In the next 20 years, low-income countries (LICs) and lower-middle-income countries (LMICs) are projected to add a collective $10 trillion to their gross domestic product (GDP), explained global health and policy expert Gavin Yamey to a room full of Stanford students and faculty Mar. 4.  This economic growth, paired with a relatively modest increase in domestic government investments in public health, has the potential to yield tremendous returns and extraordinary strides in closing the global health gap.

Economic growth of LICs and LMICs is among the foundational pillars that Dr. Yamey says will make it possible to achieve a “grand convergence” in health within just one generation. “Grand convergence” refers to a concept detailed in a 2013 landmark report from the Lancet Commission on Investing in Health, which asserts that, with the help of financial and ever-improving technical capacity, the current generation is uniquely positioned to make major strides in closing the global health gap by reducing infectious, child and maternal mortality rates to universally low levels by 2035.

“All we’re saying to [low and middle-income] countries is to set aside one to three percent of that additional money, and invest it into health, and the rewards will be enormous,” said Dr. Yamey in a seminar hosted by Stanford University’s Center for Innovation in Global Health. “10 million lives saved by 2035 year-on-year for this investment. I can’t think of any other investment on the planet that could improve human welfare in such a huge way.”

An associate professor of epidemiology and biostatistics at the University of California-San Francisco, Dr. Yamey is one of 25 renowned economists and global health experts that make up the Lancet Commission on Investing in Health and led the writing of the Commission’s report, also known as Global Health 2035.  

“We have an extraordinary opportunity to bring down maternal, newborn and infectious disease deaths to universally low levels everywhere,” said Dr. Yamey.  “But for that to happen, we need an aggressive scale up of existing tools and interventions, investment in new tools and a build-up of delivery systems.”

These tremendous gains are possible, says Dr. Yamey, citing the case of Rwanda, a country that has become well known among public health and development experts for its transformative success in rebuilding its economy and healthcare system in the aftermath of the 1994 genocide.

Over the past decade, Rwanda has experienced significant drops in mortality associated with HIV, malaria and maternal death, and achieved the greatest drop in child mortality rates in recorded history. While scholars acknowledge several factors that contributed to such an extraordinary rebound, government spending on public health, the smart use of aid, and economic growth were all integral to the equation.

Rwanda is just one of several case studies revealing significant returns to investing in health.  The authors of Global Health 2035 point to the “4C countries” – Chile, China, Costa Rica and Cuba – that provide evidence for how even poor countries can achieve rapid declines in mortality rates by investing in health.  All four countries were classified as LICs or LMICs in 1990, and yet by 2011 they had all sharply reduced their avertable death rates, in part from smart health sector investments.

Drawing upon lessons learned from the past, Dr. Yamey suggests that evidence must be a key factor that shapes policy-making decisions. But while the evidence for investing in health is strong, Dr. Yamey noted that the global health community is not always quick to adopt new strategies, even when there might be strong evidence supporting them. He gave the example of the slow adoption of a group of malaria drugs called artemisinin-based combination therapies (ACTs).

Evidence to Policy

Dr. Yamey leads the Evidence to Policy Initiative (E2Pi) in the UCSF Global Health Group, which works to narrow the gap between evidence and action in global health policy creating tools and information policymakers need in order to make informed decisions. The group specializes in translating evidence and analysis into practical “real world” decision-making.

E2Pi’s focus areas are reproductive maternal, newborn and child health; HIV, TB, and malaria; and the financing, governance, architecture, and delivery of global health.

Looking Ahead

In 2000, UN member states adopted eight Millennium Development Goals (MDGs), including the goal of reducing child mortality by two thirds from 1990 to 2015 (MDG 4) and reducing maternal mortality by three quarters over the same time period (MDG 5). These two MDGs have become a major focus of the international health community. Dr. Yamey explained that while all eight targets were not met, significant progress has been made, particularly in child health. The first goal (MDG 1)—the goal of halving the proportion of people living on less than $1.25 a day—was achieved 5 years ahead of the 2015 deadline.

Stanford Medicine’s chief communications officer Paul Costello, who facilitated the Mar. 4 event, noted that the good news is that children in developing nations are increasingly surviving childhood diseases that they did not survive before, thereby creating a new band of adolescents in the population pyramid. However, this growing band of adolescents presents new challenges, such as more people living with chronic illnesses.

“In some ways, this is really a good news story. There are five million fewer children dying under the age of five than 20 years ago. But of course, that does mean we need to think about the future,” said Dr. Yamey in response.

The authors of Global Health 2035 discuss this “paradox of success” in which as LMIC nations successfully reduce deaths from infections and maternal conditions, they accelerate a shift in the disease burden to non-communicable diseases and injuries in adults. Dr. Yamey offered several strategies the global health community should consider to mitigate these new risks, all which require commitment at the domestic level to investing in health.  

At a time when the international community is laying out new targets for global health development, Dr. Yamey emphasized the opportunity presented to achieve a “grand convergence.” But such ambitious goals will only be achieved through an evidence-based approach to investments in global health technology, health systems and policies.