Investing in health

Abstract

As public health professionals devoted to global health equity, we would like to express our deep concern with the The Lancet Commission Global health 2035: a world converging within a generation (Dec 7, p 1898),1Jamison DT Summers LH Alleyne G et al.Global health 2035: a world converging within a generation.Lancet. 2013; 382: 1898-1955Summary Full Text Full Text PDF PubMed Scopus (772) Google Scholar a re-run of the 1993 World Development Report, whose policies contributed to the shrinkage of government institutions and massive privatisation and fragmentation of health-care systems, effectively decreasing coverage and accessibility.2Laurell AC Arellano OL Market commodities and poor relief: the World Bank proposal for Health.Int J Health Serv. 1996; 26: 1-18Crossref PubMed Scopus (76) Google Scholar, 3Lister J Globalization and health systems change. WHO Commission on Social detetminants of Health. University of Ottawa, 2008http://www.globalhealthequity.ca/webfm_send/14Google Scholar The Lancet Commission on Investing in Health comprised mostly of individuals affiliated with or funded by international financial institutions, corporations, public–private partnerships, bilateral donor agencies, and their philanthropic and academic partners, mostly from high-income countries, presents a biased perspective reminiscent of failed neoliberal prescriptions rooted in the reinvention of formulas by co-opting terms like universal health care and access. The recommendations are based on the principle of return on investment, not on health equity, while creating a double standard: one for the rich and another for the rest of us. Any policy for the poor is by definition a poor policy. The Lancet Commission's recommendations do not represent the global health community and are fundamentally flawed by neglecting the principle of the right to health. The report analyses Millennium Development Goals progress without reference to stagnant levels of health inequity: 20 million deaths each year, more than a third of all deaths, are avoidable and caused by socio-economic injustice—a number and a proportion that have not changed for the past 40 years.4Garay J, Harris L, Beam M, Zompi S. Global inequity death toll: targeting global health equity and estimating the burden of inequity. 141st American Public Health Association Annual Meeting; Boston, MA, USA; Nov 2–6, 2013. Abstr 291133.Google Scholar Every individual, organisation, or government working to promote heath equity and WHO's objective of enjoyment by all peoples of the best attainable level of health should be on their guard. We declare that we have no competing interests. Download .pdf (.11 MB) Help with pdf files Supplementary appendix Global health 2035: a world converging within a generationPrompted by the 20th anniversary of the 1993 World Development Report, a Lancet Commission revisited the case for investment in health and developed a new investment framework to achieve dramatic health gains by 2035. Our report has four key messages, each accompanied by opportunities for action by national governments of low-income and middle-income countries and by the international community. Full-Text PDF Investing in health – Authors' replyThe publication of The Lancet Commission1 sparked intense discussion and debate at country, regional, and international levels. This extraordinary response is perhaps not surprising, given that the report lays out an extremely ambitious global health investment framework and claims that investing in this framework would achieve very dramatic health gains within a generation. Our claims are bold, but we are confident that they are based on rigorous and replicable analyses. Full-Text PDF