Good Nutrition is Part of the Framework that Supports Investments in Global Health
Today is the 20th anniversary of the landmark 1993 World Development Report that identified how important investments into health care are for human development. A Lancet Commission has developed a new investment framework to further reduce the health gap between developed and developing countries and improve global health during the next two decades.
Contributors to the Commission make the following points regarding how to best invest in health care systems to raise health standards in developing countries:
Mark Dybul from the Global Fund to Fight AIDS, Tuberculosis and Malaria comments that innovative solutions to health care delivery systems, strong partnerships between countries health care systems, government, NGOs and the private sector, and making health a central part of development programs are required to meet goals of reducing infections, improving child and maternal health, and preventing non-communicable diseases.
Margaret Chan of the World Health Organization stresses the importance of quantitating how investments improve quality of life and improve the health of populations. Health resources should be distributed equitably. Carefully planned policy measures are required to ensure that interventions targeted at multi-factorial non-communicable diseases are effective. Altruism rather than cost-benefit considerations have improved access to anti-retroviral drugs. New social media has changed how people interact, and social activism is growing in importance.
Helen Clark, from the United Nations Development Programme, states that investments in health are investments in human development. She mentions the importance on acting not just on improvements in the health care system, but also the effect of social determinants on how resources are used: social stigmas, poverty, and poor governance in the health sector affect uptake of health care. There should be a balance between short- and long-term health investments. Government sectors may need to work together to find synergies in improving health. Health and development objectives can be better achieved in tandem.
The World Bank’s Jim Yong Kim named the 1993 World Development Report as a catalyst for global health and development policy. Health investments are essential to end poverty. There are certain inefficiencies in health care delivery systems that means that around 250,000 people every day fall into poverty due to the costs of health care. Universal health coverage is an important tool to ensure that health care reaches the most in need. He calls for time-bound targets for meeting objectives in reducing maternal and child mortality before 2035. Current global health care spending is currently only 2% of government spending, and this needs to be increased to 3-4% to meet critical thresholds in provision of care to populations. Solutions arising from sectors outside the health care system are also critical in the prevention of disease, accidents and disability. Factors that have contributed to successful implementations of programs in countries should be analyzed and the results shared.
The Lancet Commission provide a new investment framework “to achieve dramatic health gains by 2035.” The report highlights four key messages:
1) There is an enormous payoff from investing in health
2) A “grand convergence” in health is achievable within our lifetimes
3) Fiscal policies are a powerful and underused lever for curbing of non-communicable diseases and injuries
4) Progressive universalism, a pathway to universal health coverage (UHC), is an efficient way to achieve health and financial protection
The role that nutrition plays in meeting goals for reducing disease, stimulating human development and improving global quality of life should also not be overlooked. The four key messages can also be applied to nutrition. The Micronutrient Initiative highlights that micronutrient initiatives have already shown the highest return on investment for any investment in global development. Malnutrition is preventable; preventing under-nutrition and specific nutrient deficiencies should be achievable. Fiscal policies can also be used for nutrition interventions: Thow, Jan, Leeder and Swinburn found that food taxes and subsidies can reduce chronic disease risk. The Food and Agriculture Organisation improve both the health and safety of food, and benefits nutritional status. Universal Health Coverage also improves access to nutrition-related education and programs; for example, Child Health Days, held twice annually in Ethiopia have been shown to be an instrument for providing both nutrition and health care to at-risk populations.
The report makes essential reading for anyone involved in how health care affects human devopment, and provides a framework for improving population health.
Margaret Chan, Investing in health: progress but hard choices remain, The Lancet, Available online 3 December 2013, ISSN 0140-6736, http://dx.doi.org/10.1016/S0140-6736(13)62336-3.
Helen Clark, Towards a more robust investment framework for health, The Lancet, Available online 3 December 2013, ISSN 0140-6736, http://dx.doi.org/10.1016/S0140-6736(13)62335-1.
Mark Dybul, A grand convergence and a historic opportunity, The Lancet, Available online 3 December 2013, ISSN 0140-6736, http://dx.doi.org/10.1016/S0140-6736(13)62344-2.
Jim Yong Kim, Time for even greater ambition in global health, The Lancet, Available online 3 December 2013, ISSN 0140-6736, http://dx.doi.org/10.1016/S0140-6736(13)62374-0.
Dean T Jamison, Lawrence H Summers, George Alleyne, Kenneth J Arrow, Seth Berkley, Agnes Binagwaho, Flavia Bustreo, David Evans, Richard G A Feachem, Julio Frenk, Gargee Ghosh, Sue J Goldie, Yan Guo, Sanjeev Gupta, Richard Horton, Margaret E Kruk, Adel Mahmoud, Linah K Mohohlo, Mthuli Ncube, Ariel Pablos-Mendez, K Srinath Reddy, Helen Saxenian, Agnes Soucat, Karene H Ulltveit-Moe, Gavin Yamey, Global health 2035: a world converging within a generation, The Lancet, Available online 3 December 2013, ISSN 0140-6736, http://dx.doi.org/10.1016/S0140-6736(13)62105-4.