Lancet Commission: Global Health 2050 Strategy Highlights Diagnostics as Key to Halving Premature Death

Original abstract

Global health 2050 (GH2050), a new report from the Lancet Commission on Investing in Health, finds that dramatic improvements in human welfare are achievable by mid-century with focused health investments. By 2050, countries that choose to do so can halve their probability of premature death (PPD)·the probability of dying before age 70·from their pre-pandemic level in 2019. We call this goal “50 by 50”: a 50% reduction in PPD by 2050. The interventions for achieving “50 by 50” will also reduce morbidity and disability at all ages. Historical experience and continued scientific advance indicate that this is a feasible aspiration. Eight of the 30 most populous countries reduced their PPD over the last decade at a rate that would halve PPD before 2050, including countries as diverse as Bangladesh, Iran, Tanzania, and Turkey. These focused gains can be achieved relatively early on the pathway to full universal health coverage (UHC). The path to achieving “50 by 50” runs through control of a remarkably narrow set of just 15 conditions. For currently high mortality countries, eight infectious diseases and maternal conditions are the highest priority. Seven clusters of noncommunicable diseases and injuries are important everywhere and addressing them will prove central to achieving “50 by 50” in most countries with lower initial levels of mortality. Focused attention to health system strengthening (HSS) for primary care and first level hospitals will generate capacity to better tackle the 15 priority conditions and will be a critical step on the way to improving capacity to address all the conditions in a UHC package. Packaging interventions into 19 modules (e.g., a childhood immunization module, a module on cardiovascular disease prevention and low-cost, widely available treatment) will address the 15 priority conditions. Adopting this focused approach also invests in key areas of HSS and addresses major morbidities, such as psychiatric illness, not already covered by mortality-reducing interventions. Value for money can be assessed through a two-step process: technical cost effectiveness to assess how best to achieve module-specific goals (e.g., reduction in child mortality, reduction in cardiovascular mortality) and political evaluation of trade-offs in investing in expanding module coverage. In many countries seeking reform, standard budgetary mechanisms have failed to successfully reorient systems toward priority interventions that improve health. This mechanism of blanket budget transfers from ministries of finance to ministries of health has not been fit to support such reorientation. The Commission concluded that this problem could be addressed by directing a substantial and increasing fraction of budget transfers to making available and affordable the specific drugs, vaccines, diagnostics, and other commodities that are currently available for control of the 15 priority conditions. Drug availability and affordability will typically require four complementary components: (i) redirecting general budget transfers to line item transfers (subsidies) for specific priority drugs; (ii) centralized procurement by government (or perhaps internationally); (iii) procurement in sufficient volumes to ensure availability when needed; and (iv) use and strengthening of existing supply chains, public and private. Of the many intersectoral policies that governments can adopt to help achieve “50 by 50,” tobacco control is by far the most important, given the number of deaths caused by tobacco and the established and improving capacity of governments to implement tobacco policy. A high level of tobacco taxation is essential, and valuable in the short to medium term for public finance, and should be accompanied by a package of other effective tobacco control policies. Background research conducted for the Commission points to exceptionally high ongoing levels of mortality risk from pandemics. Country performance against COVID-19 varied greatly, a