How Every Country Can Halve Premature Death by 2050

The world faces a perfect storm of crises, many of which can seem intractable. The impacts of climate change are becoming more obvious by the day, including injuries and deaths from storms, flooding, and wildfires. The Middle East, central Europe, and Africa, among other regions, are embroiled in deadly and destabilizing wars. We have just been through a pandemic that caused an estimated 23 million deaths, and we remain in an era in which there will be a constant risk of more epidemics and pandemics.

Yet despite these challenges, we remain profoundly optimistic when it comes to tackling disease and improving human health worldwide.

We are no Pollyannas. Our optimism is based on a report recently published in the Lancet that we coauthored as members of a team of 50 health experts and economists worldwide, the Commission on Investing in Health, chaired by former U.S. Treasury Secretary Lawrence Summers.

Our report, called Global Health 2050, shows that a remarkable goal is within reach: any country that chooses to do so, regardless of how wealthy it is, could halve the probability of their citizens dying before age 70 by the year 2050. We call this goal “50 by 50”—a 50% reduction in the probability of premature death by 2050, starting from a baseline year of 2019 (the year before the COVID-19 pandemic).

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Although we concluded that “50 by 50” is an achievable goal for all countries, recent history suggests that some countries would require major redirections of policy. The U.S., for example, is the only country among the world’s 30 most populous countries to have experienced an actual increase in the probability of premature death in the decade preceding COVID-19. Achieving “50 by 50” in the U.S. would require far more dramatic improvements in policy than for recently successful populous countries like South Korea, Russia, Bangladesh, and Turkey.

Why do we focus on premature death? Because dying prematurely is ruinous—not just for the individual, but for their families and communities. Premature death takes a human toll as well as an economic one on households and societies, striking down wage earners in the prime of their lives. And it can be averted. To quote the legendary British epidemiologist Richard Doll, who pioneered research showing that smoking caused lung cancer, “In old age death is inevitable, but death before old age is not.” (Doll lived to age 92.)

For any country, reaching “50 by 50” would be transformative. It would mean more children surviving into adulthood, more women surviving childbirth, and fewer people dying in middle age from illnesses and injuries that are preventable and treatable.

Our optimism that “50 by 50” can be achieved is based both on looking back to historical experience of mortality decline and on looking forward to the new scientific innovations coming out of the research and development pipeline.

Historical experience shows that our goal is challenging but feasible. Since 1970, 37 countries have halved the probability of their citizens dying before age 70 in 31 years or less, including seven of the world’s most populous countries. This group of seven countries— Bangladesh, China, Iran, Italy, Japan, South Korea, and Vietnam—is remarkably diverse in terms of geography, politics, income level, and their “starting point” (their country’s probability of premature death in the year that the 50% reduction began). If such different nations from such varying starting points could achieve this goal, it’s a feasible one.

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Looking forward, based on the rich pipeline of candidates being developed today, our research suggests that about 450 new medicines, vaccines, and diagnostics for preventing and treating infectious diseases and maternal-health conditions will be launched before 2050. When countries adopt and widely disseminate such new health technologies, the decline in premature death accelerates.

To give just one example: tuberculosis (TB) is the No. 1 infectious cause of premature death worldwide, but the vaccine we have against it is not widely used because it’s not very effective. However, there are three promising vaccine candidates that are now in late-stage clinical trials, and it seems likely that at least one will be approved. Having a highly effective TB vaccine would be a true game changer.

So, if “50 by 50” is feasible and would be transformative, what do countries need to do to reach it? The path to halving premature death requires governments to take four critical steps.

The first step is to focus on the biggest killers. Out of the many thousands of health conditions listed in the latest version of the International Classification of Diseases—the “Bible” of health conditions—just 15 of these explain most of the difference in life expectancy between the regions where people live longest and those where they live the shortest lives. Eight are maternal conditions and infectious diseases, such as diarrhea, pneumonia, and TB. Seven are non-communicable diseases and injuries, including diabetes, cardiovascular diseases, road injuries, and suicide. The path to “50 by 50” runs through tackling these 15 priority conditions.

The second step is for governments to finance the delivery of highly effective, high value-for-money prevention and treatment services that can reduce illness and death from these 15 conditions. Examples include expanding childhood immunizations and low-cost prevention and treatments for cardiovascular disease. Global immunization coverage stalled last year, and low measles vaccine coverage in some parts of the world has led to measles outbreaks, and so action will be needed to close these immunization gaps. There is no “one size fits all” prescription for each country: the specific interventions that are required will have to be locally contextualized to each country’s health needs and situation. Scaling up delivery of prevention and treatment services will require substantial financial investments, which may be challenging for resource-constrained nations. Governments will need to prioritize health spending amidst competing demands and explore ways to raise revenue, such as improving their tax systems.

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The third step is to make medicines more accessible and affordable to everyone. In many parts of the world, paying out-of-pocket costs for commonly prescribed medicines, such as for high blood pressure or diabetes, places a major economic burden on individuals and households, and can even push people into poverty. The government should subsidize these costs. It should buy large volumes of critical medicines for the 15 priority conditions to ensure wide availability.

The fourth step is for governments to increase taxation on tobacco products and unhealthy foods and drinks, while reducing the typically very large subsidies on fossil fuels. These policies would not only reduce illness and death attributable to those products but would also raise needed revenue for cash-strapped governments. While all these fiscal policies are win-win, by far the biggest priority is high taxes on tobacco. Smoking is one of the biggest causes of preventable mortality in many parts of the world, and in those countries raising taxes on tobacco can do more to reduce premature mortality than any other single policy outside of the health system.

While the steps we outlined above are aimed mostly at national governments, there is also an important role for international health organizations and foreign aid donors in supporting countries in reaching “50 by 50.” Aid should be directed towards countries with the fewest resources to help strengthen their health systems to better control the 15 high priority conditions. And the international community should step up its investments in tackling the shared threats that cross national boundaries, like reducing the development and spread of antimicrobial-resistant pathogens, preparing for and responding to pandemics, and developing and disseminating new health technologies. Regional economic, political, and strategic disputes could limit much needed support and collaboration for achieving “50 by 50,” so continued advocacy and diplomacy will be required to maintain global momentum.

It is easy to get despondent about the state of the world. But at least in one domain, there is good reason to double down on past success: “50 by 50” is a prize within reach. As we conclude in our report, “by focusing resources on a narrow set of conditions and scaling up financing to develop new health technologies, we believe that the global health landscape can be utterly transformed within our lifetimes.”