Sweta Adhikari is a data analyst at the Columbia University Mailman School of Public Health and a former CDDEP researcher.
On January 16th, a discussion session entitled Toward a Grand Convergence in Global Health: What Convergence Means for Health after 2015 , organized by the Permanent Mission of Norway to the United Nations, took place at the UN Headquarters in New York. Five members of the Lancet Commission on Investing in Health (CIH) presented the commission s report, Global Health 2035 (GH2035), which presents an investment framework for low- and middle-income countries (LMICs) to help achieve a grand convergence in global health a dramatic reduction of infectious, child and maternal mortality rates to universally low levels.
Dr. Margaret E. Kruk, assistant professor of Health Policy & Management at Columbia University Mailman School of Public Health and one of the 25 CIH commissioners, introduced the initiative by explaining how wealth disparities have resulted in divergence across global health indicators in the 200 years since the Industrial Revolution. Citing success stories of four countries ( the 4 C s : Chile, China, Costa Rica and Cuba), Dr. Kruk asserted that dedicated and targeted investment in health systems can bring the health status of LMICs up to par with developed countries. Such investments, she explained, have highly beneficial returns as they not only bring great health outcomes but also vibrant economic growth because people will be more productive .
Dr. Kruk was followed by Dr. Gavin Yamey, who leads the Evidence-to-Policy Initiative at the Global Health Group of the University of California, San Francisco. Dr. Yamey, one of the lead authors of the report, presented the four key messages of Global Health 2035: 1) a grand convergence in health is achievable within one generation; 2) returns on investment in health are enormous and even larger than previously imagined; 3) fiscal policies can dramatically delay the onset of non-communicable diseases and injuries while simultaneously raising significant revenue for governments; and 4) pro-poor universal health coverage is an efficient way to ensure health and financial protection for all citizens. Marking the iconic 3-year anniversary of polio eradication in India on January 13th, Dr. Yamey asserted that targeted health systems investments (programmatic and structural) are achievable through the aggressive implementation of both currently used and new methods.
Presenting an example of the positive results of investing in health, Dr. Agn s Binagwaho, the Rwandan Minister of Health, spoke about her country s formula for success. Noting that Rwanda was one of the few countries to have met its Millennium Development Goals, Binagwaho said, If we struggle and fight the right way, we can win those fights. The strategies in place to ensure efficient healthcare delivery in Rwanda include: 1) economic growth; 2) the integrated fight against malaria, tuberculosis and HIV; 3) health financing that focuses on the most vulnerable; 4) public participation in health; and 5) evidence-based methods to promote innovation, equity and accountability for good governance.
Dr. Ariel Pablos M ndez, assistant administrator for Global Health at USAID, commented on the obvious implications of the report by citing the first law of health economics: increased per capita health investment results in simultaneous improvements in health. He emphasized the need for international donor communities, including USAID, to engage LMICs in new ways to work toward universal health coverage. He also mentioned the formation of new programs, such as USAID s Global Health Initiative, which focus on solidarity, local capacity-building and sustainable approaches to health delivery.
Dr. K. Srinath Reddy, president of the Public Health Foundation of India, was the final speaker at the event. He emphasized the need for a strong health system and financial risk protection to ensure healthcare for all. Global Health 2035 argues for an initial focus on financing interventions toward a grand convergence and essential interventions for non-communicable diseases and injuries to maximize health status these, Dr. Reddy said, are pillars for pro-poor universal health coverage. Presenting a strong case for progressive universalism, he stated that user fees at the point of care shut the door on the poor; hence there is a need for greater tilt to the poor to create a stake for everybody in the system.