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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;”
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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]
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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“Lowerincome countries now constitute only 12% of all nations, whereas as late as 1990 it had been 58% [7].”
Persad, G., & Emanuel, E. J. (2017) · The Hastings Center Report · doi:10.1002/hast.764 · Cited by 13
The Grand Divergence in Global Child Health
Wise, P. H., & Darmstadt, G. L. (2016) · Archives of Pediatrics and Adolescent Medicine · doi:10.1001/jamapediatrics.2015.4275 · Cited by 13
The business case for investing in social and behavior change for family planning
Rosen, J. E., Bellows, N. M., Bollinger, L. A., Plosky, W. D., & Weinberger, M. (2019) · doi:10.31899/rh14.1114 · Cited by 13
Schäferhoff, M., Zimmerman, A., Diab, M. M., Mao, W., Chowdhary, V., Gill, D., Karanja, R., Madikizela, M., Ogbuoji, O., & Yamey, G. (2022) · The Lancet Global Health · doi:10.1016/s2214-109x(22)00206-6 · Cited by 11
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Zeng, Z., Luo, Y., Tao, W., Zhang, R., Zeng, B., Yao, J., & Zhang, W. (2024) · BMC Family Practice · doi:10.1186/s12875-024-02450-0 · Cited by 12
“This novel funding model transformed fragmented investments into a systematic resource allocation process [27], pivotal for sustainable investment in underserved rural regions [4].”
BackgroundBuilding from the HIV Response toward Universal Health Coverage
Jay, J. S., Buse, K., Hart, M., Wilson, D. P., Marten, R., Kellerman, S., Odetoyinbo, M., Quick, J. D., Evans, T., Piot, P. K., et al. (2016) · PLoS Medicine · doi:10.1371/journal.pmed.1002083 · Cited by 12
“They can cite evidence on the economic benefits of health reform, including the estimate that health system investments will generate 9- to 20-fold returns in LMICs by 2035 [35].”
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“…Initiative was a formal statement adopted by African health ministers in 1987 in Bamako, Mali, to implement strategies designed to increase the availability of essential drugs and other healthcare services for Sub-Saharan Africans) 40 WHO 2003 41 McIntire and others2017 42 Jamison et al. 2013.”
BackgroundPandemic preparedness in the 21st century: which way forward?
Khor, S. K., & Heymann, D. L. (2021) · The Lancet Public Health · doi:10.1016/s2468-2667(21)00101-8 · Cited by 12
Herrick, C. (2022) · SSM - Qualitative Research in Health · doi:10.1016/j.ssmqr.2022.100068 · Cited by 17
Promoting Oral Health through Programs in Middle Childhood and Adolescence
Benzian, H., Garg, R. M., Monse, B., Stauf, N., & Varenne, B. (2017) · World Bank, Washington, DC eBooks · doi:10.1596/978-1-4648-0423-6_ch16 · Cited by 12
A national stratification of the global macroeconomic burden of central nervous system cancer
Gerstl, J. V. E., Yearley, A. G., Kilgallon, J. L., Lassarén, P., Robertson, F. C., Herdell, V., Wang, A. Y.-D., Segar, D. J., Bernstock, J. D., Laws, E. R., et al. (2022) · Journal of neurosurgery · doi:10.3171/2022.9.jns221499 · Cited by 12
Rethinking how development assistance for health can catalyse progress on primary health care
Kasper, T., Yamey, G., Dwyer, S., McDade, K. K., Lidén, J., Lüdemann, C., Diab, M. M., Ogbuoji, O., Poodla, P., Schrade, C., et al. (2023) · The Lancet · doi:10.1016/s0140-6736(23)01813-5 · Cited by 15
“24 Yet, many countries have plateaued in the coverage of these interventions as a Too often, care is siloed, with external resources used to hire health workers to focus on specific diseases, with laboratory facilities equipped only to diagnose the conditions that receive dedicated support.”
BackgroundSelf-citationBenefits and Costs of the Health Targets for the Post-2015 Development Agenda
Jha, P., Hum, R. J., Gauvreau, C. L., & Jordan, K. (2018) · Cambridge University Press eBooks · doi:10.1017/9781108233767.012 · Cited by 12
Watkins, D., & Nugent, R. A. (2017) · Heart Asia · doi:10.1136/heartasia-2015-010690 · Cited by 12
“15 This method is in harmony with the aforementioned WHO ’ s ‘ Making Fair Choices ’ report, which recommended that UHC include priority lists of services (similar to the health bene fi ts package concept) that start with the interventions that are the most cost-effective, prioritise the worst off…”
MethodIs the sustainable development goal target for financial risk protection in health realistic?
Verguet, S., Woldemariam, A. T., Durrett, W. N., Norheim, O. F., & Kruk, M. E. (2017) · BMJ Global Health · doi:10.1136/bmjgh-2016-000216 · Cited by 12
Self-citationPublic–Private Partnerships for Global Health
Babacan, H. (2021) · Springer eBooks · doi:10.1007/978-3-030-45009-0_117 · Cited by 17
Health and Disease in Adolescence
Reavley, N. J., Patton, G. C., Sawyer, S. M., Kennedy, E. C., & Azzopardi, P. S. (2017) · World Bank, Washington, DC eBooks · doi:10.1596/978-1-4648-0423-6_ch18 · Cited by 13
Understand Sexual Risk Behaviours in Young Adults and Challenges in their Education
Martínez, L. A., Hawrylak, M. F., Sevilla, D. H., & Sánchez, D. O. (2021) · Qualitative Research in Education · doi:10.17583/qre.2021.6996 · Cited by 11
“…proposals from this approach should start from the population analysis of sexual knowledge, attitudes, and behaviours to conduct integrative and transversal interventions that are individually and collectively appropriate from a perspective focused on Global Health (Jamison et al., 2013).”
How to Apply Excise Taxes to Fight Obesity
Petit, P., Mansour, M., & Wingender, P. (2021) · IMF How to Notes · doi:10.5089/9781513585697.061 · Cited by 11
RETRACTED: Economic burden of suicide deaths in India (2019): a retrospective, cross-sectional study
Nigam, A., Vuddemarry, M., & Zadey, S. (2024) · The Lancet Regional Health - Southeast Asia · doi:10.1016/j.lansea.2024.100477 · Cited by 11
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“84010 107 Open Journal of Preventive Medicine not equipped to respond [8].”
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Covre, E. R., de Melo, W. A., Tostes, M. F. D. P., & Fernandes, C. A. M. (2019) · Revista Latino-Americana de Enfermagem · doi:10.1590/1518-8345.2618-3136 · Cited by 11
“Despite this, the effect of this investment on the volume of surgeries is little known(3).”
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Holler, J. T., Cortez, A., Challa, S., Eliezer, E., Hoanga, B., Morshed, S., & Shearer, D. W. (2022) · Journal of Bone and Joint Surgery · doi:10.2106/jbjs.21.00727 · Cited by 11
The sustainable development agenda and the end of AIDS
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Are the conditions right for a 21st-century medical school?
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Reorienting health aid to meet post-2015 global health challenges: a case study of Sweden as a donor
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Self-citationAligning values and outcomes in priority–setting for health
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Estimating the Values of Mortality Risk Reductions in Low- and Middle-Income Countries
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SDGs, health and the G20: a vision for public policy
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“Health is central for individuals and households, for national growth and development and it fundamentally contributes to employability and productivity (Jamison et al. 2013).”
BackgroundInto the Machine: Economic Tools, Sovereignty, and Joy in a Global Health Institution
Walker, A. N. (2019) · Medical Anthropology Quarterly · doi:10.1111/maq.12529 · Cited by 11
Recent progress in global newborn health: thinking beyond acute to strategic care?
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Wise, P. H., & Darmstadt, G. L. (2015) · Seminars in Perinatology · doi:10.1053/j.semperi.2015.06.008 · Cited by 11
Imagining Global Health with Justice: In Defense of the Right to Health
Friedman, E., & Gostin, L. O. (2015) · Health Care Analysis · doi:10.1007/s10728-015-0307-x · Cited by 11
“Economic benefits of the FCGH should be widespread, as better health contributes to higher productivity and economic growth [36].”
BackgroundGama, E. M. (2015) · International Journal of Health Policy and Management · doi:10.15171/ijhpm.2015.203 · Cited by 11
Bibliometric analysis of vaccine hesitancy research from behavioural perspectives (2015–2022)
Acharya, S., Aechtner, T., Venaik, S., & Dhir, S. (2024) · Journal of Risk Research · doi:10.1080/13669877.2024.2317318 · Cited by 10
“Moreover, vaccines have been identified as one of the most cost-effective solutions for global health and development, as the benefits of vaccination surpass their costs by 5–15 times (Jamison et al. 2013).”
BackgroundWang, Z., Liang, Z., Dong, X., Gao, L., Zhou, S., Yin, H. Y., Jin, Y., & Zheng, Z. (2024) · Globalization and Health · doi:10.1186/s12992-024-01023-1 · Cited by 10
“Therefore, there is a wide variance in these rates among member states, but those with better performance may be less inclined to cooperate in this area [70, 71].”
Background
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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