Alma-Ata at 40 years: reflections from the Lancet Commission on Investing in Health

• Published in: The Lancet (British edition) Vol. 392; no. 10156; pp. 1434 - 1460
• Main Authors: Watkins, David A, Yamey, Gavin, Schäferhoff, Marco, Adeyi, Olusoji, Alleyne, George, Alwan, Ala, Berkley, Seth, Feachem, Richard, Frenk, Julio, Ghosh, Gargee, Goldie, Sue J, Guo, Yan, Gupta, Sanjeev, Knaul, Felicia, Kruk, Margaret, Nugent, Rachel, Ogbuoji, Osondu, Qi, Jinyuan, Reddy, Srinath, Saxenian, Helen, Soucat, Agnés, Jamison, Dean T, Summers, Lawrence H
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 20.10.2018; Elsevier Limited
• Subjects: Accounting; Cardiovascular disease; Collective action; Commodities; Cost estimates; Counterfeiting; Delivery of Health Care - economics; Delivery of Health Care - standards; Disease control; Drug resistance; Economic models; Epidemics; Epidemiology; Externality; Financing; Global economy; Global Health; Health care; Health Expenditures - statistics & numerical data; Health policy; Health Policy - trends; Healthy People Programs - standards; Households; Humans; Infectious diseases; Influenza; Low income groups; Maternal mortality; Mortality; Pandemics; Policy research; Population growth; Primary care; Primary Health Care - standards; Product development; Public health; Sustainable development; Trends; Tuberculosis; Universal Health Insurance; Vaccines; Eurasia; United States > US; China; Sub-Saharan Africa; Latin America; India
• DOI: 10.1016/S0140-6736(18)32389-4
• ISSN: 0140-6736

[...]GH2035 conveyed the importance of countries to realise the exceptionally high economic value of successful investment in health relative to cost. In a recent review40 of the lessons learnt from the CIH, we noted that GH2035 initiated several new directions for global health policy research. (appendix p 3). Since 2013, a range of new analyses have been made as an extension to the analyses by the CIH, and this report provides an opportunity to disseminate these results. LICs and lower-MICs in particular have little incentive to prepare for low-probability events in the face of so many pressing health needs. [...]health ODA and international collective action for health should fund national preparedness and mitigate externalities of epidemics that often start out in LICs and MICs. Recent trends in domestic spending In 2015, $7·3 trillion was spent on health worldwide, accounting for 7% of global GDP. Since 2000, the health sector of the global economy has grown at a faster rate annually (4%) than the overall global economy (2·8%), and in LICs and lower-MICs health sector growth has been even faster (6%).37 Growth in health spending has been primarily driven by increased domestic rather than external resources; external resources are only an important source of finance in LICs, where they represent 30% of current health expenditure.37 Yet LICs have generally decreased the allocation of domestic resources to health and have become even more reliant on ODA for health since 2000.37 In our re-analysis of WHO's Global Health Expenditure Database, we break down trends in the growth of public expenditure on health (from domestic sources) and out-of-pocket spending by households (appendix pp 64–65).