The world’s poorest nations would boost growth by almost a quarter and attain health standards and life expectancies comparable to those of wealthier mid-ranking countries if a concerted effort was made to invest in health systems, a landmark report concludes.
Written by a group of 25 leading health experts and economists from across the globe and chaired by Larry Summers, a Harvard economist and former adviser to the Obama and Clinton administrations, the Lancet Commission report says “health disparities between nations could be eliminated within a generation” if around $60bn (£37bn) a year was injected into healthcare systems.
In the year 2035 alone, roughly 10 million lives could be saved in low-income and middle-income countries, “eliciting enormous social and economic gains for the countries most affected”.
The commission said the poorest nations in the world would see economic gains by bringing down mortality levels from maternal and childhood conditions, TB and Aids, to those achieved by the best-performing middle-income countries: Chile, China, Costa Rica, and Cuba, labelled the “4C” countries.
In an interview Summers acknowledged that not enough progress had been made in global health – the rate of decline in maternal and child mortality in the developing world will not be sufficient to reach the United Nations’ millennium development goals by 2015.
However, he said that “any goal you are sure to meet is not a goal worth setting … I think we have set an aspiration that is very much achievable”.
The “convergence plan” is summarised by the commission as “16-8-4″ – reducing under-five mortality to 16 per 1,000 live births, cutting annual Aids deaths to eight per 100,000 population and bringing down annual tuberculosis (TB) deaths to four per 100,000 population.
The commission warned that provision of public health goods would need to “regain prominence” for the strategy to succeed. In 1990, only $47bn was spent on health research worldwide. By 2009, annual funding had risen to $248bn, of which 60% came from the business sector and was mostly targeted at developed-world conditions such as cancer.
Only about $3bn, representing just 1% of total spend, is spent annually on R&D for infectious diseases – of particular concern to low-income and middle-income countries. “Clearly resources should not just be driven by commercial priorities,” Summers said, echoing the report’s conclusion that research budgets in this area needed to double.
Not only are the wrong diseases targeted but underfunding of global institutions remains a worry. Since 1994, the World Health Organisation‘s budget has decreased steadily in real terms and the organisation is struggling to pay to run its offices. The WHO’s entire influenza budget in 2013 is just $7.7m – less than a third of what New York devotes to preparing for public health emergencies.
“The global system is very much frayed,” said Summers, adding that the issue needed to be improved on.
Some poorer nations have been reaping economic growth today through health gains made in the past. The rates of increase in life expectancy in the second half of the 20th century in countries such as China and Mexico were at least twice as fast as those that occurred in high-income countries in the same period, said the commission.
The commission also said the value of a one-year increase in life expectancy in the low- and middle-income countries was estimated to be 2.3 times per capita income.
Summers said calculations showed that “between 2000 and 2011, about 24% of the growth in full income came from health gains” and if the poorest countries could continue this trend this fraction “was a reasonable estimate (for the future). I think it’d be somewhat more if the full programme was adopted”.
A cost-benefit analysis by the commission reveals that spending an extra $25bn in the poorest nations would cost just $23 a head but yield $216 per capita increase in economic growth.
“We think that there is an extraordinarily high return from these investments,” said Summers. “The benefits outweigh the costs nine times in low-income countries and 20 times in lower middle-income countries.”
He said the estimated $60bn a year in funding was “a lot of money but (had to be) compared to the growth in income that is expected”. Summers pointed out that given the lingering effects of recession in the west rising powers such as China would play a much greater role in aid provision in the decades ahead.