A really interesting and thoughtful piece by Dr Charles Clift at the Chatham House Centre on Global Health Security on the new Lancet commissioned report Global 2035: A World Converging Within A Generation (you will need to register to gain access to the full report).
He provides nice summary of the issues in the report and its historical context as a successor to the World Bank's 1993 Report Investing in Health.
My three take aways:
The report’s key innovation (akin to the DALY) is to support and popularize the concept of ‘full income’ – adding to conventional national income measures a valuation of the increase in life expectancy. On that basis it estimates that, between 2000 and 2011, 24 per cent of the growth in ‘full income’ in low and middle income countries was due to health improvements, equivalent to a 1.8 per cent per annum addition to GDP growth. Based on this methodology it concludes that ‘there is a very large payoff from investing in health’.
Its other big idea, captured in the title, is that with rising incomes in the developing world and continued improvements in health and delivery technologies, an achievable goal for nearly all countries in 2035 is to bring down infection, maternal and child mortality rates to the current levels of the four best performing middle income countries (Chile, China, Costa Rica and Cuba).
The Lancet also provides commentaries on the report by three global health leaders – Richard Horton (Lancet editor), Margaret Chan (WHO) and Mark Dybul (Global Fund) and heads of two key development institutions (Jim Kim of the World Bank and Helen Clark of the UN Development Programme). While the first group is largely favourably disposed, the latter two both focus on the commission’s failure to address the social and economic determinants of health. The report essentially argued that there are ‘complex and entrenched political obstacles’ to addressing them so it is better to focus on the health sector where a more immediate impact can be realized.
Kim and Clark argue strongly against this – they contend that there needs to be a balance between investments inside and outside the health sector if the goal of improving health is to be achieved. The global health community will need to heed these words if it wishes to find a proper place for health in the post-2015 development agenda.
I thought it ironic that the WB and UNDP (to a lesser extent) were advocating for a social determinants of health approach to the report (while the report authors were justifying why they didn't in the report)!
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