Many of the world’s leading health scientists and advocates are uniting in pursuit of an ambitious yet achievable goal: To halve premature deaths around the world by 2050.
The Lancet Commission on Investing in Health announced the goal in a report last October, Global Health 2050, declaring that any country that sets out to do so, regardless of population or income, could dramatically reduce the probability that its citizens will die before age 70.
Leaders of the commission, including scientists from UCSF’s Institute for Global Health Sciences (IGHS), convened at UCSF in January to discuss both progress made toward the goal and strategies to achieve it.
“We are united in the work of saving lives, improving health and advancing equity,” said Payam Nahid, MD, MPH, executive director of IGHS. “These principles are not confined by nations, borders or political movements, and they endure, especially in challenging times.”
“The report is not just a vision for the future, but also serves as a call to action for justice and health for all,” Nahid said.
Lancet Commissions are expert-driven initiatives established to address critical global health and policy issues. The Lancet Commissioners have come to use the label “50 by 50” as a shorthand for this report’s effort to reduce premature death (death before age 70) by 50 percent by 2050.
Gavin Yamey, MD, MPH, MA, one of the lead authors of the Lancet report and the director of the Center for Policy Impact in Global Health at Duke University—and a former UCSF IGHS professor—said that the work to improve global health “faces fairly significant headwinds,” including climate change, shifting national policies, and the likelihood of more pandemics, among other challenges.
However, Yamey said, health has improved in many different countries and strategies exist to keep that momentum going.
“Sharp reductions in mortality and morbidity can be achieved early on the path to universal health coverage,” Yamey said.
Key Recommendations
Some of the recommendations that can have a huge impact include countries publicly financing a short list of key medicines for 15 priority conditions, adopting a large tobacco tax to discourage the largest scourge on public health, and adopting basic public health measures that can go a long way to preventing many deaths in the next pandemic.
“Today, the case is better than ever for the value of investing in health for reducing mortality and morbidity, alleviating poverty and improving human welfare,” Yamey said. “Our analysis really shows that a practical pathway is in reach.”
Making progress on the 15 priority conditions that the report urged countries to focus on—eight infectious and maternal health conditions, including HIV, tuberculosis and malaria, and seven non-communicable disease and injury-related conditions—would go a long way toward reducing premature death.
Yamey noted that some suggest new health challenges have surpassed tobacco as a leading cause of preventable death but expressed skepticism toward this view.
“It’s quite trendy to hear that sugar is the new tobacco or sitting is the new smoking,” Yamey said. Instead, he offered, “Tobacco is the new tobacco, and that’s because smoking remains the biggest avoidable cause of premature mortality in many populations worldwide. We argue that tobacco taxation is the most important intersectoral policy for achieving 50 by 50.”
Countries are Making Progress
Dean Jamison, MS, PhD, a professor emeritus with IGHS and one of the co-chairs of the Lancet commission that produced the report, cited some positive developments. He said since 1993—when the World Bank, where he served as a staff economist, sounded the alarm about the need to improve global health—he’s seen a “much increased capacity and agency of most countries around the world to affect the important changes for themselves with their scientific, technical and managerial leadership.”
Justina Seyi-Olajide, MBBS, FWACS, a surgeon from Lagos University Teaching Hospital, said she appreciated the report’s optimistic outlook that the goal can be achieved. “It was presented in a way that was not a prescription,” she said. “Countries can follow the recommendations of the report, contextualize them locally, and be able to achieve this. That’s what was really helpful.”
Noting the emphasis on injury-related conditions, Seyi-Olajide said she found it “inspiring and exciting” that the report mentioned the importance of surgery. “An investment in strengthening surgical care in these countries will lead to improved outcomes and is cost-effective,” she said. “Being a surgeon, for me, that was really cool.”
Moving Forward
Mike Reid, MD, MPH, MA, a UCSF professor and clinician, praised the portion of the report that said countries need to build their own national health infrastructure.
“The trajectory that will help us realize the goals outlined in the report most successfully should involve ensuring that there is greater country ownership of the programs that are currently largely funded by donor agencies like PEPFAR,” Reid said. If governments take on greater funding for those programs, specifically the HIV program, Reid said, “that will enable the health system to strengthen such that it can respond to other external shocks and threats on the horizon.”
Neha Agarwal, MS, the Senior Director of Strategy for PATH (formerly known as the Program for Appropriate Technology in Health), an international, nonprofit global health organization, said recent events show the world has gotten better at anticipating and slowing pandemics.
With the ongoing Mpox outbreak in the Democratic Republic of the Congo, for instance, Agarwal said that while there are “still lots of areas for improvement, I will say that there has been a lot of positive resource mobilization from the major G7 governments. They’re asking, how do we catalyze financing much quicker than we did during COVID?”
Countries made sure Gavi, the Vaccine Alliance, had sufficient supplies, which helped shave six to nine months off the timeline of getting vaccines where they needed to go, Agarwal said. Similarly, thanks to investments made in health systems to combat the Ebola virus, when a Marburg virus disease outbreak occurred in Rwanda last September, Agarwal said, “it hardly even made the news because it was so effectively managed.”
Science and industry also will play a role in meeting the goals. “Innovation is advancing rapidly for the greatest global health challenges, like infectious disease,” said Thu Do, MPH, Medical Affairs Director of Gilead Patient Solutions. “I come from a malaria background, and that’s the world’s oldest and deadliest disease, but now we have a vaccine for it that’s being rolled out in 17 countries.” She also noted another innovation, a long-acting injectable that protects against HIV infection for six months, which Mike Reid noted as Science Magazine’s 2024 breakthrough of the year.
Agarwal concurred that advances in artificial intelligence may shorten research and development timeframes and help get new medications to market faster.
A Call to Action
In a rousing coda on the forum, Mauakowa Malata, FAAN, PhD, MSc, BSc, Vice Chancellor of the Malawi University of Science and Technology and 2024 UCSF Presidential Chair Awardee, praised The Lancet report for striking the right notes on what to do and how to do it.
She noted that her sister died of AIDS at age 35 in 1985. “Premature death is a real issue,” she said.
With countries taking ownership, focusing on the priority conditions, emphasizing partnerships and collaboration, and putting money into the efforts, 50 by 50 is achievable.
“You can write and you can publish,” Malata said. “At the end of the day, what happens on the ground is what matters.”
Photos by Elisabeth Fall