Global health 2035: a world converging within a generation
Open accessAbstract
countries can be reduced by 2035 through inexpensive population-based and clinical interventions.Fiscal policies are an especially promising lever for reducing this burden. Opportunities:• National governments can curb NCDs and raise signifi cant revenue by heavily taxing tobacco and other harmful substances, and they can redirect fi nances towards NCD control by reducing subsidies on items such as fossil fuels.Investment in strengthening health systems to deliver packages of costeff ective clinical interventions for NCDs and injuries is another important national opportunity.• International action should focus on provision of technical assistance on fi scal policies, regional cooperation on tobacco, and funding of population, policy, and implementation research on scaling-up of interventions for NCDs and injuries.Progressive universalism, a pathway to universal health coverage (UHC), is an effi cient way to achieve health and fi nancial protectionThe Commission endorses two pro-poor pathways to achieving UHC within a generation.In the fi rst, publicly fi nanced insurance would cover essential health-care interventions to achieve convergence and tackle NCDs and injuries.This pathway would directly benefi t the poor because they are disproportionately aff ected by these problems.The second pathway provides a larger benefi t package, funded through a range of fi nancing mechanisms, with poor people exempted from payments.Opportunities:• For national governments, progressive universalism would yield high health gains per dollar spent and poor people would gain the most in terms of health and fi nancial protection.• The international community can best support countries to implement progressive universal health coverage by fi nancing population, policy, and imple mentation research, such as on the mechanics of designing and implementing evolution of the benefi ts package as the resource envelope for public fi nance grows.Our report points to the possibility of achieving dramatic gains in global health by 2035 through a grand con vergence around infectious, child, and maternal mortality; major reductions in the incidence and consequences of NCDs and injuries; and the promise of universal health coverage.Good reasons exist to be optimistic about seeing the global health landscape utterly transformed in this way within our lifetimes.For the background papers see http://globalhealth2035.org Panel 2: Social and intersectoral determinants and consequences of better healthThree key WHO publications have advanced our understanding of these relations: • The 1999 World Health Report (WHR), the fi rst WHR issued by WHO Director General Gro Harlem Brundtland, estimated that half of the health improvements between 1960 and 1990 in low-income and middle-income countries were from changes in two social determinants: income and education.7 The report noted that these determinants aff ect health through consequences such as poor nutrition, sanitation, and other risk factors for ill health.Nevertheless, WHR 1999 argued that the health community could have the greatest eff ect on health by focusing on the health sector, including health systems strengthening, rather than by taking action outside this sector.• The 2001 report of the Commission on Macroeconomics and Health, chaired by Jeff rey Sachs, emphasised the importance of investment not only in the health sector but also in education, water, sanitation, and agriculture, to reduce poverty.8 By quantifying both the substantial economic consequences of better health and the costs of achieving it, the report had a hugely important role in informed advocacy for the health sector.• The Commission on Social Determinants of Health, chaired by Michael Marmot, was established by WHO in 2005 to lay out evidence for how to promote health equity through sound social and economic policies and to foster a global movement towards its achievement.9 The Commission made three broad recommendations: improve daily conditions; take "far-reaching and systematic action" to improve the distribution of resources to ensure "fair fi nancing, corporate social responsibility, gender equity and better governance"; and improve data collection for better measurement of health inequities and monitor the eff ect of interventions in improving these inequities.
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Studies show that for every dollar spent on key health services, direct and indirect benefits exceed costs by a factor of 9 to 20.
“Furthermore, studies show that for every dollar spent on key health services, the direct and indirect benefits would exceed costs by a factor of between 9 and 20, further showing the benefits that arise from investing in health.3”
From The legal determinants of health: harnessing the power of law for global health and sustainable development (2019) · cites this paper as [3]
The National opportunities and Costs and consequences of convergence sections report projected benefits exceeding costs by about 9-fold for low-income countries and about 20-fold for lower-middle-income countries. These are estimates for a specified scale-up of interventions toward convergence by 2035, conditional on targeting the right interventions and strengthening health systems—not a general return for every dollar spent on key health services. No page numbers were provided for these passages. (LLM, conf=0.86)
Experimental — accuracy not yet measuredLaw can implement fair, evidence-based health interventions and is a powerful instrument for global health.
“Law can be used to implement fair, evidence-based health interventions, and can be a powerful tool for global health.3”
From The legal determinants of health: harnessing the power of law for global health and sustainable development (2019) · cites this paper as [3]
Section 3, “Stronger health systems and policies” (page unavailable), identifies laws and regulations as tools for tackling health risks. “Regulation and legislation” and “National opportunities” (pages unavailable) give evidence-backed examples, including drink-driving laws and pesticide restrictions. The paper does not establish that the interventions implemented through law are fair; its discussion of equity is separate from these legal measures. (LLM, conf=0.85)
Experimental — accuracy not yet measuredGlobal health hazards have common underlying causes such as dangerous pathogens, unhealthy behaviours, or unsafe environments.
“(ii) they have common underlying causes, such as dangerous pathogens, unhealthy behaviours, or unsafe environments;”
From The legal determinants of health: harnessing the power of law for global health and sustainable development (2019) · cites this paper as [3]
Global health hazards require a coordinated, multi-sectoral global response.
“(iv) they require a coordinated, multi-sectoral global response.”
From The legal determinants of health: harnessing the power of law for global health and sustainable development (2019) · cites this paper as [3]
Global health hazards are exacerbated by inequities linked to socio-economic determinants of health.
“(iii) they are exacerbated by inequities linked to the socio-economic determinants of health;”
From The legal determinants of health: harnessing the power of law for global health and sustainable development (2019) · cites this paper as [3]
Global health hazards are not bound by borders, ranging from infectious diseases to non-communicable diseases and injuries.
“Global health hazards nowadays share four important features: (i) health hazards are not bound by borders, ranging from infectious diseases, to non-communicable diseases, and injuries;”
From The legal determinants of health: harnessing the power of law for global health and sustainable development (2019) · cites this paper as [3]
Despite progress, the burden of infectious diseases remains unacceptably high, especially in low-income and middle-income countries and among poor and rural populations.
“Despite considerable progress, the burden of infectious diseases remains unacceptably high, particularly in low-income and middle-income countries, and among poor and rural populations.3”
From The legal determinants of health: harnessing the power of law for global health and sustainable development (2019) · cites this paper as [3]
In a grand convergence, mortality from infections and maternal conditions could, in countries that chose to do so, be brought down to levels that would allow their life expectancies to converge toward that of the frontier country.
“In a grand convergence, mortality from infections and maternal conditions could, in countries that chose to do so, be brought down to levels that would allow their life expectancies to converge toward that of the ‘frontier’ country (the best-performing country).”
From Global health 2050: the path to halving premature death by mid-century (2024) · cites this paper as [2]
From about 1850 onwards, life expectancy in the best performing countries increased steadily at a rate of about 2.5 years of life expectancy every decade until the time GH2035 was published.
“It found that from about 1850 onwards, life expectancy in the best performing countries increased steadily at a rate of about 2.5 years of life expectancy every decade until the time GH2035 was published.”
From Global health 2050: the path to halving premature death by mid-century (2024) · cites this paper as [2]
This value was almost half as large as the value of increases in income levels during this period.
“This value was almost half as large as the value of increases in income levels during this period.”
From Global health 2050: the path to halving premature death by mid-century (2024) · cites this paper as [2]
In South Asia, the value of mortality decline in 2000-2011 was about 2.9% of average national income per year.
“In South Asia, for example, it estimated that the value of mortality decline in 2000–2011 was about 2.9% of average national income per year.”
From Global health 2050: the path to halving premature death by mid-century (2024) · cites this paper as [2]
GH2035 provided estimates of the value, relative to income levels, of the mortality declines experienced by countries.
“GH2035 provided estimates of the value, relative to their income levels, of the mortality declines experienced by countries.2”
From Global health 2050: the path to halving premature death by mid-century (2024) · cites this paper as [2]
The world is in the midst of a process some call the third global health transition or a grand convergence, emerging from a demographic transition into an epidemiologic transition from a high burden of maternal and child conditions and communicable diseases to noncommunicable diseases.
“On a broader scale, we are in the midst of a process some are calling “the third global health transition” [31] or “a grand convergence” [32]—emerging from a demographic transition (from higher to lower death and birth rates) into an epidemiologic transition (from a high burden of maternal and child conditions and communicable diseases to noncommunicable diseases [NCDs]).”
From Community health workers at the dawn of a new era: 11. CHWs leading the way to “Health for All” (2021) · cites this paper as [32]
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Self-citationThe Global Burden of Cardiovascular Diseases and Risk
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Every Newborn: progress, priorities, and potential beyond survival
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“7 Stenberg and colleagues 36 attributed two-thirds of that derived value to the instrumental components, which are measured here directly via the labour force outcomes, leaving the remaining third for the intrinsic benefi ts of health, which is equivalent to 0 · 5 times per person income.”
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Self-citationThe global burden of women's cancers: a grand challenge in global health
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Self-citationCountry-Level Cost-Effectiveness Thresholds: Initial Estimates and the Need for Further Research
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“Indeed, similar approaches continue to be used to advocate for increased health care spending [9].”
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Size and distribution of the global volume of surgery in 2012
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Global hearing health care: new findings and perspectives
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Thrombosis: a major contributor to the global disease burden
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The Lancet Global Health Commission on financing primary health care: putting people at the centre
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Women and Health: the key for sustainable development
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Self-citationPriorities for cancer research in low- and middle-income countries: a global perspective
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“Furthermore, many methods used in health economic analyses fail to account for the different economic contexts, health impacts, individual and societal preferences or values of LMICs 69,70 .”
Improvement of maternal and newborn health through midwifery
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“17 A future of health opportunities, albeit with important caveats, has also been envisioned by other landmark Lancet Commissions, including the possibility of reaping very large payoffs coming from investing in health 17 or the objective of ending AIDS as a public health threat by 2030.”
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Adolescence and the next generation
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Economic Impacts of Overweight and Obesity: Current and Future Estimates for Eight Countries
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“75 Although the proportion of Nigerian women aged 15–49 years with no education has reduced between 1999 and 2018, it is still relatively high, with 34·9% of women having no formal education as of 2018 (figure 4).”
Health in the sustainable development goals: ready for a paradigm shift?
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Self-citationMalaria eradication within a generation: ambitious, achievable, and necessary
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Self-citationBuilding a tuberculosis-free world: The Lancet Commission on tuberculosis
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Self-citationPandemic risk: how large are the expected losses?
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“15,16”
Self-citationBarriers to Accessing Maternal Care in Low Income Countries in Africa: A Systematic Review.
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“[2] [3] [4] A crucial element of that response will be the strategic use of law at all levels-local, national, and international-resting on stronger cooperation between the legal and health professions.”
BackgroundSelf-citationEssential surgery: key messages from Disease Control Priorities, 3rd edition
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Self-citationVaccines, new opportunities for a new society
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Assuring health coverage for all in India
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Self-citationStrengthening health systems for universal health coverage and sustainable development
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Self-citationDiversity and divergence: the dynamic burden of poor maternal health
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Thrombosis: A major contributor to global disease burden
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Catastrophic expenditure to pay for surgery worldwide: a modelling study
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Defeating AIDS—advancing global health
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“The recent Lancet Commission report on Global Health 2035 makes a strong economic case for health that should facilitate greater prioritization of health by the economic ministries in countries [25].”
BackgroundMaking fair choices on the path to universal health coverage
Ottersen, T., & Norheim, O. F. (2014) · Bulletin of the World Health Organization · doi:10.2471/blt.14.139139 · Cited by 262 · see citing works
Haakenstad, A., Yearwood, J. A., Fullman, N., Bintz, C., Bienhoff, K., Weaver, M. R., Nandakumar, V., LeGrand, K. E., Knight, M., Abbafati, C., et al. (2022) · The Lancet Global Health · doi:10.1016/s2214-109x(22)00429-6 · Cited by 258 · see citing works
Self-citationAgyepong, I. A., Sewankambo, N., Binagwaho, A., Coll-Seck, A. M., Corrah, T., Ezeh, A., Fekadu, A., Kilonzo, N., Lamptey, P., Masiye, F., et al. (2017) · The Lancet · doi:10.1016/s0140-6736(17)31509-x · Cited by 245 · see citing works
“The Lancet Commission on Investing in Health proposes to reorient international development financing for health from direct investments in country level services to core global functions such as pandemic preparedness and research and development for neglected diseases.(10) However, particularly countries in crisis or…”
Self-citationDelivery of affordable and equitable cancer care in India
Pramesh, C. S., Badwe, R. A., Borthakur, B. B., Chandra, M., Raj, E. H., Kannan, T., Kalwar, A., Kapoor, S., Malhotra, H., Nayak, S., et al. (2014) · The Lancet Oncology · doi:10.1016/s1470-2045(14)70117-2 · Cited by 254 · see citing works
The men's health gap: men must be included in the global health equity agenda
Baker, P., Dworkin, S. L., Tong, S., Banks, I., Shand, T., & Yamey, G. (2014) · Bulletin of the World Health Organization · doi:10.2471/blt.13.132795 · Cited by 253 · see citing works
Self-citationAction to address the household economic burden of non-communicable diseases
Jan, S., Laba, T., Essue, B. M., Gheorghe, A., Muhunthan, J., Engelgau, M. M., Mahal, A. S., Griffiths, U. K., McIntyre, D., Meng, Q., et al. (2018) · The Lancet · doi:10.1016/s0140-6736(18)30323-4 · Cited by 249 · see citing works
Rwanda 20 years on: investing in life
Binagwaho, A., Farmer, P. E., Nsanzimana, S., Karema, C., Gasana, M., Ngirabega, J. D. D., Ngabo, F., Wagner, C. M., Nutt, C. T., Nyatanyi, T., et al. (2014) · The Lancet · doi:10.1016/s0140-6736(14)60574-2 · Cited by 252 · see citing works
Self-citationBircher, J., & Kuruvilla, S. (2014) · Journal of Public Health Policy · doi:10.1057/jphp.2014.19 · Cited by 215 · see citing works
“At the macro level, dwindling natural resources, population growth, and the effects of climate change are likely to impede improving global health.(4,14) A shared understanding of the nature of health, and the links between individual, social, and environmental determinants, could help promote a dialog between leaders…”
BackgroundMapping child growth failure in Africa between 2000 and 2015
Osgood-Zimmerman, A. E., Millear, A., Stubbs, R. W., Shields, C., Pickering, B. V., Earl, L., Graetz, N., Kinyoki, D. K., Ray, S. E., Bhatt, S., et al. (2018) · Nature · doi:10.1038/nature25760 · Cited by 246 · see citing works
Valuing Mortality Risk Reductions in Global Benefit-Cost Analysis
Robinson, L. A., Hammitt, J. K., & O’Keeffe, L. (2019) · Journal of Benefit-Cost Analysis · doi:10.1017/bca.2018.26 · Cited by 244 · see citing works
Gostin, L. O., & Friedman, E. (2015) · The Lancet · doi:10.1016/s0140-6736(15)60644-4 · Cited by 241 · see citing works
National spending on health by source for 184 countries between 2013 and 2040
Dieleman, J. L., Templin, T., Sadat, N., Reidy, P., Chapin, A., Foreman, K. J., Haakenstad, A., Evans, T., Murray, C. J. L., & Kurowski, C. (2016) · The Lancet · doi:10.1016/s0140-6736(16)30167-2 · Cited by 232 · see citing works
Jamison, D. T., Alwan, A., Mock, C. N., Nugent, R., Watkins, D., Adeyi, O., Anand, S., Atun, R., Bertozzi, S., Bhutta, Z., et al. (2018) · The Lancet · doi:10.1016/s0140-6736(17)32906-9 · Cited by 227 · see citing works
Self-citationSacco, R. L., Roth, G. A., Reddy, K. S., Arnett, D. K., Bonita, R., Gaziano, T. A., Heidenreich, P. A., Huffman, M. D., Mayosi, B. M., Mendis, S., et al. (2016) · Circulation · doi:10.1161/cir.0000000000000395 · Cited by 268 · see citing works
Self-citationActing on non-communicable diseases in low- and middle-income tropical countries
Ezzati, M., Pearson‐Stuttard, J., Bennett, J. E., & Mathers, C. D. (2018) · Nature · doi:10.1038/s41586-018-0306-9 · Cited by 227 · see citing works
Understanding and improving the one and three times GDP per capita cost-effectiveness thresholds
Robinson, L. A., Hammitt, J. K., Chang, A. Y., & Resch, S. (2016) · Health Policy and Planning · doi:10.1093/heapol/czw096 · Cited by 216 · see citing works
“7 The Lancet Commission on Investing in Health (Jamison et al. 2013) reports values per life year using a more thoroughly documented approach.”
MethodInfluentialThe Effects of Two Influential Early Childhood Interventions on Health and Healthy Behaviour
Conti, G., Heckman, J. J., & Pinto, R. (2016) · The Economic Journal · doi:10.1111/ecoj.12420 · Cited by 213 · see citing works
“Discussions of ways to control the soaring costs of the health care system in the US and elsewhere largely focus on the provision of health care (Emanuel, 2012; Jamison et al., 2013).”
Gelband, H., Sankaranarayanan, R., Gauvreau, C., Horton, S., Anderson, B. O., Bray, F., Cleary, J., Dare, A., Denny, L., Gospodarowicz, M., et al. (2016) · The Lancet · doi:10.1016/s0140-6736(15)00755-2 · Cited by 205 · see citing works
Self-citationOvercoming social segregation in health care in Latin America
Cotlear, D., Gómez‐Dantés, O., Knaul, F. M., Atun, R. A., Barrêto, I. C. D. H. C., Cetrángolo, O., Cueto, M., Francke, P., Frenz, P., Guerrero, R., et al. (2014) · The Lancet · doi:10.1016/s0140-6736(14)61647-0 · Cited by 202 · see citing works
- Authors
- Jamison, D. T., Summers, L. H., Alleyne, G., Arrow, K. J., Berkley, S., Binagwaho, A., Bustreo, F., Evans, D., Feachem, R. G. A., Frenk, J., Ghosh, G., Goldie, S. J., Guo, Y., Gupta, S., Horton, R., Kruk, M. E., Mahmoud, A., Mohohlo, L. K., Ncube, M., Pablos-Mendez, A., Reddy, K. S., Saxenian, H., Soucat, A., Ulltveit-Moe, K. H., & Yamey, G.
- Affiliations
- University of Washington (US)
- Harvard University (US)
- University of the West Indies (JM)
- Stanford University (US)
- Gavi (CH)
- World Health Organization (CH)
- University of California, San Francisco (US)
- Gates Foundation (US)
- Peking University (CN)
- International Monetary Fund (US)
- Columbia University (US)
- Princeton University (US)
- African Development Bank Group (CI)
- Public Health Foundation of India (IN)
- Results for Development Institute (US)
- Corresponding author
- Yamey, Gavin
- ORCID
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 2013-12
- Volume
- 382
- Issue
- 9908
- Pages
- 1898-1955
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- OpenAlex
- W4320288076
- Cited by
- 1,220
- References
- 174
- Citations by year
- 2026: 47 · 2025: 62 · 2024: 49 · 2023: 53 · 2022: 72 · 2021: 121 · 2020: 101 · 2019: 112 · 2018: 106 · 2017: 125 · 2016: 129 · 2015: 141 · 2014: 95 · 2013: 6
- FWCI
- 215.66
- Type
- journal article
- Language
- en
- Update notices
- erratum (2014-01-18)
- Open access
- hybrid
- doi.org
- Licence
- other-oa
- Locations
- The Lancet (publishedVersion, other-oa)
- PubMed (publishedVersion)
- Funders
- Bill and Melinda Gates Foundation
- World Bank Group
- Harvard University
- University of Washington
- Harvard Global Health Institute
- Department for International Development
- Direktoratet for Utviklingssamarbeid
- University of California, San Francisco
- Topics
- Social Sciences › Economics, Econometrics and Finance › Finance › Healthcare Systems and Reforms
- Health Sciences › Health Professions › General Health Professions › Global Health Care Issues
- Social Sciences › Business, Management and Accounting › Organizational Behavior and Human Resource Management › Global Public Health Policies and Epidemiology
- Keywords
- global health, non-communicable diseases, injuries, universal health coverage, fiscal policy, tobacco taxation, fossil fuel subsidies, health system strengthening, health care financing, social determinants of health, health equity, financial protection, population-level interventions, child mortality, maternal mortality, infectious disease mortality
- MeSH terms
- Delivery of Health Care, Developing Countries, Health Expenditures, Humans, International Cooperation, Global Health, Universal Health Insurance
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