In the new report, Global Health 2050: the path to halving premature death by mid-century, its authors propose an ambitious target. They propose that, by prioritizing 15 priority health problems, countries can reduce to 50% the probability of dying before age 70 by 2050, taking 2019 levels as a reference. Despite the ambition of the idea, however, it is surprising that low birth weight, acute malnutrition and chronic malnutrition in children under 5 are completely ignored. How is this possible?
Guiding global health investment, from 1993 to today
This new report is neither an isolated nor a new idea. Back in 1993, Dean T. Jamison (an influential world expert on health economics) and Lawrence Summers (chief economist at the World Bank), published one of the major reports in the history of global health. It was the World Development Report 1993: Investing in Health of the World Bank. This seminal document, intended for international finance ministers and donors, argued that investing strategically in cost-effective interventions for high-burden diseases could rapidly improve health outcomes, as well as boost the economy.
Twenty years later, in 2013, these same authors led the Lancet Commission on Investing in Health and published Global Health 2035, consolidating their approach. Later, in 2018, they launched another similar report. This time it was focused on universal health coverage and its importance. The report they are releasing now, in 2024, comes just six years later, in reaction to the rapid changes taking place in the world. They believe that their proposal needs to be revised considering the current impact of climate change, the resurgence of many infections, and the impact of epidemics such as COVID-19. They also believe there are other key factors forcing a rethink: the rise of populism and the stagnation in progress toward universal health coverage.
A new report in 2024: Global Health 2050
Focus on 15 health priorities proposed to reduce preventable deaths
The path they propose to halve the probability of dying before age 70 is to prioritize 15 priority health conditions, in a modular fashion. In countries with the highest probability of premature mortality, these priorities focus on infectious diseases and maternal health problems. Thus, the 8 priorities in this category are neonatal conditions, lower respiratory infections, diarrheal diseases, HIV/AIDS, tuberculosis, malaria, childhood infectious diseases preventable with vaccines (such as measles, whooping cough, diphtheria, tetanus, and polio), and maternal health conditions.
Along with these 8 priorities, 7 more are proposed, related to trauma and noncommunicable diseases. These are proposed as priorities in countries where premature mortality is lower. These are atherosclerotic cardiovascular diseases, diabetes, hemorrhagic stroke, noncommunicable diseases linked to infections (such as hepatitis or papillomavirus), noncommunicable diseases linked to smoking (such as COPD and lung cancer), road traffic injuries and suicide.
Among these priorities, nutrition is hardly mentioned at all, and only in older children
It would not be fair to say that nutrition is completely forgotten in the Global Health 2050 report. The authors mention (albeit timidly) interventions such as micronutrient supplementation or the importance of school canteens. However, they do not focus their analysis of the problem on the period of pregnancy and the first five years of life. They focus on "the next 7000 days" up to the age of 19. The reasons they give are clear: they allude to the fact that early age is not the only period of vulnerability. The period from 5 to 19 years is also a critical period of development and growth that is often forgotten. These are years in which important emotional, physical, behavioral and even future mental health-related changes take place.
By focusing the analysis on reducing the probability of premature death, the five to 19 years of age range is given a weight that it does not usually have in other analyses. What is worrying, however, is that this displaces the period from gestation to 5 years of age, a key period in which these same children face very significant physical, mental and emotional risks....
The author of the Global Health 2050 report himself published, in 2006, another very important World Bank report, entitled Disease Control Priorities in Developing Countries. This report highlighted that child undernutrition increased vulnerability to diseases such as pneumonia, diarrhea or malaria and that it contributed significantly to child mortality. Moreover, it was estimated that eliminating undernutrition could prevent up to 53% of under-five deaths. How can this be wiped off the map, just a few years later?
We cannot ignore malnutrition in children under 5 years of age
Malnutrition is not a problem unrelated to global health. The understanding of malnutrition in any of its forms cannot be limited to a problem of humanitarian health, for contexts of conflict and displacement. Humanitarian action interventions cannot come close to alleviating a problem that needs sustainable investment and international cooperation for development. On the other hand, malnutrition cannot be seen only as a problem of food insecurity. Malnutrition is multi-causal and its approach must therefore be multi-sectoral. Moreover, the integration of nutrition services into health systems, with a strong primary care and community mobilization base, is key.
Although there are advantages to using the probability of premature death as the main indicator in the report, there are also enormous risks. One of them is to give the same importance to a death occurring at age 65 as a death occurring at age 4. However, deaths at younger ages result in a greater loss of potential years of life. Furthermore, underestimating the importance of earlier deaths is to underestimate the health problems of poorer countries, where these early deaths are more frequent.
We cannot lose sight of equity and justice with the excuse of globality. Nor can investment in the fight against malnutrition be discouraged. Investing in health requires, precisely, not missing the opportunity to continue to address, and more forcefully than ever, all the social determinants of hunger.
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External links
- Jamison, 2024. Global health 2050: the path to halving premature death by mid-century.
- Ritchie, 2024. Half of all child deaths are linked to malnutrition.
- IHME, 2024. Global Burden of Disease 2021.
- World Bank, 2006. Disease Control Priorities in Developing Countries.
- World Bank, 1993. World Development Report 1993: Investing in Health.
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