Jamison Dean T, Summers Lawrence H, Alleyne George, Arrow Kenneth J, Berkley Seth, Binagwaho Agnes, Bustreo Flavia, Evans David, Feachem Richard G A, Frenk Julio, Ghosh Gargee, Goldie Sue J, Guo Yan, Gupta Sanjeev, Horton Richard, Kruk Margaret E, Mahmoud Adel, Mohohlo Linah K, Ncube Mthuli, Pablos-Mendez Ariel, Reddy K Srinath, Saxenian Helen, Soucat Agnes, Ulltveit-Moe Karen H, Yamey Gavin
Department of Global Health, University of Washington, Seattle, Washington, Estados Unidos de América.
Harvard University, Cambridge, Massachusetts, Estados Unidos de América.
Salud Publica Mex. 2015 Sep-Oct;57(5):444-67.
Prompted by the 20th anniversary of the 1993 World Development Report, a Lancet Commission revisited the case for investment in health and developed a new investment framework to achieve dramatic health gains by 2035. The Commission's report has four key messages, each accompanied by opportunities for action by national governments of low-income and middle-income countries and by the international community. First, there is an enormous economic payoff from investing in health. The impressive returns make a strong case for both increased domestic financing of health and for allocating a higher proportion of official development assistance to development of health. Second, modeling by the Commission found that a "grand convergence" in health is achievable by 2035-that is, a reduction in infectious, maternal, and child mortality down to universally low levels. Convergence would require aggressive scale up of existing and new health tools, and it could mostly be financed from the expected economic growth of low- and middle-income countries. The international community can best support convergence by funding the development and delivery of new health technologies and by curbing antibiotic resistance. Third, fiscal policies -such as taxation of tobacco and alcohol- are a powerful and underused lever that governments can use to curb non-communicable diseases and injuries while also raising revenue for health. International action on NCDs and injuries should focus on providing technical assistance on fiscal policies, regional cooperation on tobacco, and funding policy and implementation research on scaling-up of interventions to tackle these conditions. Fourth, progressive universalism, a pathway to universal health coverage (UHC) that includes the poor from the outset, is an efficient way to achieve health and financial risk protection. For national governments, progressive universalism would yield high health gains per dollar spent and poor people would gain the most in terms of health and financial protection. The international community can best support countries to implement progressive UHC by financing policy and implementation research, such as on the mechanics of designing and implementing evolution of the benefits package as the resource envelope for public finance grows.
受1993年《世界发展报告》发表20周年的启发，《柳叶刀》委员会重新审视了健康投资问题，并制定了一个新的投资框架，以在2035年前实现显著的健康改善。该委员会的报告有四条关键信息，每条信息都伴随着低收入和中等收入国家政府以及国际社会采取行动的机会。第一，投资健康能带来巨大的经济回报。这些可观的回报有力地证明了增加国内卫生融资以及将更高比例的官方发展援助用于卫生发展的合理性。第二，该委员会的模型研究发现，到2035年实现健康领域的“大趋同”是可行的，即把传染病、孕产妇和儿童死亡率降至普遍较低的水平。实现趋同需要大力扩大现有和新的卫生工具的使用规模，而且大部分资金可以来自低收入和中等收入国家预期的经济增长。国际社会支持趋同的最佳方式是资助新卫生技术的研发和推广，并控制抗生素耐药性。第三，财政政策，如对烟草和酒精征税，是政府可以用来遏制非传染性疾病和伤害、同时为卫生筹集资金的有力但未充分利用的杠杆。关于非传染性疾病和伤害的国际行动应侧重于提供财政政策方面的技术援助、烟草问题区域合作以及为扩大应对这些疾病的干预措施的资金政策和实施研究提供资金。第四，渐进式普遍主义是实现全民健康覆盖的一条途径，它从一开始就将贫困人口纳入其中，是实现健康和财务风险保护的有效方式。对于各国政府而言，渐进式普遍主义每花费一美元就能带来很高的健康收益，而且贫困人口在健康和财务保护方面的收益最大。国际社会支持各国实施渐进式全民健康覆盖的最佳方式是为政策和实施研究提供资金，比如随着公共财政资源总量的增加，研究设计和实施福利包演变机制等问题。
