Achieving a Grand Convergence in Health by Focusing on TB and Child Survival

20 Dec 2013

RESULTS UK Health Advocacy Officer, Megan Wilson-Jones reflects on the findings of the Lancet Commission on Investing in Health, launched in London on 3rd December 2013.

Earlier this month, distinguished global health professionals convened in London’s Royal College of Physicians to attend the launch of the Lancet Commission on Investing in Health - Global health 2035: a word converging within a generation.

Lancet

The report was prompted by the 20th anniversary of the highly influential 1993 Word Development Report (WDR) of the World Bank, which introduced an economic logic for investing in health for development. It was the first report that highlighted the role of health in economic development and was unique in being targeted towards Heads of State and Finance Ministers around the world, beyond just focusing on the health community. This was particularly important since more often than not it is the Finance Ministers who will make important decisions regarding health and budget allocations.

In the wake of the 1993 WDR anniversary, authors Dean Jamison and Lawrence Summers, decided to revisit their work by convening 25 distinguished commissioners to review the latest evidence. The timing was appropriate given the growing body of evidence, but also the vastly different landscape of global health today in comparison to 20 years ago. The 25 commissioners were tasked with developing a new investment framework which aims to deliver dramatic health gains by 2035.

During the launch, the commissioners reinforced the economic case for investing in health for development and poverty elimination. However, a major progression in this rationale was introduced through the concept of including the value of health in and of itself when measuring returns on health investment. Traditionally, health economists tend to focus on capturing the benefits resulting from improved economic performance, while failing to capture the intrinsic value that we as individuals place on increasing our own life expectancy. By using a country’s “full income” -  income growth plus the value of additional life-years - this offers a more comprehensive understanding of the value of investments in health. According to the report, using a country’s “full income”, investing in health over the period 2015 to 2035 would return between $9-20 for every $1 invested – a major return in investment.

The report set out to introduce the concept of a “grand convergence” in health within our lifetimes – the notion that we collectively have the financial resources and technical “know-how” to reduce infections, child and maternal mortality rates, and incidence and consequences of non-communicable diseases in low-income and middle-income countries to the levels seen in high-performing middle-income countries by 2035. The authors explain that by focusing on these key areas of health, we would be able to reduce mortality outcomes to those seen in the best performing middle-income countries, conveniently titled the “4C’s” – Chile, China, Costa Roca and Cuba. It is estimated that by achieving convergence in 2035, this would save 10 million lives in that year.

The 2035 “grand convergence” goals are summarised as “16-8-4” referring to; reducing under-5 child mortality to 16 per 1,000 live births, reducing annual AIDS deaths to 8 per 100,000 and reducing annual TB deaths to 4 per 100,000. The emphasis on these health issues aligns with RESULTS UK health work which is underpinned by our focus on TB and child survival, including nutrition. This further illustrates that by prioritising these health areas, this has important implications for improving overall health outcomes and advancing economic development in the poorest countries to those seen in the best performing middle-income countries - an achievable and realistic target within our lifetime.

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