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Grand global health convergence within our grasp
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THE world is at a unique 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 wealthy 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.
With scaled-up health investments, ten million lives could be saved annually, beginning in 2035. And the economic payoff would be enormous: every dollar invested in low- and middle-income countries (LMICs) to achieve this grand convergence would return US$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 also require increased funding for the development and delivery of new health tools to redress the conditions that disproportionately kill women and children in LMICs.
To this end, one of the central features of the convergence strategy is family planning.
As it stands, more than 220 million women worldwide lack access to modern contraception — an inexcusable situation, given that scaling up family planning would be remarkably simple and inexpensive. And the benefits would be vast.
For starters, improved access to contraception would prevent an estimated one-third of maternal deaths, and would have a large impact among those facing the highest risk. These include 15-19-year-old women in poor countries, who currently have the least access to contraception, and women who have multiple pregnancies in quick succession, by allowing them to space out their pregnancies.
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 immunization.
At the same time, it would facilitate social change that fuels increased productivity. According to a study coordinated by the World Health Organization, the economic return from scaling up contraception in 27 countries with very high birth rates would exceed 8 percent of 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 US$70 billion annually, with US$1 billion 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 percent of the additional GDP that these countries are expected to generate in the next two decades.
The international community must play a major role in achieving convergence. Specifically, it must increase investment in research and development for the diseases that affect the poor, like childhood pneumonia and diarrhea, which kill around two million children every year.
And direct financial assistance to LMICs — for example, to fund family planning programs and combat malaria and HIV/AIDS — will be required for years to come.
Gavin Yamey, a professor in the Global Health Group at the University of California, San Francisco, leads the Evidence to Policy Initiative. Helen Saxenian is a senior consultant at the Results for Development Institute, Washington, DC. Copyright: Project Syndicate, 2014. www.project-syndicate.org
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