June 04, 2014
Six months ago, the Lancet Commission on Investing in Health released its report Global Health 2035: A world converging within a generation. The Commission makes the case for world leaders, governments, and donors to not only continue investing in health, but to increase investments and capitalize on the unique opportunity to achieve a grand convergence in health by 2035. Since its launch, Global Health 2035 has attracted the attention of governments and development organizations around the world, and commissioners have been invited to discuss the report’s findings at Davos, the World Bank and the International Monetary Fund.
CDDEP spoke with Gavin Yamey, one of the report’s commissioners and an associate professor of Epidemiology & Biostatistics at the University of California-San Francisco School of Medicine, about the report’s reception among the global health community.
CDDEP: Presentations on Global Health 2035 have now taken place at important international forums, including Davos, the IMF and the World Bank. What has been the reaction from potential investors in global health?
GAVIN YAMEY: The most important investors are Ministries of Finance and we are hoping that the report’s message on the value of investing in health resonates with finance ministers. We’ve so far had very positive reactions.
In his presentation at the World Bank, Commission Chair Lawrence Summers said the report’s findings should matter to ministers of finance who care and to ministers of finance who count. Obviously there s a moral case for improving the health of your nation, but there’s also a very solid economic case for investing in health.
The returns on investing in health are extraordinary. If you use so-called full-income approaches to valuing investment in health, every dollar spent on achieving grand convergence between 2015 and 2035 will generate a return of between $9 and $20. We know of no other development investment with such high returns. It’s a once-in-human-history opportunity to achieve a closing of the health gap one that, once closed, will hopefully never reopen.
CDDEP: How have members of the global heath community reacted to the report’s recommendation that governments take fiscal interventions, such as taxing tobacco and alcohol?
GAVIN YAMEY: There has been tremendous excitement and enthusiasm for the report’s incredibly bold stance on fiscal reasons for such taxes. We make a point that fiscally the taxation of tobacco and alcohol and the removal of subsidies on fossil fuels are arguably the most powerful and underused lever for preventing non-communicable diseases (NCDs). NCD rates in many cases are now higher in poorer countries.
What is extraordinary about something like tobacco taxation is that the benefits are enormous and not only in terms of health benefits. The revenue generation is extraordinary and countries are looking for new ways to fund their health interventions. So something like the tobacco tax can provide benefits on many levels.
For example, in our report we draw on modeling that shows that using a tax to increase the price tobacco in China by 50% could prevent 20 million deaths and save $20 billion per year over the next 50 years. Eventually, as smoking hopefully declines, that additional revenue would also decline, but it would still be higher than current levels even after 50 years.
What s absolutely crucial is that the poor benefit the most. Some people believe that tobacco taxation is regressive. They say the poor get pleasure from smoking and adding a tax means removing that pleasure. But the report has shown convincingly that the highest percentage of life years gained is in the bottom income quintile. So it’s the poorest who receive the most benefit. As I view it, this is absolutely a pro-poor intervention.
CDDEP: The report draws attention to the need for more research into strategies to combat antimicrobial resistance, stating that the international community can best support convergence by funding the development and delivery of new health technologies and curbing antibiotic resistance. Have governments and international organizations responded to this particular subject? GAVIN YAMEY: We’ve seen enormous support and tremendous amounts of excitement and energy surrounding that point. Not surprisingly, it is a message that has resonated very strongly with groups that have long been campaigning to increase the paltry amount of funding being put towards diseases that disproportionately affect the poor.
Now that we are in Phase II of the plan, we are examining how to implement some of the report s recommendations. We have a series of working groups: one on international collective action; one on national government action; and one on population policy implementation. The group on international collective action is looking at the crucial role of research and development (R&D). The predictions laid out Global Health 2035 for economic growth in low- and middle-income countries is very impressive.
It’s likely that the increase in GDP in these countries will mean that they can fund much of the convergence themselves.That does not mean that the international community should retreat from global health. In fact, we recommend that they should increase their involvement and, over time, they should focus on global public goods, the management of cross-border externalities, and leadership and stewardship the three so-called core functions of global health.
Our message on R&D is a very strong one. Right now spending is at only $3bn a year. We argue that that should be doubled by at the latest 2020 and that half of this should come from MICs. Finding better technologies, tools and interventions to help close the gap, particularly for people in poor, rural areas of middle-income countries, is going to be crucial.
CDDEP: The 1993 World Development Report (WDR 1993) gained a significant amount of criticism after its release. Since the formation of the Lancet Commission on Investing in health was prompted by the 20th anniversary of WDR 1993, did Global Health 2035 encounter similar problems?
GAVIN YAMEY: In the report we look back on WDR 1993 partly to learn lessons and partly to see whether the predictions in that report were borne out. What did it get right, what did it get wrong? We were very honest in acknowledging some of the criticisms that WDR 1993 received and tacking them head-on.
This time around, Global Health 2035 is a very visionary and very inclusive roadmap to improvement. It doesn’t pit different disease communities against each other and it’s very cross-cutting in nature. It makes the point that you can’t reach universal health coverage without public sector investment. It has as its heart a focus on the poor.
In the end, we didn’t receive the kinds of criticism that WDR 1993 received. I think that’s because we didn’t shy away from examining the legacy of WDR 1993.
