Mortality Rate Convergence between High- and Low-Income Countries

A recent Lancet commission led by Watkins and others examined the rate of convergence between high- and low-income countries for a number of conditions.[1] Huge progress has been made in mortality of under-fives and from HIV/AIDS. Progress is less impressive for maternal mortality, and less impressive still for tuberculosis mortality. The authors argued for greater investment in the latter two topics. Other topics singled out for good reason include cervical cancer, hepatitis B and rheumatic heart disease, all on the grounds of great disparities between rich and poor populations. They also argue that more attention must be paid to preparing for pandemics, a topic covered by CLAHRC West Midlands.[2]

The authors argue for greater domestic spending and point out that the economic returns on investment arise from both increased productivity andthe improvement in human welfare, such as that captured in DALYs. But they are very keen to see better targeting of expenditure, which will require careful economic analysis, such as that we are carrying out into ambulance services. The authors argue for more savvy procurement to shape markets using Gavi, the vaccine alliance, as an excellent example. Following this model, rich countries could incentivise industry to develop new treatments for tuberculosis, for example. The authors make the excellent point that huge improvements could come from closing the delivery practice gap through population, policy and implementation research. The spread of unhealthy products needs to be curtailed following the model of the WHO convention in tobacco control.

A recurring theme is that many of the above objectives require international action: shaping markets, preparing for pandemics, and preventing diffusion if unhealthy products, for example. I am writing this report from Kigali at the close of the NIHR Global Surgery Unit conference. This has been precisely the kind of international collaboration that the authors are arguing for.

— Richard Lilford, CLAHRC WM Director

References:

1. Watkins DA, Yamey G, Schäferhoff M, et al. Alma-Ata at 40 years: reflections from the LancetCommission on Investing in Health. Lancet. 2018; 392: 1434-60.
2. Watson SI, Chen Y-F, Nguyen-Van-Tam JS, Myles PR, Venkatesan S, Zambon M, Uthman O, Chilton PJ, Lilford RJ. Evidence synthesis and decision modelling to support complex decisions: stockpiling neuraminidase inhibitors for pandemic influenza usage. F1000Res. 2016; 5: 2293.