Global Health 2035: WDR 1993 @20 Years CIH Report without notes Helen...§ Taxing empty calories,...

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14/10/16 1 Global Health 2035: WDR 1993 @20 Years The World Bank’s World Development Report 1993 • Evidence-based health expenditures are an investment not only in health, but in economic prosperity • AddiKonal resources should be spent on cost-effecKve intervenKons to address high-burden diseases The Lancet Commission on Inves<ng in Health • Re-examines the case for invesKng in health • Proposes a health investment framework for low- and middle-income countries • Provides a roadmap to achieving gains in global health through a ‘grand convergence’

Transcript of Global Health 2035: WDR 1993 @20 Years CIH Report without notes Helen...§ Taxing empty calories,...

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GlobalHealth2035:WDR1993@20YearsTheWorldBank’sWorldDevelopmentReport1993

• Evidence-basedhealthexpendituresareaninvestmentnotonlyinhealth,butineconomicprosperity

• AddiKonalresourcesshouldbespentoncost-effecKveintervenKonstoaddresshigh-burdendiseases

TheLancetCommissiononInves<nginHealth• Re-examinesthecaseforinvesKnginhealth• Proposesahealthinvestmentframeworkforlow-andmiddle-incomecountries

• Providesaroadmaptoachievinggainsinglobalhealththrougha‘grandconvergence’

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2015-2035:ThreeDomainsofHealthChallenges

HighratesofavertableinfecKous,child,andmaternaldeaths

Unfinishedagenda

DemographicchangeandshiXinGBDtowardsNCDsandinjuries

Emergingagenda

Impoverishingmedicalexpenses,unproducKve

costincreases

Costagenda

GlobalHealth2035:4KeyMessages

Thereturnsfrominves<nginhealthareextremelyimpressive

AgrandconvergenceinhealthisachievablewithinourlifeKme

Fiscalpoliciesareapowerful,underusedleverforcurbingnon-communicablediseases

andinjuries

Progressivepathwaystouniversalhealth

coverageareanefficientwaytoachievehealthandfinancialprotecKon

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NowonCuspofaHistoricalAchievement:NearlyAllCountriesCouldConvergeby2035

0

50

100

150

200

250

300

1990 1995 2000 2005 2010 2011 2015(MDGTarget)

Probabilityofachilddyingbyage5per1,000livebirths

Rwanda Sub-SaharanAfrica World

Rwanda:SteepestFallinChildMortalityEverRecorded

FarmerP,etal.BMJ2013;346:f65

Investment($70B/year)isNotaHighRiskVenture:RapidMortalityDeclineIsPossible

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ModelingConvergenceInvestmentCase1Comparesscale-upversusconstantcoverage

UNOneHealthtool

Country-levelcostandimpactmodel

to2035

HIV

Malaria

RMNCH

Burden,intervenKons,coverage,efficacy

ü  BurdenreducKon

ü  IntervenKoncosts

ü  “Servicedelivery”costs

GlobalHealth2035:4KeyMessages

Thereturnsfrominves<nginhealthareextremelyimpressive

AgrandconvergenceinhealthisachievablewithinourlifeKme

Fiscalpoliciesareapowerful,underusedleverforcurbingnon-communicablediseases

andinjuries

Progressivepathwaystouniversalhealth

coverageareanefficientwaytoachievehealthandfinancialprotecKon

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FullIncome:ABejerWaytoMeasuretheReturnsfromInvesKnginHealth

incomegrowth

valuelifeyearsgained(VLYs)in

thatperiod

changeincountry'sfullincomeoveraKmeperiod

Between2000and2011,aboutaquarterofthegrowthinfullincomeinlow-incomeandmiddle-incomecountriesresultedfromVLYsgained

WithFullIncomeApproach,ConvergenceHasImpressiveBenefit:CostRaKo

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SourcesofFinancingforConvergence

Economicgrowth

•  IMFesKmates$9.6trillion/yfrom2015-2035inlow-andlowermiddle-incomecountries

• Costofconvergence($70billion/y)islessthan1%ofan<cipatedgrowth

MobilizaKonofdomesKcresources

•  TaxaKonoftobacco,alcohol,sugar“win-wins”

•  Broadeningandstrengtheningtaxbase

Inter-sectoralreallocaKonsandefficiencygains

•  Removaloffossilfuelsubsidies,healthsectorefficiency

•  Subsidiesaccountforan3.5%ofGDPonapost-taxbasis

Developmentassistancefor

health

• WillsKllbecrucialforachievingconvergence

GlobalHealth2035:4KeyMessages

Thereturnsfrominves<nginhealthareextremelyimpressive

AgrandconvergenceinhealthisachievablewithinourlifeKme

Fiscalpoliciesareapowerful,underusedleverforcurbingnon-communicablediseases

andinjuries

Progressivepathwaystouniversalhealth

coverageareanefficientwaytoachievehealthandfinancialprotecKon

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SingleGreatestOpportunityToCurbNCDsisTobaccoTaxaKon

50%riseintobaccopricefromtaxincreasesinChina§  prevents20milliondeaths+

generatesextra$20billion/yinnext50y

§  addiKonaltaxrevenuewouldfalloverKmebutwouldbehigherthancurrentlevelsevenaXer50y

§  largestshareoflife-yearsgainedisinbojomincomequinKle

WeAlsoArgueforTaxesonSugare.g.producttaxesonSugar-SweetenedSodas

§  Taxingemptycalories,e.g.sugarysodas,canreduceprevalenceofobesityandraisepublicrevenue

§  Thesetaxesdonothurtthepoor:maindietaryprobleminlow-incomegroupsispoordietaryqualityandnotenergyinsufficiency

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LessonsfromTaxingTobaccoandAlcohol

§  TaxesmustbelargetochangeconsumpKon

§  Mustpreventtaxavoidance(loopholes)andtaxevasion(smuggling,bootlegging)

§  Designtaxestoavoidsubs<tu<on

§  Young/low-incomegroupsrespondmost

GlobalHealth2035:4KeyMessages

Thereturnsfrominves<nginhealthareextremelyimpressive

AgrandconvergenceinhealthisachievablewithinourlifeKme

Fiscalpoliciesareapowerful,underusedleverforcurbingnon-communicablediseases

andinjuries

Progressivepathwaystouniversalhealth

coverageareanefficientwaytoachievehealthandfinancialprotecKon

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OurRecommendaKononUHC:ProgressiveUniversalism(BlueShading)

+essen<alpackageforNCDIs

ProgressiveUniversalism

InsurancecoverswholepopulaKon

Targetspoorbyinsuringhighlycost-effecKve

healthintervenKonsfordiseases

disproporKonatelyaffecKngpoor

IntervenKonsarefundedthroughtaxrevenues,

payrolltaxes,orcombinaKon

NoOOPexpensesfordefinedbenefitpackageofpubliclyfinanced

services

Asresourceenvelopegrows,sodoespackage(asseeninMexico),e.g.

addwiderrangeofintervenKonsforNCDs

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AdvantagesofProgressiveUniversalism

§  GovernmentdoesnothavetoincurcostlyadministraKveexpensesidenKfyingwhoispoor(everyoneiscovered)

§  UniversalpackagepromotesbroadersupportamongpopulaKonandhealthprovidersthanschemestargeKngpooralone—suchsupporthelpstosustainfinancingoverKme

AVariantofProgressiveUniversalism

§  LargerpackagetowholepopulaKonwithpaEentcopaymentbutpoorareexemptedfromcopay(e.g.Rwanda)

§  Usesawidervarietyoffinancingmechanisms(generaltaxaKon,payrolltax,mandatoryinsurancepremiums,copayments)

Advantages:widerpackage,engagesnon-poorinprepaidmandatoryschemefromday1,transiKonmaybemorefeasible

Majordisadvantage:costlytoidenKfypoor,toorganizeandcollectcopays/premiums

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Thankyou

GlobalHealth2035.org

Caveats&Challenges

InherentuncertainKesinanymodelingexercise

Assumesaggressivecoveragelevels(typically90-95%by2035)—wouldallcountrieshavetheinsKtuKonalcapacity?

Modeldoesnotaccountforroleofother

developmentsectors(e.g.climate,water)orsocialdeterminantsofhealth

Mayover-playorunder-playroleofR&D


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