Expert Commentary

Global health 2035: A world converging within a generation

2013 report for The Lancet that quantifies the future of global health and development and maps out how progress might be achieved through investments.

Prompted by deepening concerns over poverty and global inequality, the U.N. General Assembly in 2000 adopted the Millennium Development Declaration, putting forward a series of goals which were meant to be achieved by 2015. Core issues included improving global health, including reducing child mortality, improving maternal health and combating HIV/AIDS and other diseases.

Some progress has been made since, but most of the outstanding problems are still far from being resolved. As the 2015 deadline of the Millennium Development Declaration approaches, the U.N. General Assembly in September 2013 proposed scaling up interventions to achieve the goals articulated in 2000. What remains contested is how best to intervene to meet the Millennium Development Goals and drive development.

A December 2013 research report tries to answer this question. Chaired by Harvard’s Lawrence Summers and the University of Washington’s Dean Jamison, a commission of 25 experts on economics and health authored “Global Health 2035: A World Converging Within a Generation,” which was published in The Lancet. The report follows up on the World Bank’s influential World Development Report from 1993, which focused on global health 20 years ago. The new report is one of the most rigorous attempts to quantify the future of global health and development and map out how progress might be achieved.

Based on new insights from health economics, the report aims to better quantify the value of investing in global health. The researchers measure its contribution to a nation’s economic well-being by calculating the value of additional life-years — called a “full-income approach.” The economic benefits of health in a particular country or region are approximated by calculating the value of additional life-years gained — the increase in life expectancy.

The authors note that this measurement is highly sensitive to how changes in child mortality are calculated. The more-conservative method used by the researchers follows formulas used by the Institute of Medicine, which values reductions in child mortality at half the life-years gained from those reductions. Based on this quantitative design, the authors conduct a cost-benefit analysis for the “convergence” — a pattern of more equal outcomes — between high-mortality and low-mortality countries by 2035.

The key results from the study include:

  • The economic benefits of improved health are far greater than previously estimated. The authors find that across low-income and middle-income countries “health contributes to annual growth in full income by about 1.2% per year of the initial value of GDP for the period 1990-2000 and 1.8% per year in the period 2000-2011.” Thus, “between 2000 and 2011, about 24% of the growth in full income in low-income and middle-income countries resulted from health improvements.”
  • In the last 20 years some low- and middle-income countries, including Chile, Costa Rica, Cuba and China, have succeeded in dramatically improving health. These countries have narrowed the gap in preventable mortality and infection within low-mortality countries. For the majority of low- and middle-income countries, the current mortality gap remains substantial, however. It constitutes 19.5 years of life expectancy lost for low-income countries, 9.9 years of life expectancy lost for lower-middle income countries and 5.8 years of life expectancy lost for upper-middle income countries.
  • The researchers find that if low- and lower-middle income countries increased health-systems investments to reduce infections and improve reproductive, maternal, newborn, and child health, they could follow the trajectory of Chile, Costa Rica, Cuba and China by 2035. The benefits of such policies would exceed their costs by a factor of about nine in low-income countries, and by a factor of 20 in lower-middle-income countries, as measured by full-income calculations.
  • Successfully tackling infectious and reproductive, maternal, newborn and child health diseases accelerates the shift in disease burden to non-communicable disease and injuries of adults. This is shown, for example, in the increasing significance of smoking and high blood pressure in China. “As incomes rise, the proportion of deaths from cancers increases steadily, while the share from AIDS, tuberculosis, malaria, diarrhea and lower respiratory infections decreases.” Indeed, “On the basis of evidence from more than 100 studies, including those undertaken in low-income and middle-income countries, the single most important opportunity for national governments worldwide to curb [non-communicable diseases] is to tax tobacco heavily.”

Ultimately, the experts recommend increasing spending on both “crucial health system components,” for example, health care workers, and research and development in health fields. The total annual cost of funding these interventions — with costs going up over time — among low-income countries would be $23-$27 billion, and would be $38-$54 billion among lower-middle-income countries. “Economic growth in many low-income and middle-income countries is enabling resource mobilisation for health,” they conclude. “With the digital revolution, we envision acceleration in the spread of health knowledge among the public and health workers and in the dissemination of policies that allow national decision makers to fully reap the fruits of global science.”

The authors acknowledge some uncertainty in their estimates, but state that “our report points to the possibility of achieving dramatic gains in global health by 2035.” They conclude that bringing an end to the differences in infectious, maternal and child death rates between countries of differing income levels is within reach. “Good reasons exist to be optimistic about seeing the global health landscape completely transformed in this way within a generation.”

Keywords: global health, millennium development goals, poverty


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