Alma-Ata at 40 Years: Reflections From the Lancet Commission on Investing in Health

This report published by The Lancet assesses global progress towards a grand convergence in health—a reduction in infectious, child, and maternal mortality to rates seen in the best-performing middle-income countries—and discusses the future of primary health care through the lens of universal health coverage and health-related Sustainable Development Goals (SDGs). More specifically, the authors of the Lancet Commission on Investing in Health revisit their conclusion from the 2013 Commission report, Global Health 2035: A World Converging Within a Generation (GH2035), that a grand convergence in health is technically and financially feasible for all but the poorest countries by 2035. In GH2035, the authors underscored the “unprecedented” demographic and epidemiological shifts which, alongside the globalization, had immense implications for achieving grand convergence.

In this report, issued on the 40th anniversary of the landmark Alma-Ata Declaration that established primary health care as the key to achieving “Health for All,” the authors conclude that convergence targets for under-5 and HIV/AIDS mortality could be achieved by 2035 should global mortality trends from 2010-2016 continued. In contrast, should rates of decline for maternal mortality and tuberculosis follow 2010-2016 trends, convergence targets would not be reached until 2067 and 2074 respectively. The Commission report also projects that by 2035, most middle-income countries will be able to afford primary health care platforms for delivery of essential universal health coverage. Nonetheless, for many middle-income countries, achieving the mortality reduction target for non-communicable diseases set forth in SDG 3 will remain difficult to achieve by 2030. For many low-income countries, domestic health financing systems lack the capability to complete the “unfinished agenda” of grand convergence.

This report is a renewal of the call for national governments to invest in health. In particular, the Commission identifies five high-return priorities in international collective action: improved drugs and vaccines for tuberculosis; pandemic preparedness; international support to non-communicable disease control programs; development of evidence base to improve health system quality and resilience; and provision of resources to the World Health Organization and other UN agencies to strengthen their financial and legal capacity. The Commission emphasizes the importance of countries to realize the exceptionally high economic value of successful investment in health relative to cost, to boost wellbeing and prosperity globally.