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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”
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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“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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“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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Mathers, C. D., Stevens, G., Hogan, D. R., Mahanani, W. R., & Ho, J. Y. (2017) · World Bank, Washington, DC eBooks · doi:10.1596/978-1-4648-0527-1_ch4 · Cited by 56
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How much donor financing for health is channelled to global versus country-specific aid functions?
Schäferhoff, M., Fewer, S., Kraus, J., Richter, E., Summers, L. H., Sundewall, J., Yamey, G., & Jamison, D. T. (2015) · The Lancet · doi:10.1016/s0140-6736(15)61161-8 · Cited by 54
Self-citationSocially Embedded Preferences, Environmental Externalities, and Reproductive Rights
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Self-citationWatkins, D., Olson, Z. D., Verguet, S., Nugent, R. A., & Jamison, D. T. T. (2015) · Health Policy and Planning · doi:10.1093/heapol/czv023 · Cited by 55
“ECEA is thus intended to inform priority setting, particularly for diseases that have a socioeconomic gradient – for example, between wealthy and poor, women and men, urban and rural – or which are concentrated in marginalised ethnic groups or associated with high OOP expenditures (Jamison et al. 2013).”
BackgroundSelf-citationEconomists' declaration on universal health coverage
Summers, L. H. (2015) · The Lancet · doi:10.1016/s0140-6736(15)00242-1 · Cited by 54
Self-citationGlobal Health Governance Challenges 2016 – Are We Ready?
Kickbusch, I. (2016) · International Journal of Health Policy and Management · doi:10.15171/ijhpm.2016.27 · Cited by 53
Ethical Perspective: Five Unacceptable Trade-offs on the Path to Universal Health Coverage
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Dougherty, S., Beaton, A., Nascimento, B., Zuhlke, L. J., Khorsandi, M., & Wilson, N. J. (2018) · Annals of Pediatric Cardiology · doi:10.4103/apc.apc_135_17 · Cited by 53
“, low-income countries (LIC) now make up only 12% of all nations, whereas that figure was 58% in 1990),[47] economic development is not always associated with a reduction in poverty for all.”
BackgroundAvilés, A. M. O., Verstraeten, R., Huybregts, L., Andrade, S., Camp, J. V., Donoso, S., Ramírez, P. L., Lachat, C. K., Maes, L., & Kolsteren, P. W. (2017) · Nutrition Journal · doi:10.1186/s12937-017-0299-5 · Cited by 56
“To our knowledge, the ACTIVITAL trial is innovative in its setting as it (i) was tailored to the local context using a theoretical framework and participatory approaches and (ii) targeted multiple populations (i.e. adolescents, school staff, and parents) and dietary risk factors for NCDs as well as physical activity.”
BackgroundInfluentialSundaram, N., Duckett, K., Yung, C. F., Thoon, K. C., Sidharta, S., Venkatachalam, I., Chow, A. L., & Yoong, J. (2018) · Vaccine · doi:10.1016/j.vaccine.2018.02.102 · Cited by 53
“Vaccines, including influenza vaccines, are considered a key enabler for the global community’s aspirations to a grand convergence in health [31,32].”
BackgroundGlobal Surgery System Strengthening: It Is All About the Right Metrics
Watters, D. A., Guest, G. D., Tangi, V., Shrime, M. G., & Meara, J. G. (2018) · Anesthesia & Analgesia · doi:10.1213/ane.0000000000002771 · Cited by 53
Reddy, C. L., Peters, A. W., Jumbam, D. T., Caddell, L., Alkire, B. C., Meara, J. G., & Atun, R. A. (2020) · BMJ Global Health · doi:10.1136/bmjgh-2020-002375 · Cited by 54
The poverty of the concept of ‘poverty eradication’
Benatar, S. R. (2015) · South African Medical Journal · doi:10.7196/samj.2016.v106i1.10417 · Cited by 52
Financing Common Goods for Health: Fundamental for Health, the Foundation for UHC
Soucat, A. L. B. (2019) · Health Systems & Reform · doi:10.1080/23288604.2019.1671125 · Cited by 52
“The world faces formidable, often paradoxical, challenges— population growth and aging, increasing wealth and widening inequities, undernutrition among some and obesity among others, and environmental and pandemic threats that seem to emerge in the wake of fast-paced development.(1) In this, the Anthropocene era, the…”
BackgroundSelf-citationSexual and reproductive health and rights in changing health systems
Sen, G., & Govender, V. (2014) · Global Public Health · doi:10.1080/17441692.2014.986161 · Cited by 52
Innovative financing instruments for global health 2002–15: a systematic analysis
Atun, R. A., Silva, S., & Knaul, F. M. (2017) · The Lancet Global Health · doi:10.1016/s2214-109x(17)30198-5 · Cited by 52
Nomura, S., Sakamoto, H., Ghaznavi, C., & Inoue, M. (2022) · The Lancet Regional Health - Western Pacific · doi:10.1016/j.lanwpc.2021.100377 · Cited by 53
Marseille, E. A., & Kahn, J. G. (2019) · Philosophy Ethics and Humanities in Medicine · doi:10.1186/s13010-019-0074-7 · Cited by 51
“low-income countries needed to achieve global health convergence by 2035 [12].”
BackgroundThe Medical and Nursing Education Partnership Initiatives
Goosby, E., & von Zinkernagel, D. (2014) · Academic Medicine · doi:10.1097/acm.0000000000000346 · Cited by 50
Nigeria's new government and public financing for universal health coverage
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Universal health coverage: not why, what, or when—but how?
Horton, R. C., & Das, P. (2014) · The Lancet · doi:10.1016/s0140-6736(14)61742-6 · Cited by 50
Self-citationRobinson, L. A., Hammitt, J. K., Jamison, D. T. T., & Walker, D. G. (2019) · Journal of Benefit-Cost Analysis · doi:10.1017/bca.2019.4 · Cited by 50
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Delivery of Type 2 diabetes care in low‐ and middle‐income countries: lessons from Lima, Peru
Cárdenas, M. K., Miranda, J. J., & Beran, D. (2016) · Diabetic Medicine · doi:10.1111/dme.13099 · Cited by 49
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“Despite the limited number of current examples, the pace of development of new products, processes, and policies from LMICs that are relevant to HICs is only going to increase, as disease patterns converge and healthcare coverage in low-resource settings increases [19].”
BackgroundAlfvén, T., Dahlstrand, J., Humphreys, D., Helldén, D., Hammarstrand, S., Hollander, A., Målqvist, M., Nejat, S., Jørgensen, P. S., Friberg, P., et al. (2019) · Global Health Action · doi:10.1080/16549716.2019.1670015 · Cited by 51
“priorities in jeopardy [13,14], it is more important than ever to articulate the interlinked nature of child health.”
BackgroundAsghar, M. M., Wang, Z., Wang, B., & Zaidi, S. A. H. (2019) · Environmental Science and Pollution Research · doi:10.1007/s11356-019-06686-7 · Cited by 51
Cost of hospitalisation for non‐communicable diseases in India: are we pro‐poor?
Tripathy, J. P., Prasad, B. M., Shewade, H. D., Kumar, A. M. V., Zachariah, R., Chadha, S. S., Tonsing, J., & Harries, A. D. (2016) · Tropical Medicine & International Health · doi:10.1111/tmi.12732 · Cited by 48
“Many countries have already introduced NCD packages into UHC programmes using frameworks developed by WHO [34].”
Watkins, D., Qi, J., Kawakatsu, Y., Pickersgill, S. J., Horton, S., & Jamison, D. T. T. (2020) · The Lancet Global Health · doi:10.1016/s2214-109x(20)30121-2 · Cited by 52
Self-citationCha, S., & Jin, Y. (2019) · International Journal for Equity in Health · doi:10.1186/s12939-019-1102-3 · Cited by 47
Li, R., Ruan, Y., Sun, Q., Wang, X., Chen, M.-T., Zhang, H., Zhao, Y., Zhao, J., Chen, C., Xu, C., et al. (2015) · The Lancet Global Health · doi:10.1016/s2214-109x(15)70021-5 · Cited by 47
Implementation of the Every Newborn Action Plan: Progress and lessons learned
Kinney, M. V., Cocoman, O., Dickson, K., Daelmans, B. M. E. G., Zaka, N., Rhoda, N. R., Moxon, S. G., Kak, L. P., Lawn, J. E., Khadka, N., et al. (2015) · Seminars in Perinatology · doi:10.1053/j.semperi.2015.06.004 · Cited by 47
Assessing the impact of one million COVID-19 deaths in America: economic and life expectancy losses
Silva, S., Goosby, E., & Reid, M. J. A. (2023) · Scientific Reports · doi:10.1038/s41598-023-30077-1 · Cited by 47
El‐Sayed, A. M., Palma, A. M., Freedman, L. P., & Kruk, M. E. (2015) · Health Policy · doi:10.1016/j.healthpol.2015.07.006 · Cited by 46
“A recent Lancet commission stressed that niversal health coverage will be an important mechnism to achieve a “grand convergence” in infectious, hild, and maternal mortality between low and highchieving middle-income countries and will be essential o addressing NCDs in LMICs, as well [7].”
InfluentialSelf-citationTranslational research in nephrology: chronic kidney disease prevention and public health
Brück, K., Stel, V. S., Fraser, S. D., de Goeij, M. C. M., Caskey, F. J., Abu–Hanna, A., & Jager, K. J. (2015) · Clinical Kidney Journal · doi:10.1093/ckj/sfv082 · Cited by 45
“However, according to The Lancet Commissions, specific excise taxes are the most effective intervention against tobacco use and related non-communicable diseases at population level [68].”
BackgroundInequitable Access to Timely Cleft Palate Surgery in Low‐ and Middle‐Income Countries
Carlson, L. C., Hatcher, K. W., Tomberg, L., Kabetu, C., Ayala, R., & Burg, R. V. (2015) · World Journal of Surgery · doi:10.1007/s00268-015-3374-0 · Cited by 46
Implementing pro-poor universal health coverage
Bump, J. B., Cashin, C., Chalkidou, K., EVANS, D. B., González-Pier, E., Guo, Y. J., Holtz, J., Htay, D. T. T., Levin, C., Marten, R., et al. (2015) · The Lancet Global Health · doi:10.1016/s2214-109x(15)00274-0 · Cited by 46
Self-citationNational nursing science priorities: Creating a shared vision
Eckardt, P. A., Culley, J. M., Corwin, E. J., Richmond, T. S., Dougherty, C. M., Pickler, R. H., Krause‐Parello, C. A., Roye, C. F., Rainbow, J. G., & DeVon, H. A. (2017) · Nursing Outlook · doi:10.1016/j.outlook.2017.06.002 · Cited by 46
“However, these improvements are not universal and for many in low and middle-income countries health outcomes are still poor (Jamison et al., 2013).”
BackgroundNagata, J. M., Hathi, S., Ferguson, B. J., Hindin, M. J., Yoshida, S., & Ross, D. A. (2018) · Journal of Global Health · doi:10.7189/jogh.08.010501 · Cited by 46
Bechange, S., Jolley, E., Virendrakumar, B., Pente, V. Y., Milgate, J., & Schmidt, E. (2020) · BMC Health Services Research · doi:10.1186/s12913-020-05279-2 · Cited by 45
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Japan's vision for health care in 2035
Miyata, H., Ezoe, S., Hori, M., Inoue, M., Oguro, K., Okamoto, T., Onishi, K., 小野崎, 耕., Sakakibara, T., Takeuchi, K., et al. (2015) · The Lancet · doi:10.1016/s0140-6736(15)61135-7 · Cited by 45
Counting the cost of child mortality in the World Health Organization African region
Kirigia, J. M., Muthuri, R. N. D. K., Nabyonga‐Orem, J., & Kirigia, D. G. (2015) · BMC Public Health · doi:10.1186/s12889-015-2465-z · Cited by 45
“This is largely because the national health systems and structures for providing these services are weak from gross underinvestment [30, 31].”
BackgroundProgressive realisation of universal health coverage: what are the required processes and evidence?
Baltussen, R. M. P. M., Jansen, M., Bijlmakers, L. A., Tromp, N. B., Yamin, A. E., & Norheim, O. F. (2017) · BMJ Global Health · doi:10.1136/bmjgh-2017-000342 · Cited by 45
“6 In addition, societal perceptions of what should count as legitimate arguments for recommendations are subject to change over time or with new evidence becoming available.”
BackgroundMethodInfluentialBoundary-spanning: reflections on the practices and principles of Global Health
Sheikh, K., Schneider, H. M., Agyepong, I. A., Lehmann, U., & Gilson, L. (2016) · BMJ Global Health · doi:10.1136/bmjgh-2016-000058 · Cited by 44
“It has also seen greatly increased flows of funding to the disease burdens of the south, from a combination of bilateral, public– private partnership and philanthropic sources.(2) Global Health programmes, departments and technical agencies have sprung up across the”
BackgroundBeattie, A., Yates, R., & Noble, D. J. (2016) · BMJ Global Health · doi:10.1136/bmjgh-2016-000190 · Cited by 44
“The Lancet Commission on Investing in Health in 2013 found that the economic benefits of achieving a grand convergence of global health outcomes for infectious diseases and for maternal and child health would outweigh the costs by a factor of between 9 and 20 over 20 years from 2015 to 2035.(3) When implemented well U…”
BackgroundInfluentialBickler, S. W., Wang, A., Amin, S., Halbach, J. L., Lizardo, R. E., Cauvi, D. M., & Maio, A. D. (2017) · World Journal of Surgery · doi:10.1007/s00268-017-4389-5 · Cited by 44
“in The Lancet Commission Report on Global Health 2035 [40].”
BackgroundPutting palliative care on the global health agenda
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Self-citationGlobal Fund lessons for Sustainable Development Goals
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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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