wellness Programs Can Generate Savings'. Health Affairs, 29(2), 304–311.

Full URL:

https://doi.org/10.1377/hlthaff.2009.0626

Song, Z. and Baicker, K. (2019). 'Effect of a Workplace Wellness Program on Employee Health and Economic Outcomes: A Randomized Clinical Trial'. JAMA, 321(15), 1491–1501.

Full URL:

https://doi.org/10.1001/jama.2019.3307

Full PubMed URL:

https://pubmed.ncbi.nlm.nih.gov/30990549/

Full PMC URL:

https://pmc.ncbi.nlm.nih.gov/articles/PMC6484807/

Song, Z. and Baicker, K. (2021). 'Health and Economic Outcomes Up to Three Years After a Workplace Wellness Program'. Health Affairs.

Full URL:

https://pmc.ncbi.nlm.nih.gov/articles/PMC8425177/

GLP-1 and Clinical Evidence

Lincoff, A. M. et al. (2023). 'Semaglutide and Cardiovascular Outcomes in Obesity without Diabetes'. New England Journal of Medicine.

Full URL:

https://www.nejm.org/doi/full/10.1056/NEJMoa2307563

PubMed URL:

https://pubmed.ncbi.nlm.nih.gov/37952131/

Wilding, J. P. H. et al. (2021). 'Once-Weekly Semaglutide in Adults with Overweight or Obesity'. New England Journal of Medicine.

Full URL:

https://www.nejm.org/doi/full/10.1056/NEJMoa2032183

Contemporary Bank of America Evidence

CNBC (2026). Bank of America spends $250 million a year on GLP-1 drugs for its employees, CEO says.

Full URL:

https://www.cnbc.com/2026/08/05/bank-of-america-ceo-glp-1-drugs-cost.html

Fortune (2026). Bank of America is splashing out $250 million a year on weight loss drugs for its staff: 'We see a great impact on employees,' CEO says.

Full URL:

https://fortune.com/2026/08/07/bank-of-america-splashing-out-250-million-a-year-on-weight-loss-drugs-for-staff-great-impact-ceo-says/

Selected Prior Work — Capability Economics

Capability Infrastructure

Capability as Productive Infrastructure.

Full URL:

https://theglobalstructurenetwork.com/f/capability-as-productive-infrastructure

The Capability Infrastructure Field.

Full URL:

https://www.gsdiandadvocacy.co.uk/the-capability-infrastructure-field

The ACE Extension — System Architecture.

Full URL:

https://www.gsdiandadvocacy.co.uk/the-ace-extension--system-architecture

Macroeconomic Theory: Why Capability Is Becoming the World's Most Valuable Productive Asset.

Full URL:

https://papers.ssrn.com/sol3/papers.cfm?abstract_id=7086180

Affordability

Affordability as Economic Freedom.

Full URL:

https://theglobalstructurenetwork.com/f/affordability-as-economic-freedom

SSRN:

https://papers.ssrn.com/sol3/papers.cfm?abstract_id=6470839

The Cost-Stack Economy.

Full URL:

https://theglobalstructurenetwork.com/f/the-cost%E2%80%91stack-economy

SSRN:

https://papers.ssrn.com/sol3/papers.cfm?abstract_id=6471040

The Participation Penalty.

Full URL:

https://theglobalstructurenetwork.com/f/the-participation-penalty

SSRN:

https://papers.ssrn.com/sol3/papers.cfm?abstract_id=6487398

The Competitiveness Dividend.

Full URL:

https://theglobalstructurenetwork.com/f/the-competitiveness-dividend

SSRN:

https://papers.ssrn.com/sol3/papers.cfm?abstract_id=6487540

The Affordability–Productivity Loop.

Full URL:

https://theglobalstructurenetwork.com/f/the-affordability%E2%80%93productivity-loop

SSRN:

https://papers.ssrn.com/sol3/papers.cfm?abstract_id=6545240

The Architecture of Affordability.

Full URL:

https://theglobalstructurenetwork.com/f/the-architecture-of-affordability

SSRN:

https://papers.ssrn.com/sol3/papers.cfm?abstract_id=6545658

The Household Affordability Frontier.

Full URL:

https://theglobalstructurenetwork.com/f/the-household-affordability-frontier

SSRN:

https://papers.ssrn.com/sol3/papers.cfm?abstract_id=6608781

Capability Consumer

The Capability Consumer.

Full URL:

https://theglobalstructurenetwork.com/f/the-capability-consumer

The Consumer-to-Thrive Manifesto.

Full URL:

https://theglobalstructurenetwork.com/f/the-consumer-to-thrive-manifesto

From Household Capability to Financial Value.

Full URL:

https://theglobalstructurenetwork.com/f/from-household-capability-to-financial-value

Capability and Mobility

Mobility Escalators, Mobility Traps and Capability Throughput.

Full URL:

https://theglobalstructurenetwork.com/f/mobility-escalators-mobility-traps-and-capability-throughput

Capability Economy

From the Experience Economy to the Capability Economy.

Full URL:

https://www.gsdiandadvocacy.co.uk/from-the-experience-economy-to-the-capability-economy

Health and Self-Care

Health Resilience as Infrastructure.

Full URL:

https://theglobalstructurenetwork.com/f/health-resilience-as-infrastructure

When Capability Becomes Infrastructure: The Commercial Architecture of the Modern Self-Care Economy.

Full URL:

https://www.gsdiandadvocacy.co.uk/when-capability-becomes-infrastructure-the-commercial-architecture-of-the-modern-self-care-economy

Capital Architecture

Why We Are Catalytic Capital.

Full URL:

https://theglobalstructurenetwork.com/f/why-we-are-catalytic-capital

The Capital-Raising and Execution Architecture for Capability Infrastructure.

Full URL:

https://www.gsdiandadvocacy.co.uk/appendix-the-capitalraising-and-execution-architecture-for-capability-infrastructure

Structural Reconstruction

The Invasive Reconstruction.

Full URL:

https://theglobalstructurenetwork.com/f/the-invasive-reconstruction

About This Publication

This briefing is produced within the Global Structure Network research framework and forms part of the Network's continuing programme of research on structural economic architecture, institutional design, capability formation, and capital-system analysis.

The publication is situated within a broader body of research examining how affordability, capability, participation, and capital-environment structures influence long-term economic performance, productive capacity, institutional resilience, and economic value.

The present paper applies that research architecture to employer health expenditure and examines the proposition that expenditure which preserves health-related capability can alter future liabilities and preserve productive capacity.

The paper's empirical and theoretical foundations remain the established academic literature cited in the main body and references. The Architecture of Capability Economics constitutes the author's integrating framework through which those established fields are connected.

Author and Research Framework

Gary — Founder and Architect, The Global Structure Network Limited

Message from the Founder:
https://theglobalstructurenetwork.com/message-from-the-founder

LinkedIn (Network):
https://www.linkedin.com/company/the-global-structure-network/

The Global Structure Network research programme is organised as a layered body of work concerning institutional structure, economic capability, capital environments, and the mechanisms through which economic capacity is formed, preserved, constrained, and converted into value.

1. The Hybrid Theory of the Corporate Form

This foundational body of research develops a structural account of corporate form, property relations, and institutional power within UK company law. It provides the legal-institutional layer through which corporate agency is situated within broader capital-system architecture.

Property, Power, and the Corporate Form: A Hybrid Theory of UK Company Law (SSRN, 2026)
https://papers.ssrn.com/sol3/papers.cfm?abstract_id=6339778

Extended discussion:
https://www.gsdiandadvocacy.co.uk/property-power-and-the-corporate-form-a-hybrid-theory-of-uk-company-law

2. The Doctrine of the Architecture of Capability Economics (ACE)

The Architecture of Capability Economics develops capability as an economic variable and examines affordability, participation, constraint, and productive capacity as interconnected structural conditions.

The framework treats capability as an infrastructural economic condition rather than solely as a behavioural outcome.

Doctrine of ACE:
https://theglobalstructurenetwork.com/f/doctrine-of-the-architecture-of-capability-economics

Unlocking Value Under Economic Constraint:
https://theglobalstructurenetwork.com/f/unlocking-value-under-economic-constraint

The Capability Infrastructure Field:
https://www.gsdiandadvocacy.co.uk/the-capability-infrastructure-field

The ACE Extension — System Architecture:
https://www.gsdiandadvocacy.co.uk/the-ace-extension--system-architecture

ACE System Architecture Registry:
https://www.gsdiandadvocacy.co.uk/ACE

3. Capital Environment Theory (CET)

Capital Environment Theory extends the research architecture into the analysis of capital-system environments and institutional competitiveness.

It examines how jurisdictional structures, regulatory systems, and capital-allocation environments influence long-term economic positioning and structural advantage.

The Banner of Capital and the Capital Environment: Foundations of Capital Environment Theory (SSRN Working Paper No. 6827759):

https://papers.ssrn.com/sol3/papers.cfm?abstract_id=6827759

Expanded version:

https://www.gsdiandadvocacy.co.uk/the-banner-of-capital-and-the-capital-environment-foundations-of-capital-environment-theory-cet

CET complements the Architecture of Capability Economics and the Hybrid Theory of the Corporate Form by extending the analysis from corporate structure and household capability into system-level capital environments and competitive jurisdictional dynamics.

4. The Capability Consumer

This body of research develops the consumer as a capability-producing unit within the broader Capability Economy.

It provides a behavioural and systemic bridge between household-level capability formation and the measurement, allocation, and economic valuation of capability infrastructure.

Macroeconomic Theory: Why Capability Is Becoming the World's Most Valuable Productive Asset (SSRN, 2026):
https://papers.ssrn.com/sol3/papers.cfm?abstract_id=7086180

The Capability Consumer:
https://theglobalstructurenetwork.com/f/the-capability-consumer

The Consumer to Thrive Manifesto:
https://theglobalstructurenetwork.com/f/the-consumer-to-thrive-manifesto

From Household Capability to Financial Value:
https://theglobalstructurenetwork.com/f/from-household-capability-to-financial-value

Island of Conscious Consumer Power:
https://www.gsdiandadvocacy.co.uk/the-global-structure-network-limited-and-the-global-structure-diamond-international-and-advocacy-stand-as-islands-of-conscious-consumer-power-amidst-a-sea-of-transactions-across-the-global-consumer-la



5. Capability Infrastructure Field — Applied System Layer

The Capability Infrastructure Field operationalises the Architecture of Capability Economics as an applied structural framework.

It defines the relationship between:

• household capability formation;
• affordability as a binding constraint;
• systemic friction and economic drag;
• participation capacity; and
• economic resilience.

Within this framework, capability is treated as infrastructural rather than merely consumptive, while households are treated as primary units of economic resilience and productive participation.

The Capability Infrastructure Field:
https://www.gsdiandadvocacy.co.uk/the-capability-infrastructure-field

6. C2T Exchange — Capability Market Infrastructure

The C2T Exchange represents the applied market architecture of the Capability Infrastructure Field.

It operationalises the Architecture of Capability Economics through a structured capability marketplace designed to connect household resilience, participation capacity, affordability, and long-term economic outcomes.

The system is founded on the proposition that affordability constitutes a structural constraint on participation rather than merely a distributional outcome. The Exchange therefore provides an applied mechanism through which capability can be represented, measured, allocated, and aligned with economic outcomes.

Capability Clearinghouse — C2T Marketplace:
https://theglobalstructurenetwork.com/f/the-capability-clearinghouse-the-c2t-marketplace

Registry and Governance

© 2026 Global Structure Network (GSDI & Advocacy)

Doctrinal Integrity Registry:
https://theglobalstructurenetwork.com/doctrinal-integrity