BERLIN – Countries worldwide, regardless of income level, can halve premature death rates by 2050, a new Lancet report presented at the closing of the World Health Summit in Berlin suggests.

Fifteen key health threats are driving premature deaths worldwide, with tobacco use leading the pack “by far”, the Lancet Commission for Investing in Health found. Targeting interventions in these areas – with over half involving maternal, newborn, child, and infectious diseases – could dramatically reduce global deaths before age 70, the Commission said.

“Sharp reductions in mortality and morbidity can be achieved by focusing on 15 priority conditions,” Dr Angela Chang from the University of Southern Denmark and lead author of the report, told a panel at the World Health Summit in Berlin on Tuesday. “Doubling down on past health investments, focusing resources on a narrow set of conditions, scaling up financing and developing new technologies can continue to have an enormous impact despite the headwinds.”

The 15 priority conditions, selected from over 17,000 internationally recognized health diagnoses, account for approximately 80% of the life expectancy gap between most regions and the North Atlantic, defined in the report as North America and Europe. 

These conditions account for 86% of the gap between China and the North Atlantic, and 74% between sub-Saharan Africa and the North Atlantic.

“There’s a 22-year gap in life expectancy between Sub-Saharan Africa and the North Atlantic, Chang explained. “Close to 80% of this gap can be explained by these 15 priority conditions, and over half of the difference can be attributed to eight infectious and maternal health conditions.”

If the global goal is met, the average premature mortality rate worldwide would fall to about 15%, matching levels currently seen in Europe and North America—today’s global benchmark.

Achieving this would mean dramatic improvements for billions, especially in low- and middle-income countries. In Sub-Saharan Africa, the worst-performing region, premature mortality sits at 52%.

Setting priorities straight

The report’s optimism is rooted in historical data. Globally, the probability of dying before 70 has halved since the 1960s, falling from 62% to 31% for individuals born in 2019.

Thirty-seven countries, including populous nations like Bangladesh, China, Japan, and Vietnam, have already halved their premature death rates in similar or shorter periods than the 26 years remaining until the 2050 target date. 

The Commission recommends public financing for essential medicines targeting the 15 key conditions driving premature mortality. It suggests mobilizing international funding and joint procurement efforts, similar to strategies used by GAVI, PEPFAR, and the Global Fund, to reduce costs for patients and governments alike.

“Inadequate access to medicines and high out-of-pocket costs are major threats to cutting premature mortality,” Chang noted. “We learned from the Global Fund’s experience how national government subsidies can steer resources towards priority interventions and reduce out-of-pocket payments.” 

While the Commission believes halving premature mortality by 2050 is globally achievable, it acknowledges this target may be “perhaps only aspirational for some countries, realistically speaking.”

“We have a tendency to focus on the new, shiny things,” Chang added. “Our message is for countries to stay focused on these priority conditions.”

‘Tobacco is the new tobacco’

High tobacco taxes are “by far” the most crucial policy tool for reducing premature deaths, according to the report.

“You often hear about other risk factors, but we argue tobacco is the new tobacco,” Chang explained.

Recent research suggests raising excise taxes on tobacco, alcohol, and sugary drinks by 50% could yield $2.1 trillion for low- and middle-income countries over five years. This could boost healthcare spending in these nations by 40% if directed towards health initiatives.

The Commission highlights the Middle East and North Africa as an example of untapped potential in tobacco control. With 160 million smokers and rising prevalence among youth and women, the region faces a growing health crisis.

Egypt’s smoking rates doubled between 2000 and 2018, while tobacco became more affordable in conflict-affected countries like Iraq and Syria. The region’s tobacco taxes, second-lowest globally, fall far short of the World Health Organization’s recommended 70% excise tax.

“Despite wide experience with its successful use, tobacco taxation remains a policy tool that is still greatly underused,” the Commission found. “Raising taxes on tobacco can do more to reduce premature mortality than any other single health policy.”

High risk of  ‘COVID magnitude’ pandemic in next decade

New modeling for the Commission’s report indicates a 23% chance of a pandemic as severe as COVID-19 occurring within a decade. Unprepared health systems could see progress on reducing premature deaths plummet if caught off guard again.

“There is a high risk of another pandemic of Covid-like magnitude,” Chang warned. “To put it another way, in most years there will be zero pandemic deaths, and in some years there will be millions of pandemic deaths.”

The Commission’s analysis estimates an average of 2.5 million deaths per year due to pandemics when viewed over a long time horizon. This figure is comparable to the current annual death toll from AIDS, malaria, and tuberculosis combined, and significantly exceeds even pessimistic projections for annual climate change-related deaths in coming decades.

“People should wake up at that figure,” Helen Clark, former Prime Minister of New Zealand, warned the summit. 

The warning from the Commission comes as global headwinds from conflict, climate change and debt hammer health budgets. Neglecting pandemic preparedness could have severe consequences, particularly for poorer countries less equipped to handle sudden outbreaks.

“We need to learn the lessons not just from COVID, but from Mpox, Ebola … and avoid this panic-neglect cycle,” said Dr Seth Berkley, former CEO of Gavi, the Vaccine Alliance. “Unfortunately, I don’t think we’re doing a very good job.” 

From 1993 to Berlin 

The Lancet Comission report is the latest in a line of studies that traces its lineage back to a pivotal World Bank report that changed the landscape of global health finance.

The World Bank’s 1993 report, Investing in Health, the only report on health ever published by the Bank, was the first to make an argument still used by health advocates and ministers across the globe: health is an investment. 

“The World Bank saying investing in health is no just a cost to society, but an investment that was justified on pure economic grounds … was revolutionary,” Berkley recalled. “Prior to this, people saw it as a cost – if you get richer, you can afford health, but this really changed the thinking.” 

The Commission’s work has expanded on the World Bank’s initial calculations, incorporating factors such as the impact of out-of-pocket health costs on economies and personal livelihoods. This broader perspective has significantly increased the estimated economic benefits of maintaining healthy societies, from the World Bank’s initial 11% to 24%.

“The important thing is that each one of these reports, including this one, says the case is better than ever for investing in health, and we need to keep talking about that, particularly at a time when the headwinds are so strong,” Berkley emphasizes.

The latest report continues this tradition, reaffirming that health investment remains one of the most effective strategies for improving both individual and societal outcomes.

“Today, the case is better than ever for going for mortality reduction,” said Dr Gavin Yamey, director of Duke University’s Center for Policy Impact in Global Health and lead author of the commission report “It’s a prize within reach. It will have extraordinary health, welfare and economic benefits.”

Image Credits: Sarah Johnson.