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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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“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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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“Law can be used to implement fair, evidence-based health interventions, and can be a powerful tool for global health.3”
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“(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]
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“(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]
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“(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]
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“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]
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“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”
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“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]
In the citing paper
“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]
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“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]
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“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]
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“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]
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“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]
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Finkelstein, E. A., Baid, D., Almudarra, S., Alqunaibet, A., Msemburi, W., Watkins, D., Dong, D., & Herbst, C. H. (2021) · World Bank, Washington, DC eBooks · doi:10.1596/978-1-4648-1717-5_ch4 · Cited by 1
The business of recovery: embedding health in economies after COVID-19
McIntosh, B., Sheppy, B., Moscone, F., & Areal, A. (2022) · British Journal of Healthcare Management · doi:10.12968/bjhc.2021.0156 · Cited by 1
Debt, Structural Adjustment, and Health
Rudin, J., & Sanders, D. M. (2021) · Cambridge University Press eBooks · doi:10.1017/9781108692137.013 · Cited by 1
Pogge, T. W. (2021) · Cambridge University Press eBooks · doi:10.1017/9781108692137.033 · Cited by 1
Dwyer, J. (2021) · Cambridge University Press eBooks · doi:10.1017/9781108692137.038 · Cited by 1
Responsibility for Global Health
Buchanan, A. E., & DeCamp, M. W. (2021) · Cambridge University Press eBooks · doi:10.1017/9781108692137.010 · Cited by 1
State of Global Health in a Radically Unequal World
Schrecker, T., & Labonté, R. (2021) · Cambridge University Press eBooks · doi:10.1017/9781108692137.002 · Cited by 1
Convergence and Determinants of Health in North Sumatera Province
Hastuti, I. M. (2022) · Signifikan Jurnal Ilmu Ekonomi · doi:10.15408/sjie.v11i1.20576 · Cited by 1
Chandrappa, R., & Das, D. B. (2021) · Springer eBooks · doi:10.1007/978-3-030-64484-0_1 · Cited by 1
Cotlear, D., Nagpal, S., Smith, O., Tandon, A., & Cortez, R. A. (2015) · World Bank, Washington, DC eBooks · doi:10.1596/978-1-4648-0610-0_ch1 · Cited by 1
Nigeria Biannual Economic Update, Fall 2018
World Bank Group (2018) · World Bank, Washington, DC eBooks · doi:10.1596/31008 · Cited by 1
Delivering Universal Health: A Collaborative Approach
Ivbijaro, G. O., Kolkiewicz, L., N'jie, I., & Enum, Y. (2021) · Springer eBooks · doi:10.1007/978-3-030-57296-9_109 · Cited by 1
K, N. P. R. (2022) · International Journal of Nursing and Health Care Research · doi:10.29011/2688-9501.101294
“20% of the Neonatal mortality rate and 13% of the under-five mortality rate is attributed to lack of breastfeeding [12].”
BackgroundGiving Voice to Social Values in Achieving Universal Health Coverage
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Universal Health Coverage, National Health Insurance, and Sustainable Workforce
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Investing in health – Authors' reply
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Self-citationDynamics of the Health-Care Labor Markets
Araújo, E., & Dussault, G. (2016) · Elsevier eBooks · doi:10.1016/b978-0-12-803678-5.00100-4 · Cited by 1
The Funding for the NCD: The Optimistic View
Greenberg, H., & Narula, J. (2016) · Global Heart · doi:10.1016/j.gheart.2016.11.001 · Cited by 1
Will you support a patient-centred R&D agreement?—Response from Tedros Adhanom Ghebreyesus
Ghebreyesus, T. A. (2017) · The Lancet Global Health · doi:10.1016/s2214-109x(17)30027-x · Cited by 1
Setting maternal mortality targets for the SDGs – Authors' reply
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Maternal Mortality and Women's Political ParticipationPreprint
Bhalotra, S. R., Clarke, D., Gomes, J., & Venkataramani, A. S. (2018) · SSRN Electronic Journal · doi:10.2139/ssrn.3205877 · Cited by 1
TOSSD - Tracking global health expenditure in support of the SDGs
Bejraoui, A., Delalande, G., Li, M., & Benn, J. (2021) · OECD development co-operation working papers · doi:10.1787/cb8be42b-en · Cited by 1
Dean, M., & Sautmann, A. (2022) · World Bank policy research working paper · doi:10.1596/1813-9450-9986 · Cited by 1
Jamison, D. T. T., Gelband, H., Horton, S., Jha, P., Laxminarayan, R., Mock, C. N., & Nugent, R. A. (2017) · World Bank, Washington, DC eBooks · doi:10.1596/978-1-4648-0527-1_fm · Cited by 1
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Aguolu, O. G., Kiti, M. C., Nelson, K., Liu, C. Y., Sundaram, M. E., Gramacho, S., Jenness, S. M., Melegaro, A., Sacoor, C. N., Bardají, A., et al. (2023) · medRxiv · doi:10.1101/2023.12.05.23299472 · Cited by 1
Health Workforce Shortages and Surpluses: The Case of Unsalaried Workers in Kurdistan Region of IraqPreprint
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Vision 2020: on the home stretch
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“International eye care community should be able to mobilize and bring the control of blindness to the set of actions that are being prepared for the WHO second cycle of development of this millennium (2015-2035)((9)).”
Setting targets, achieving goals: can analysis of past progress help?
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Trans‐Tasman ageing: comparisons and collaborations
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Metadata
- 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
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Healthcare Systems and Reforms
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Global Health Care Issues
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › 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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