SAN FRANSISCO – Large parts of the world have not enjoyed the remarkable global progress in health conditions that have taken place over the past century. Indeed, millions of deaths in impoverished nations are avoidable with prevention and treatment options that the rich world already uses.
This year, ten million children will die in low- and middle-income countries. If child death rates were the same as those in developed countries, this figure would be lower than one million. Conversely, if child death rates were those of rich countries just 100 years ago, the figure would be 30 million.
The key difference between now and then is not income but technical knowledge about the causes of disease, and interventions to prevent disease, or at least the most pernicious symptoms. Today’s tools for improving health are so powerful and inexpensive that health conditions could be reasonably good even in poor countries if policymakers spent even relatively little in the right places.
Recent research for the Copenhagen Consensus identifies six highly cost-effective options that would tackle some of the planet’s most urgent health problems.
The most promising investment is in tuberculosis treatment. Some 90% of the 1.6 million tuberculosis deaths in 2003 occurred in low- and middle-income countries. Because tuberculosis affects working-age people, it can be a trigger of household poverty.
The cornerstone of control is prompt treatment using first-line drugs, which doesn’t require a sophisticated health system. Spending $1 billion on tuberculosis treatment in a year would save one million lives. Because good health accompanies higher levels of national economic welfare in the long run, the economic benefits are worth $30 billion.
The second most cost-effective investment is tackling cardiovascular disease. Heart disease might not seem like a pressing issue for poor nations, but it represents more than a quarter of their death toll. Measures to reduce risk factors other than smoking – high intake of saturated animal fat, obesity, binge drinking of alcohol, physical inactivity, and low fruit and vegetable consumption – have had little success.
Treating acute heart attacks with inexpensive drugs is, however, cost-effective. Spending $200 million could avert several hundred thousand deaths, yielding benefits that are 25 times higher than the costs.
The third option is prevention and treatment of malaria. A billion dollars would expand the provision of insecticide-treated bed-nets and facilitate provision of highly effective treatment. This would save more than a million child deaths and produce economic benefits worth $20 billion. The nascent Affordable Medicines Facility-malaria (AMFm) is a particularly attractive mechanism for committing resources to malaria control.
The fourth alternative for policymakers is to focus on child health initiatives. The best measures are familiar ones: expanding immunization coverage, promoting breastfeeding, increasing the use of simple and cheap treatments for diarrhea and childhood pneumonia, ensuring widespread distribution of key micronutrients, and spreading the use of anti-retroviral drugs and breastfeeding substitutes to prevent mother-to-child HIV transmission.
Expanding immunization and micronutrient coverage are perhaps the most critical measures. Spending a billion dollars on such initiatives could save one million lives annually and create economic benefits worth more than $20 billion a year.
The next option is to reduce the number of tobacco-related deaths. On current patterns, cigarette smoking will account for 10 million deaths per year by 2030. Most will occur in poor countries.
Some 100 million of China’s 200 million young male smokers and about 40 million of India’s 100 million young male smokers will eventually die from tobacco-related causes. A multi-faceted approach to smoking control is one of the few proven approaches to prevention of heart disease and cancer. A tobacco tax is particularly effective, with a 10% increase in price reducing consumption by 4-8%.
Arresting the spread of HIV/AIDS is the sixth option. For dozens of countries around the world, the AIDS epidemic threatens every aspect of development. But there is some good news: HIV infection rates are slowing in large parts of Asia and Latin America, which appears to reflect a (very uneven) increase in prevention programs.
The greatest successes in prevention involve what has been called “combination prevention,” involving simultaneous and substantial scaling up of multiple interventions, including condom distribution, treatment of sexually transmitted disease, male circumcision, and peer interventions among sex workers. Preventing two million HIV infections each year would be relatively expensive, at $2.5 billion, but would yield benefits twelve times higher.
The changes that we are advocating are designed to target specific areas of need instead of strengthening health system capacity. But there is an important exception: strengthening surgical capacity, particularly in local hospitals, can inexpensively (and often decisively) address abdominal conditions. Long-neglected investments in surgical capacity would yield high returns.
Even if the costs of all these initiatives were two or three times higher than we estimate, these efforts would still provide amazing opportunities to reduce health inequality and do good in the world.