It is becoming increasingly clear that health challenges are many and complex. Aging, mental health, zoonoses and emerging pathologies, cardiovascular and respiratory diseases, premature death… Numerous problems faced by exhausted and collapsed health systems, with a lack of human and economic resources, and on which action must be taken to improve the health conditions of the population. Something that, as the ‘Global Health 2050’ report of the The Lancet Commission on Investment in Health, can be achieved: “Dramatic improvements in human well-being are possible by mid-century.” The next question is clear, how? The answer, known: investment.
However, as the authors highlight, at a global level investment in health cannot be general, but must be specific to address shared problems that exist, such as premature death. With this, “by 2050, those countries that take these measures could reduce the probability of premature death by 50% of their populations, that is, deaths before the age of 70,” they indicate.
The experts’ recipe affects what is known, the importance ofuniversal health coverage: “They must strengthen primary and hospital care, “It is the first level on which it is crucial to work to improve the ability to address health problems.” As WHO’s 2023 Universal Health Coverage Monitoring report highlighted, since 2015, there has been very little progress in meeting all health needs, only continued progress in HIV treatment. . A stagnation to which “catastrophic health expenses that are increasingly common” have been added.
The objective is that by 2050, health spending will increase by 1.1% more of GDP compared to 2019 in low-income countries and 2% more of 2019 GDP in lower-middle-income countries.
In addition to investing in health and strengthening universal health coverage to address infectious diseases, maternal health and non-communicable diseases, the Commission The Lancet on Investment in Health proposes that, in order to address the main health problems, it is necessary to take a modular approach that allows us to focus first on the priority problems, the aforementioned groups of diseases, and the main morbidities that each country has.
Also, call a gradual public financing, to first start with a few medicines and commodities to deliver high-probability health interventions, and then increase public resources for “availability and affordability of medicines, vaccines, diagnostics and other specific commodities needed,” including subsidy of medicines, joint purchasing or long-term commitment with manufacturers. The objective is that by 2050, health spending will increase by 1.1% more of GDP compared to 2019 in low-income countries and 2% more than 2019 GDP in lower-middle-income countries.
Another of the points that the authors collect as a priority is tobacco control, a measure that is added to other more expensive medical interventions to reduce the impact of non-communicable diseases. “Given the number of deaths caused by tobacco, this is the most important intersectoral policy to improve global health,” they emphasize. Raising taxes on its consumption, creating laws such as prohibiting the use of raw charcoal or regulations on its consumption according to age, regulating advertising, promotion, packaging or availability are measures that help curb the consumption of one of the main causes of the worsening of people’s health. Steps that are beginning to be taken in Europe.
To face a future pandemic, as seen with Covidrapid public health measures and vaccination These are points that must be worked on. Finally, they call the financial solidarity with countries with fewer resources and financing global public goods to face challenges such as antimicrobial resistance, pandemic prevention and the implementation of new health technologies.
KEEP MOVING
In addition to the seven points to work on set out in the report, a group of researchers has delved into the measures to take. As the authors highlight in this comment to the report, many advances have been made in reducing the most frequent pathologies, but we must continue to focus mainly on those non-communicable pathologies increasingly common: diabetes, obesity, cancer, pain… Investing in the development of national health systems is essential, but it is important “that each country knows its national or local priorities.”
In this sense, researchers are very critical of global health initiatives, a concept that hides, they point out, “imbalance, fragmentation” and that must “adapt to changing needs and contexts.” That is, to the political measures that each country carries out in the investment context. And in this sense, they go deeper, “it is necessary political leadership to achieve a 50% reduction in premature death by 2050” both internationally and nationally, since, they elaborate, it is the national policy that “makes the difference” in guaranteeing protection, promoting healthy behaviors, providing equitable access to care of effective and regular quality and create synergies between public and private health actors to contribute to equitable health outcomes. “Progress will depend on national efforts to double national financial allocations to health, while focusing investment on a limited package of services such as the disease groups identified by The Lancet Commission.”
“National and global health financing is becoming more complex and interconnected”
The countries with the fewest resources are the ones that have the most difficulties in achieving this reality. In this sense, “transnational health challenges, global public goods and the externalities of insufficient responses to health emergencies imply the need for investments “beyond aid” to address global issues such as health security and pollution management. National and global health financing is becoming more complex and interconnected they point out.
Given this, they call create new partnerships and cooperation to advance new treatments, with the promotion of coordinated networks of clinical trials and the increase in the development of platforms that have proven to be used for different health problems, such as RNA therapies. An innovation that must entail an effort in accessibility. “Steps are needed to accelerate equitable access to quality, affordable health products, including through more resilient, regionally distributed manufacturing and supply chains.”
A huge and complex effort, as the authors of both the report and the subsequent commentary acknowledge, but not impossible. “There are countries that are already on the way to achieving this improvement in global health, so with all these measures it is possible to achieve it,” they indicate. “Together, governments, civil societies, the health and research communities and the private sector can halve premature mortality by 2050 and witness a broader convergence towards longer, healthier lives for all citizens,” they conclude.