Columns - Simply strengthening health services

01 May 2015 / 00:07 H.

    LAST year, life expectancy on the planet reached 70, with 75 years in Malaysia. This is remarkable progress – in 1900, life expectancy was about 30. Compared to a century ago, each of us has now been granted more than two lifetimes. But there are still many health problems we could tackle better. The question is which we should focus on.
    By September, 193 governments, working through the UN, will be deciding which targets the world should be focusing on until 2030. The world will spend more than US$2.5 trillion (RM8.93 trillion) on these targets over the next 15 years, and to help them do as much good as possible for every dollar spent, my think tank, the Copenhagen Consensus Centre, has asked 60 teams of economists to assess which targets are best, across all areas from health and nutrition to environment and education.
    There are lots of excellent proposals to address particular health challenges, such as malaria, vaccinations or infant death. But focusing on these single issues that have lots of media attention and straightforward solutions easily means forgetting about the many other ailments. Our new peer-reviewed reports suggest that we should look at strengthening the entire health system. For each person, Malaysia spends US$230 on public health care. Compare this to low-income countries, where the world's poorest one billion live. These countries will this year spend a measly US$14 per person on public health care. Not surprisingly, spending just a little more could do a lot of good.
    This year, 9 million people in low-income countries like Bangladesh, Uganda and Haiti will die before their 70th birthday. This will affect another 19 million in lower middle-income countries like India, Nigeria and Guatemala. But as countries get richer by 2030, they will also get healthier. It is estimated that by 2030, the total premature death will have dropped from 28 million to 24 million a year, despite the population having grown by almost a billion. Yet, we can do much better.
    The Canadian authors of the study find it is possible to achieve a further reduction, resulting in a two-thirds drop from 2010 child mortality and a one-thirds drop from 2010 deaths from people between 5 and 69 years of age. In total, this would reduce deaths in the poor half of the world by another 7 million annually by 2030.
    This would require increasing health spending from the current 2% of GDP to 5% of GDP. In low-income countries public health spending will have risen to US$23 per person by 2030 because countries will be richer. But increasing it another US$34 will allow us to avoid an extra 2 million deaths each year. For lower middle income countries, the average public health expenditure will be US$85 per person, but increasing this another US$128 will save almost 5 million more lives by 2030.
    Because we're talking about helping half the world's population, this is not cheap. Total extra costs will run to almost half a trillion dollars each year by 2030. Yet, it still compares favourably to the benefits of saving 7 million lives, both as measured in lost productivity and as the intrinsic value ascribed to human beings. The overall estimate shows that for every dollar spent, we will achieve US$4 of human benefits. For the poorest one billion, because the spending is so much lower that there are many more low-hanging fruits, each dollar spent would do US$13 worth of good.
    This compares to some of the high-profile diseases like tuberculosis, which will do US$43 worth of good for every dollar spent, or malaria, which will produce US$36 of benefits for every dollar. These are higher, because it is very effective to save lives of children and young adults afflicted with easily curable diseases. Helping everyone through a more comprehensive health system is more just but also means dealing with less easy diseases and helping higher age groups, where you can save fewer life-years.
    Of course, it's more complicated than just spending more money on cures; the funds have to be channelled into more trained staff, more clinics and more medicines, to be employed as effectively as possible in each area to reduce overall mortality (and also the wider burden of disease and disability). But the benefits of having better health provision are undeniable. Medical staff can not only provide continuing care and prevent or treat the normal range of illnesses and ensure safer births, but they are in a position to react to emergencies as they arise.
    For example, considerable numbers of people die from injuries each year, and the team of economists reckons that this number could also be reduced by a third. The Ebola outbreak in West Africa is another clear example. The countries which are suffering most have very poor general health provision and large amounts of international assistance are being poured in to halt the epidemic. With a properly functioning local health service, the disease may never have got a hold in the first place.
    There are plenty of potentially very good health targets proposed as priorities for the next 15 years, focusing on HIV, malaria, TB and infant mortality in particular. All are worthy of our attention, but a good case has been made for simply strengthening health services to achieve an overall cut in premature death.

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