A private health centre in Kibera in Nairobi, Kenya: Health disparities between nations could be eliminated in a generation.
A new report by health and economic experts on investing in health and health financing says that developing countries could see dramatic health and economic improvements by 2035, if the right investments are made today.
If the report’s recommendations for increased global investment in health are followed, the authors estimate that in the year 2035 alone, roughly 10 million lives could be saved in low-income and middle-income countries, bringing enormous social and economic gains for the countries most affected.
Through an ambitious, but feasible, investment plan, authors show how governments and donors could achieve a “grand convergence” by bringing preventable infectious, maternal, and child deaths in all countries down, to the levels currently seen in the best-performing middle-income countries, within a generation.
The ‘Global Health 2035: A World Converging within a Generation’ report has been written by a group of 25 leading global health experts and economists from across the globe, to commemorate the 20th anniversary of the 1993 World Development Report, a publication which aimed to help governments and development partners make choices in how best to allocate scarce resources.
“Now, for the first time in human history, we are on the verge of being able to achieve a milestone for humanity: eliminating major health inequalities, particularly inequalities in maternal and child health, so that every person on earth has an equal chance at a healthy and productive life…It is our generation’s unique opportunity to invest in making this vision real,” says Professor Lawrence H. Summers of Harvard University, the group’s chair.
The authors urge governments and donors to continue investing in health and to incorporate the “grand convergence” into the post-Millennium Development Goals Framework. Further, they recommend to policymakers to adopt a “full income” approach to measuring national income, combining growth in national income (GDP) with the value people place on increased life expectancy (the value of their additional life years or VLYs). Calculated using the full income approach – as increasingly advocated by economists – the benefits of achieving the grand convergence will exceed costs by a factor of 9-to-20 for low-income and lower-middle-income countries from 2015 – 2035.
Margaret Chan, Director General of World Health Organisation, says the concept of “convergence” proposed by the report is helpful as a trajectory against which to track future progress.
“The report’s conclusions on non-communicable diseases (NCDs) are most welcome, particularly the need for policy responses across government,” she said. However, she points out that achieving a coherent response across societies remains a key challenge in global health governance.
This is best exemplified in Kenya where a 2009 Modes of Transmission analysis by National Aids and Sexually Transmitted Infections Control Programme and World Bank estimated that female sex workers, men having sex with men and injecting drug users contribute 33% of new HIV infections, yet the Kenyan government has proposed amendments to the Public Benefits Organisation Act, which will limit funding to the civil society, which contribute 40% in the fight against HIV/Aids.
Different government agencies seem to be working at cross purposes. John Mathenge, a male sex worker, says there is alot of violence against male and female sex workers, from the general public and law enforcement officers, and stigma from health workers and even the media.
Dr. Sobbie Mulindi of the National Aids Control Council says that attitude change among health workers and other segments of society is key to succeeding in the fight against stigma.
Dr. Sobbie Mulindi of NACC and Peninah Mwangi, a representative of sex workers, participating in a health forum in Nairobi recently.
“We have to build the capacity and change the attitude of health workers, of police, of the judiciary, of the journalists, so that we are all together…” he said.
The report says the international community needs to increase investment in research and development to develop new drugs, vaccines, and health technologies. Current global investment in research and development needs to be at least doubled, from current annual spending of $3 billion to $6 billion annually by 2020, with half of the increment potentially coming from middle-income countries.
While lauding the authors, World Bank president Jim Yong Kim lamented that more than a quarter of a million people are pushed into poverty every day as a result of paying for health care.
“…The new report…reinforces the case that investing in health is central to development and to achievement of the global goals to end extreme poverty by 2030 and boost shared prosperity,” he said.
The report outlines inexpensive policies and interventions which could curb the emerging burden of non-communicable diseases and injuries, prevent additional deaths by 2035, and raise significant new revenue for low-income and middle-income countries through increasing taxation on tobacco and other harmful substances, such as alcohol and sugar. Other interventions include subsidies on fuel-efficient stoves, housing legislation that requires mosquito-proofing features such as ceiling boards, and cash transfers that contribute to HIV prevention.
This report comes out when there are still many challenges facing implementation of universal health care in many developing countries.
Helen Clark, Administrator of United Nations Development Programme says that, even though investments in the health sector are welcome, they will not reap as many benefits if discrimination, bad laws, and other social determinants are not addressed.
“In Uganda, for example, stigma, poverty, and poor health-sector governance often prevent women from accessing breast cancer diagnostics and treatment,” she says.
As Kenya was celebrating World AIDS Day this week, Peninah Mwangi, a representative of sex workers, told a forum recently that sex workers fear police officers more than they fear contracting HIV or other sexually transmitted diseases.
“As a result of the stigma, sex workers are fearing to come out and say that they are positive and get medication…we need a lot of intervention on both the social aspect and the medical aspect,” she says.
Commenting on the report, Mark Dybul of the Global Fund to fight AIDS, TB and Malaria says improving health requires implementing effective interventions for the most-at risk and hardest-to-reach populations.
“This means thinking outside the box as we support and build the health systems that will deliver essential services, partnering effectively with civil society, and putting human rights and equity at the centre of our strategies and programmes.”
According to Richard Horton, Editor-in-Chief of The Lancet and one of the report’s authors, “Investing in health is also an investment in prosperity, social and financial protection, and national security.”
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