Global Health 2050: Cutting premature deaths in half by mid-century

UC Berkeley School of Public Health Professor of Health Policy and Management Stefano Bertozzi is a co-author of a new, landmark report that offers a roadmap to reduce the risk of premature death around the globe.

Global Health 2050 concludes that countries that choose to do so could achieve the goal of “50 by 50”—a 50% reduction in the probability of death before age 70 by the year 2050.

The report, published October 14 by the Lancet Commission on Investing in Health, is the work of more than three dozen authors from at least 14 countries, among them China, Denmark, Germany, India, Japan, and Lebanon. The authors argue that a series of targeted health investments would pay off dramatically. They focus on reducing 15 priority maladies which account for a very large percent of the life expectancy gaps between the highest performing regions and other regions.

“I think the report makes a pretty compelling case,” said Bertozzi, “both about the need to spend more money on health—because health is one of the key components of socioeconomic development—and within health, to make sure we get as much health as possible for the money.

“It turns out that those things tend to be things that help people who are disadvantaged and marginalized more, so that when you spend on that you also typically reduce inequality.”

The commission calls the 50-50 goal, with an interim milestone of a 30% reduction in premature death by 2035, “a prize within reach.”

Among the top recommended investments are expansion of childhood immunizations and low-cost prevention and treatments for common causes of preventable death, combined with scaling up financing to develop new health technologies.

Eight of the 15 priority conditions are related to infectious diseases and maternal health, while seven are related to non-communicable disease and injuries, such as cardiovascular disease.

The authors warn that there is a greater than 20% chance in the next 10 years of a pandemic that kills at least 25 million people. They recommend improvement of public health systems, so that they can be ready to respond quickly to isolate infected individuals, quarantine people who were potentially exposed, and provide social and financial support for people isolating or quarantining.

Bertozzi is aware that in many countries ministries of health struggle to make the economic case to ministries of finance for greater investment in health. He believes the report could give health ministers ammunition for the case that spending on health does improve a nation’s bottom line.

“Many governments need to raise more money and to spend more of it on making the population healthy,” Dr. Bertozzi said. “It starts with birth spacing and better nutrition to let kids take full advantage of school. Healthy adults are productive workers. Ministries of health need to shift the framing from health as social assistance to health as an investment in human capital that is essential for national socioeconomic development. Hopefully this report helps to strengthen their hand in negotiations with their colleagues in ministries of finance.”

The report also emphasizes the importance of reducing smoking and tobacco use. Despite all the progress that has been made on that issue, more than 1.3 billion people around the world still smoke cigarettes and pipes or take tobacco in other ways, such as chewing. Tobacco continues to kill more than 7 million people every year, with another 1.3 million dying from exposure to second-hand smoke, according to the World Health Organization.

For Bertozzi, this hits home.

“This has been a long time issue for me,” he said. “All four of my grandparents died from smoking, as did my father.”

One of the biggest obstacles to cutting tobacco use, Bertozzi said, is that there are countries where tobacco continues to be an important source of both employment and government revenue.

“It’s like being anti-tobacco in North Carolina,” he said. “It feels disloyal and is certainly politically unpopular.”

Dr. Gavin Yamey, director of the Duke Center for Public Impact in Global Health, and a lead author of the report, said that raising taxes on tobacco may be the single most important health policy it calls for, because of the immediate gains it could create for the world’s poorest citizens.

“They are the most price sensitive, so they’re more likely to quit when tobacco prices rise,” Yamey said. “Therefore they are more likely to get the health and financial benefits of giving up smoking.”