Achieving a "Grand Convergence" in Global Health: Modeling the Technical Inputs, Costs, and Impacts from 2016 to 2030

Abstract

Background: The Commission on Investing in Health published its report, GlobalHealth2035, in 2013, estimating an investment case for a grand convergence in health outcomes globally. In support of the drafting of the Sustainable Development Goals (SDGs), we estimate what the grand convergence investment case might achieve-and what investment would be required-by 2030.

Methods and findings: Our projection focuses on a sub-set of low-income (LIC) or lower-middle-income countries (LMIC). We start with a country-based (bottom-up) analysis of the costs and impact of scaling up reproductive, maternal, and child health tools, and select HIV and malaria interventions. We then incorporate global (top-down) analyses of the costs and impacts of scaling up existing tools for tuberculosis, additional HIV interventions, the costs to strengthen health systems, and the costs and benefits from scaling up new health interventions over the time horizon of this forecast. These data are then allocated to individual countries to provide an aggregate projection of potential cost and impact at the country level. Finally, incremental costs of R&D for low-income economies and the costs of addressing NTDs are added to provide a global total cost estimate of the investment scenario.

Results: Compared with a constant coverage scenario, there would be more than 60 million deaths averted in LIC and 70 million deaths averted in LMIC between 2016 and 2030. For the years 2015, 2020, 2025, and 2030, the incremental costs of convergence in LIC would be (US billion) $24.3, $21.8, $24.7, and $27, respectively; in LMIC, the incremental costs would be (US billion) $34.75, $38.9, $48.7, and $56.3, respectively.

Conclusion: Key health outcomes in low- and low-middle income countries can significantly converge with those of wealthier countries by 2030, and the notion of a "grand convergence" may serve as a unifying theme for health indicators in the SDGs.

Fig 1. Example of a “high-performing” country overcoming “divergence” in health.

Although starting rates of childhood mortality in Sweden and China were comparable in the mid-18^th century, Sweden was more successful than China in reducing its level of childhood mortality over time. By the early 20^th century, the divergence in child mortality outcomes between the two countries was striking. However, over the next century China’s child mortality rate fell sharply and converged on the Swedish rate, primarily due to China’s scale up of effective health interventions and strengthening of health systems.

Fig 2. Convergence analysis structure.

Fig 3. Deaths per year across scenarios, low-income countries. 2016–2030.

Fig 4. Deaths per year across scenarios, low-middle income countries. 2016–2030.