Interview: Sir George Alleyne

CDDEP recently spoke with Sir George Alleyne about the findings of the Lancet Commission on Investing in Health‘s report Global Health 2035: A World Converging within a Generation. In addition to being a former director of the Pan American Health Organization, Dr. Alleyne is a member of the Lancet commission and the chair of CDDEP’s Board of Directors.

CDDEP: What can low- and middle-income countries do to address antimicrobial resistance and how is that covered in the report?
SIR GEORGE ALLEYNE: Antimicrobial resistance has come into the report as one of the major health challenges we need to address in the near future. We point out that in addition to the unfinished agenda of the communicable diseases and injuries, critical problems to be addressed in the future are non-communicable diseases and injuries, the threat of epidemic influenza and the very real and present challenge of antimicrobial resistance.
While antimicrobial resistance is not dealt with in detail we are suggesting that some of the same measures being put in place to provide universal health coverage and tackle non-communicable diseases are also appropriate for addressing antimicrobial resistance. But the report was very conscious of the importance of antimicrobial resistance and the need for countries to be alert and put in place plans to deal with it with some degree of urgency.

CDDEP: What recommendations has the report made for the BRIC countries specifically, if any?
SIR GEORGE ALLEYNE: I don t recall any specific recommendations for the BRIC countries. This classification is becoming less and less relevant because so many other countries are advancing rapidly toward self-sufficiency.We address what low- and middle-income countries might do in terms of achieving convergence, which we explain in the report is desirable and feasible with the appropriate investment. But let me stress that some of the recommendations made, for example with regard to universal health coverage, are applicable to all countries regardless of their stage of development.

CDDEP: One major recommendation of the report is improving access to care and universal health coverage. How is it suggested that investments be changed to achieve that?
SIR GEORGE ALLEYNE: Investments have to be made to increase the extension of services of quality and ensure financial protection, which represent the essence of universal health coverage. The report was very clear that universal health coverage is an important goal, but the ultimate outcome is to improve the health of the population. Universal health coverage, therefore, is a means to achieving this improved population health.
One of the important aspects of this is the improvement in the health delivery systems; if you re to speak about implementing universal health coverage, you have to find methods that will have the appropriate interventions to reach the right populations. We need to talk about the appropriate delivery systems to reach the populations that need them. The report discusses the financing of universal health coverage in depth and opts for what is described as progressive universalism as a route to universal health coverage.

CDDEP: What recommendations are made with regard to legislation and taxation that might disincentivize unhealthy behaviors?
SIR GEORGE ALLEYNE: What the report says is that governments essentially have three instruments at their disposal for modifying policy: taxation, legislation and regulation. The desirable policy changes relate to many of the risk factors of non-communicable diseases. The changes in these risk factors involve individual agency, but in addition the government can modify the environment through use of these instruments to make the healthy choice the easy choice. Take foods, for example: these policies can be useful in altering the consumption of various foods.

CDDEP: How does the report address the increasing dual burden of disease in low- and middle-income countries?
SIR GEORGE ALLEYNE: The most fundamental change has been a shift in terms of the disease burden from communicable diseases to non-communicable disease, leaving many transitioning countries with a dual burden of disease. As the report points out, the idea that non-communicable diseases are only diseases of the wealthy is a fallacy. They are increasingly common among the poor, the majority of whom do not live in the poorest countries.
The report provides specific recommendations for addressing the new challenges while urging that the there is an unfinished agenda still to be addressed with tools that we know are effective. One of the main conclusions of the report is that it is feasible with the financial and technical capacity at our disposal to reduce rates of these infectious diseases, as well as child and maternal mortality, to rates currently being obtained in the best-performing middle-income countries. This is the convergence to which I referred.