Lancet-LIDC Commission: Applying the principles to health

Anne Mills

London School of Hygiene and Tropical Medicine

Reminder of the issues with current health MDGs

• Have set different health communities against each other (‘killer diseases’; child, maternal)

• Split the mother, neonate and child• Ignored the unifying role of the health system in

supporting achievement of all health MDGs• Neglected synergies across MDGs – eg between

poverty reduction and health; between education and health

A principled way forward

• Holism

• Equity

• Ownership

• Global obligation

• Sustainability

As applied to health development

A holistic approach to health development

• Focus on broad health gains through health systems approach

• Build on framework of reasonable health expectations over a lifetime (pregnancy, infancy, childhood, adolescence, adulthood, elderly)

• Look for synergies across conditions and services – eg ante-natal care, malaria, HIV

• Link to other elements of wellbeing – eg education

Equity and health

• Life-course approach embeds intergenerational equity in health development

• Focus on the most disadvantaged - pro-poor approach – and addressing the major causes of inequity (not just lack of income) in specific settings

• Monitor progress

Ownership and health

• Make national decisions on priorities, on the basis of national needs and opportunities

• Support national programmes to analyse and understand determinants of poor health outcomes, to enhance evidence-based decision making and strengthen country negotiating power

Global obligation and health

• Focus on interactions between rich and poor countries which constrain health improvement – eg health worker migration; access to medicines

• Strengthen science and innovation systems in poorer countries to support more equitable partnerships

Sustainability and health

• Reliable and continued funding needed from both domestic and external sources – deliver on commitments

• Address the fragmentation of external funding to health; build rather than destroy country capacity

• Support systems to be more resilient and less dependent

• Support countries in their choices

The vision• Future health development goals focused on

sustainable health systems, built around delivering objectives across the life course and linked to other elements of wellbeing

• Objectives agreed by international consensus, but developed into goals through process led at national level, building up to regional and global goals

• Aim to generate wellbeing for all within a pro-poor approach