The report Global Health 2050 of the Commission of The Lancet on Health Investment concludes that, with strategic investments, it is possible to significantly improve global health by 2050. The probability of premature death (before age 70) could be reduced by 50 percent compared to 2019 levels, target known as “50 for 50”. In addition to reducing mortality, these interventions would also reduce morbidity and disability.
According to the report, in the last decade, seven of the 30 most populous countries, including Bangladesh and Turkey, have managed to reduce premature death at a rate that could reach the goal before 2050. To achieve this, it is crucial to focus on 15 priority conditions, such as infectious and maternal diseases in countries with high premature mortality. Besides, strengthen primary care and first level hospitals is another essential goal. The report proposes grouping interventions into 19 modules, such as childhood immunization and affordable treatments for cardiovascular diseases. This approach will also enable key investments in mental health and other areas not covered by current mortality interventions.
Reorient strategies
Evaluating cost-effectiveness will be crucial to prioritize investment in these modules and maximize their impact. In many countries undergoing reform, traditional budget transfer mechanisms between finance and health ministries have failed to reorient systems toward key interventions, the report says. To improve access to medicines, vaccines and diagnostics necessary to control the 15 priority diseases, it is proposed allocate more of the budget to these specific products. This would include reorienting general transfers towards subsidies for essential medicines, making centralized purchases in sufficient volumes, and strengthening supply chains.
Furthermore, among intersectoral policies, the tobacco control stands out as the most effectivedue to its impact on mortality. Governments must implement high taxes on tobacco, accompanied by other effective control measures. This work also highlights the high risk of mortality from pandemics. The management of COVID-19 showed uneven results between countries, where success in places like China and Japan was largely due to the rapid implementation of basic public health principles. In future pandemics, these principles will remain crucial to reducing mortality while vaccines are developed and distributed.
In addition to national measures, they recommend greater commitment by the development assistance community, with two key objectives. The first is provide financial and technical support to countries with fewer resources to improve their health systems and better control diseases. The second objective is finance global public objectivessuch as the fight against antimicrobial resistance, the prevention of pandemics, the dissemination of best practices and the development of new health technologies.
15 priorities
The report proposes that countries focus their efforts on the prevention and treatment of 15 priority conditions (eight infectious and maternal health, and seven related to non-communicable diseases and injuries) as a key step to achieving the “50 for 50” goal. These conditions account for a significant portion of the differences in life expectancy between more advanced regions and others. Furthermore, the reduction in deaths from these conditions was the main contribution to the increase in global life expectancy between 2000 and 2019.
The report proposes that countries focus their efforts on the prevention and treatment of 15 priority conditions, which account for a significant portion of the differences in life expectancy between the most advanced regions and others.
The eight infectious and maternal health conditions identified, based on the categories of causes of death from the World Health Organization (WHO) Global Health Estimates, include: neonatal conditions (complications of premature birth, asphyxia, sepsis and others), respiratory infections, diarrheal diseases, HIV/AIDS, tuberculosis, malaria, vaccine-preventable childhood diseases (such as whooping cough, diphtheria, measles and tetanus), and maternal conditions.
On the other hand, the seven non-communicable diseases (NCD) and injury-related conditions are: atherosclerotic cardiovascular diseases (ischemic heart disease and ischemic stroke), hemorrhagic stroke, infection-related NCDs (cancer of the stomach, liver, cervix, rheumatic heart disease, and hepatitis B and C cirrhosis) , NCDs related to tobacco use (such as chronic obstructive pulmonary disease and various types of cancer), diabetes, traffic accidents and suicide. According to the report, controlling these 15 conditions is key to reducing premature mortality and improving global health.
Pandemic prevention, preparedness and response
Globalization, population growth, climate change and other factors have increased the world’s vulnerability to emerging diseases, including pandemics. The COVID-19 pandemic has caused more than 23 million additional deaths and has had serious economic and social repercussions, such as a decline in learning. Although many countries have invested in pandemic preparedness and response, COVID-19 exposed deficiencies in most of them.
However, each pandemic is uniquethey state in the report, so there is no universal approach to confront them. While valuable lessons have been learned from COVID-19, it is important not to draw the wrong conclusions. For example, analyzes suggest that a future flu pandemic could be deadlier and affect younger people than COVID-19, which would require different response policies.
In this sense, the agenda for prevention, preparation and response to pandemics covers three fundamental pillars: prevention, preparation and response, with the objective of minimize risks and mitigate the impacts of future pandemics.
Prevention: In this regard, the document prepared by The Lancet ensures that since most pandemics have a zoonotic origin, it is crucial to address the interaction between humans and animals, improving breeding practices and regulating the trade in wild animals. Strengthening biosafety and biosecurity in laboratories is essential, as is improving animal surveillance using advanced technologies, such as deep sequencing, and focusing on viruses that cross species barriers. Surveillance of people with fever of unknown origin, particularly those with severe respiratory illness, is essential to detect zoonotic pathogens that could evolve into human-to-human transmission.
Preparation: Preparedness involves building resilience at global, national and local levels, and updating plans for potential pandemics. Early containment of outbreaks is key, and trained personnel are required to respond at the national level or with regional support. Hospital capacity, especially in intensive care, must be strengthened, given that during the COVID-19 pandemic many countries, even high-income ones, faced significant shortages. Additionally, it is essential to strengthen global systems of equitable access to vaccines and therapeutics, and maintain stockpiles of key supplies such as protective equipment and antivirals.
Answer: The early phase of the response should focus on the detection and containment of the pathogen, using social and public health measures before vaccines or specific treatments become available. Measures such as isolation, quarantines, and eventually closures must be based on science, with research to guide when and how to implement and lift them.
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