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