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Monday, 24 February 2014

The “Grand Convergence” in health: achieving UHC in a generation!

The past 20 years (1993-2013) have seen enormous improvement in global health due to scaling up of life-saving technologies, reforms in health system especially in middle-income countries, increased funding and mobilization of development assistance for health. But, what would be the state of global health in 2035, 20 years after the MDGs ends in 2015?

A recent Lancet Commission, revisiting the payoff in investing in health, found that mortality reduction accounted for 11% of recent economic growth globally. In order to capture the ‘intrinsic value of health’ or ‘value of additional life-years (VLYs)’, beside the ‘benefits resulting from improved economic productivity’, they coined a term ‘full income’. Value of additional life-years arises from ‘people’s willingness to trade-off income, pleasure or convenience’ for increased life expectancy.

Improved health leads to increased personal and national income through five  pathways: increased productivity from better health, better health leads to better educational outputs which in turn leads to better income opportunities, increased life expectancy leads to increased savings which has an influence on national investment capacity, control of some communicable diseases (e.g., malaria) leads to improve access to natural resources, and lastly the ‘demographic dividend’ arising from a low fertility low mortality society.

Full income is calculated from a combination of national income plus VLYs gained in the measuring period. According to this calculation, between 2000 and 2011, about 24% of full income growth in LMICs resulted from VLYs gained. This led the public health champions to advocate for improved resource allocation in relevant sectors including health. Cognizance of VLYs in calculating return of investment in health will make investment in health highly cost-effective and attractive. The projected growth of LMIC economies and increased funding support for diseases that disproportionately affects LMICs presents a unique opportunity to a radical reduction of child and maternal mortalities in LMICs which is now seen in best-performimg middle income countries (the 4C countries: Chile, China, Costa Rica and Cuba), the “grand convergence” in health!

Achievement of “grand convergence” will require focused attention in the poor rural regions of the population i.e., rural regions of middle-income countries (recent data show that 70% of the world’s poor now live in middle-income countries rather than poor-income countries) and populations in the low-income countries.

To achieve this “grand convergence” and UHC in a generation, the Commission suggested two pro-poor pathways: publicly financed insurance to cover essential health interventions including NCDs and Injuries, and/or a broader benefit package funded through different financing mechanism without any burden to the poor.

These and other issues are discussed in the recently released report of the Lancet Commission which is worth reading and reflecting!

Further reading
Jamison DT and Summers LH et al. Global health 2035: a world converging within a generation. Lancet published online Dec3, 2013.

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