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The Guardian “Global  health  disparities  could  ‘end  in  a  generation’  with  annual  $60bn  funding” DATE:  December  2,  2013  LINK:­‐health-­‐disparities-­‐end-­‐60bn-­‐   funding The  world's  poorest  nations  would  boost  growth  by  almost  a  quarter  and  attain  health   standards  and  life  expectancies  comparable  to  those  of  wealthier  mid-­‐ranking  countries  if  a   concerted  effort  was  made  to  invest  in  health  systems,  a  landmark  report  concludes. Written  by  a  group  of  25  leading  health  experts  and  economists  from  across  the  globe  and   chaired  by  Larry  Summers,  a  Harvard  economist  and  former  adviser  to  the  Obama  and  Clinton   administrations,  the  Lancet  Commission  report  says  "health  disparities  between  nations  could   be  eliminated  within  a  generation"  if  around  $60bn  (£37bn)  a  year  was  injected  into  healthcare   systems. In  the  year  2035  alone,  roughly  10  million  lives  could  be  saved  in  low-­‐income  and  middle-­‐   income  countries,  "eliciting  enormous  social  and  economic  gains  for  the  countries  most   affected". The  commission  said  the  poorest  nations  in  the  world  would  see  economic  gains  by  bringing   down  mortality  levels  from  maternal  and  childhood  conditions,  TB  and  Aids,  to  those  achieved   by  the  best-­‐performing  middle-­‐income  countries:  Chile,  China,  Costa  Rica,  and  Cuba,  labelled   the  "4C"  countries. In  an  interview  Summers  acknowledged  that  not  enough  progress  had  been  made  in  global   health  –  the  rate  of  decline  in  maternal  and  child  mortality  in  the  developing  world  will  not  be   sufficient  to  reach  the  United  Nations'  millennium  development  goals  by  2015.  However,  he  said   that  "any  goal  you  are  sure  to  meet  is  not  a  goal  worth  setting  ...  I  think  we  have  set  an   aspiration  that  is  very  much  achievable". The  "convergence  plan"  is  summarised  by  the  commission  as  "16-­‐8-­‐4"  –  reducing  under-­‐five   mortality  to  16  per  1,000  live  births,  cutting  annual  Aids  deaths  to  eight  per  100,000  population   and  bringing  down  annual  tuberculosis  (TB)  deaths  to  four  per  100,000  population. The  commission  warned  that  provision  of  public  health  goods  would  need  to  "regain   prominence"  for  the  strategy  to  succeed.  In  1990,  only  $47bn  was  spent  on  health  research   worldwide.  By  2009,  annual  funding  had  risen  to  $248bn,  of  which  60%  came  from  the  business   sector  and  was  mostly  targeted  at  developed-­‐world  conditions  such  as  cancer. Only  about  $3bn,  representing  just  1%  of  total  spend,  is  spent  annually  on  R&D  for  infectious   diseases  –  of  particular  concern  to  low-­‐income  and  middle-­‐income  countries.  "Clearly  resources   should  not  just  be  driven  by  commercial  priorities,"  Summers  said,  echoing  the  report's   conclusion  that  research  budgets  in  this  area  needed  to  double. Not  only  are  the  wrong  diseases  targeted  but  underfunding  of  global  institutions  remains  a  

worry. Since  1994,  the  World  Health  Organisation's  budget  has  decreased  steadily  in  real  terms and  the  organisation  is  struggling  to  pay  to  run  its  offices.  The  WHO's  entire  influenza  budget  in   2013  is  just  $7.7m  –  less  than  a  third  of  what  New  York  devotes  to  preparing  for  public  health   emergencies.  "The  global  system  is  very  much  frayed,"  said  Summers,  adding  that  the  issue   needed  to  be  improved  on. Some  poorer  nations  have  been  reaping  economic  growth  today  through  health  gains  made  in   the  past.  The  rates  of  increase  in  life  expectancy  in  the  second  half  of  the  20th  century  in   countries  such  as  China  and  Mexico  were  at  least  twice  as  fast  as  those  that  occurred  in  high-­‐   income  countries  in  the  same  period,  said  the  commission. The  commission  also  said  the  value  of  a  one-­‐year  increase  in  life  expectancy  in  the  low-­‐  and   middle-­‐income  countries  was  estimated  to  be  2.3  times  per  capita  income. Summers  said  calculations  showed  that  "between  2000  and  2011,  about  24%  of  the  growth  in   full  income  came  from  health  gains"  and  if  the  poorest  countries  could  continue  this  trend  this   fraction  "was  a  reasonable  estimate  (for  the  future).  I  think  it'd  be  somewhat  more  if  the  full   programme  was  adopted". A  cost-­‐benefit  analysis  by  the  commission  reveals  that  spending  an  extra  $25bn  in  the  poorest   nations  would  cost  just  $23  a  head  but  yield  $216  per  capita  increase  in  economic  growth. "We  think  that  there  is  an  extraordinarily  high  return  from  these  investments,"  said  Summers.   "The  benefits  outweigh  the  costs  nine  times  in  low-­‐income  countries  and  20  times  in  lower   middle-­‐income  countries." He  said  the  estimated  $60bn  a  year  in  funding  was  "a  lot  of  money  but  (had  to  be)  compared  to   the  growth  in  income  that  is  expected".  Summers  pointed  out  that  given  the  lingering  effects  of   recession  in  the  west  rising  powers  such  as  China  would  play  a  much  greater  role  in  aid  provision   in  the  decades  ahead.  

Theguardian globalhealthdisparities 12 2 13

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