Grand convergence in global health is realisable
THE world is at a historical inflection point. By making today’s medicines, vaccines, and other health tools universally available — and by stepping up research efforts to develop tomorrow’s health tools — we could close the health gap between rich and poor countries within a generation.
By 2035, we could achieve a "grand convergence" in global health, reducing preventable maternal and child deaths, including those caused by infectious diseases, to unprecedentedly low levels worldwide. What it will take is a co-ordinated, future-oriented investment strategy.
Twenty-five global health and economics experts (including us) came together to devise such a strategy. Over a year, the group identified the tools, systems, and financing needed to achieve global health convergence, and produced Global Health 2035 — an ambitious investment blueprint that would save millions of lives and bolster human welfare, productivity and economic growth.
With aggressively scaled-up health investments, 10-million lives could be saved annually, beginning in 2035. The economic payoff would be enormous: every dollar invested in low-and middle-income countries (LMICs) to achieve this grand convergence would return $9-$20.
Success will require a global commitment to ensuring that everyone can access today’s powerful health technologies and services, like childhood vaccines, treatment for HIV/AIDS and tuberculosis, and prenatal care for pregnant women. It will require more funding for the development of new health tools to redress the conditions that disproportionately kill women and children in LMICs.
A central feature of the convergence strategy is family planning. More than 220-million women lack access to modern contraception, an inexcusable situation given that scaling up family planning would be remarkably simple and cheap. And the benefits would be vast. For a start, better access to contraception would prevent an estimated one-third of all maternal deaths, and would have a particularly large effect among those at highest risk. These include 15-19-year-olds in poor countries, who have the least access to contraception, and women who have multiple pregnancies in quick succession, by allowing them to space out their pregnancies. By reducing the rate of unwanted pregnancies, family planning also decreases deaths from unsafe abortions.
This is not only good for mothers. Reducing high-risk pregnancies, curbing unwanted pregnancies and spacing out births have been shown to decrease newborn and child death rates. The Guttmacher Institute estimates that fully meeting women’s need for contraception would prevent 600,000 newborn deaths and 500,000 child deaths annually.
Moreover, cutting birth rates, which are very high in many LMICs, would help to reduce the strain on these countries’ health-care systems by diminishing the costs of maternal and newborn care and immunisation. At the same time, it would facilitate social change that fuels higher productivity and output.
A study co-ordinated by the World Health Organisation shows the economic return from scaling up contraception in 27 countries with very high birth rates, such as Afghanistan and Chad, would exceed 8% of gross domestic product (GDP) from now until 2035.
So, how much would it cost to ensure universal access to modern medicine and health services? Global Health 2035 puts the total at an additional $70bn a year, with $1bn of this increase allocated to family planning alone. But most of the costs can ultimately be covered by LMICs themselves.
In fact, the total bill for global health convergence amounts to less than 1% of the additional GDP that these countries are expected to generate in the next two decades. In other words, public investment of less than 1% of GDP could prevent a vast 10-million deaths each year.
• Yamey is a professor in the Global Health Group at the University of California, San Francisco. Saxenian is a consultant at the Results for Development Institute, Washington, DC.