On the 20th anniversary of “Investing in Health,” the World Bank’s 1993 World Development Report (WDR 1993), a team of 25 global health and economic experts met to discuss the future of global health investment.
Lawrence Summers, the World Bank’s Chief Economist, and Dean Jamison, author of WDR 1993, led the commission, which took place in Davos, Switzerland at the World Economic Forum conference. The commission united behind the notion that dramatic improvement in health outcomes for impoverished and middle-income countries is not only possible, but also a moral imperative.
Mr. Summers explained that the Global Health 2035 initiative is a “once-in-human-history opportunity” and “the morally right thing to do.”
The commission’s findings, published in The Lancet medical journal, boil down to four messages that make a strong case for investing in health outcomes.
Returns on Investment in Global Health Have Been Underestimated
Low and middle-income nations crippled by disease stand to gain economically from improved health outcomes. Increased productivity due to decreased mortality represents an estimated 11% of all economic growth nationwide in developing countries.
That said, the value of additional life-years (VLYs) resulting from better health has gone previously unaccounted for in the economic analyses that determine health-related financing. The commission found that people are more willing to trade away income, convenience and pleasure for the possibility of an improved life span. Global Health 2035’s report lays out a “full income” yardstick for measuring economic growth with both national income and VLYs.
Since VLYs account for nearly 25% of economic growth in low-income and middle-income nations, applications of the “full income” model will bolster arguments for investment in global health.
Drastic Improvements in Global Health are Possible by 2035
A “grand convergence” in global health can be achieved by 2035, thanks to the financial and technological capability of this generation. The convergence entails a reduction in infectious disease as well as child and maternal mortality in impoverished countries to the levels currently seen in middle-income countries.
Achieving this milestone would save approximately 10 million lives and generate economic benefits (through VLYs and national income) that would offset all costs by a factor of 9-20 – a “highly attractive” investment according to Dr. Summers’ commission.
The report recommends doubling international funding for research and development specific to diseases affecting low-income countries. Arriving at the 6 billion annual funding goal by 2020 will ensure that global health’s core functions remain a priority for investors.
Fiscal Policies Should be Employed to Control Diseases and Injuries
Non-communicable diseases and injuries can be prevented inexpensively through fiscal policies. Taxes on tobacco products, cut backs on subsidies to fossil fuels and investments in health systems would improve the non-communicable disease burden and generate revenue.
The international community can provide technical support to the governments of developing nations to promote cooperation and guide policy implementation. Guidance in these areas would allow governments to profit from fiscal policies that promote healthier lifestyles and reduce the burden on healthcare professionals treating the illnesses and injuries that result from some risky behaviors.
Universal Health Care is Achievable through Progressive Universalism
A pathway called progressive universalism is a stepping stone for nations en route to universal health care (UHC), often considered the gold standard scenario in public health. In this pathway, publicly funded insurance programs would cover all essential health care needs, injuries and non-communicable diseases. Since these health issues disproportionately affect the poor, impoverished and developing nations stand to benefit from a transition to progressive universalism.
National governments would profit from “high health gains per dollar” by providing coverage and financial protection through this pathway.
The Good News
The four pillars of Global Health 2035’s recommendations are achievable in the next two decades, provided that the international community embraces a modern approach to calculating returns on investment in global health and responds accordingly. A 3 billion increase in annual investments may seem substantial in comparison to current funding, but the world’s best and brightest economists ensure that the rewards far outweigh any and all risks.
Global Health 2035 is the road map that will lead the world to a healthier, more productive and profitable future.
– Casey Ernstes