An Ambitious, but Achievable Plan to Reduce the Chance of Dying Prematurely

For nearly half a century, global health advocates have urged countries to set their sights on universal health coverage (UHC), a gold standard in which all people have access to a full suite of essential health services. But with progress toward this goal stalled in many parts of the world, a group of researchers is backing what they hope is a more realistic approach – a kind of build-your-own menu of services to help countries on the road to more cost-effective health investments. 

The idea is a central theme of the new Global Health 2050 report, published Oct. 14 by The Lancet Commission on Investing in Health. The report makes the case that targeted investments in a handful of key health priorities can make it possible for any country to reduce the chance of premature death among its citizens in half by the middle of the century. 

Six of the 50 members of the Lancet commission discussed the report at a DGHI Think Global event on Oct. 24, where they described its recommendations as ambitious, but achievable. 

“I think it’s clear the UHC and health systems strengthening agenda needs a reset,” said Osondu Ogbuoji, MBBS, deputy director of the Duke Center for Policy Impact in Global Health and one of the report’s authors. “”What we’re saying is that we should focus on the major causes of excess death and suffering , and if you can start with these priority conditions and address them, you can expand forward.”

The commission’s report asserts that every country, even the world’s poorest, can reduce premature deaths by focusing on a set of 15 conditions that account for the biggest discrepancies in life expectancy around the world. These include infectious diseases such as tuberculosis and respiratory infections, non-communicable diseases such as diabetes and cardiovascular disease, and other issues such as accidents and suicide. 

“What I think the report has done is to create a focused pathway for ultimately achieving the UHC that we all desire,” said Justina Seyi-Olajide, MBBS, a consultant Pediatric Surgeon at the Lagos University Teaching Hospital in Lagos, Nigeria.”There are clear examples backed up with evidence that show this is possible.”

Simiao Chen, PhD., an associate professor of population medicine at Heidelberg University, described how this modular approach has been deployed to address a rise in cardiovascular disease and other non-communicable diseases in rural China.  

“The project launched by employing a key indicator, the loss of expected life years, to accurately identify the region’s most pressing health concerns and prioritize interventions accordingly,” Chen said. She noted that this analysis showed that the health system was not sufficiently addressing some of the root causes of cardiovascular and respiratory conditions, particularly the use of tobacco. Which contributes to nearly a quarter of all deaths from non-communicable diseases in China. 

Noting the massive impact of global tobacco use on health, the commission calls for increased taxation of tobacco products, both to disincentivize use and to raise revenue for health interventions. 

In fact, the commission’s analysis suggests that “raising taxes on tobacco can do more to reduce premature mortality than any single health policy,” Ogbuoji said. “We are saying the agenda to reduce morbidity and mortality from tobacco is unfinished, and we should continue to focus on that agenda.”

But the commissioners also cautioned that the risk of an infectious disease causing a pandemic remain significant, underscoring the need for global collaboration on pandemic preparedness. Damope Fawole, a research associate with CPIGH, called attention to the report’s finding that there is a 23 percent likelihood of a pandemic on the scale of COVID-19, which caused 23 million excess deaths in its emergency phase, occurring during the next decade. 

In studying how well countries responded to COVID-19, Fawole said that “across the board, countries that employed public health fundamentals averted mass fatalities,” making the case that measures such as masking, contact tracing, isolation of those infected, and social and financial support for people impacted by pandemic disruptions remain an essential part of an effective health system’s toolkit. 

While the commissioners highlighted the potential for closing the gap in life expectancy between low- and high-income countries, they also noted that the plan’s recommendations are broadly applicable. As Omar Karlsson, Ph.D.,  a postdoctoral fellow at the Centre for Economic demography at Lund University, noted, “It’s relevant for all countries, because all countries have room for improvement in reducing morbidity and mortality.”