Many of the 16 million early deaths are preventable with low cost, high impact interventions including contraception, vaccines, human milk, devices (e.g. bed nets, rapid diagnostic tests), therapeutic foods and supplements, and medicines (e.g. antiretrovirals, artemisinin-based combination therapies, oral rehydration salts and zinc, and antibiotics). Others require higher cost interventions especially diagnosing and treating heart disease, cancers, and newborn birth complications. Substantial behavior changes relating to diet, alcohol and tobacco use, and cooking practices are required to reduce the leading risk factors for death and the evidence suggests where these are made alongside investments to improve the education of girls and women of reproductive age, large gains are possible. Chris Murray and colleagues found that half of the reduction in child deaths since 1970 is due to increases in the education of women of reproductive age, and a recent WHO study reported that factors outside the health system (especially education, women’s incomes and political representation, access to clean water and sanitation, poverty reduction and economic growth) are responsible for half of the reduction in child deaths since 1990. When it comes to reducing deaths from accidental injuries, much more work needs to be done on effective interventions, especially in the area of reducing deaths from road traffic accidents which are projected to increase rapidly alongside the urbanization that is occurring in many of the countries with the weakest road infrastructure and transport safety policies.
Accordingly, all countries should make reducing early deaths (<50 years) the focus of their national health goals by maintaining early deaths at <30% of all deaths by 2020 and <15% by 2030. For countries already at these levels targets of <15% and <7% should be set with Japan’s rate of 3.4% as the ultimate goal. This focus on reducing early deaths is supported by a recent Lancet study which concluded that “reducing premature deaths is a flexible target that can be pursued in different ways in different countries, according to their mortality patterns and resources,” and by the Copenhagen Consensus, which has consistently argued that investing in increasing lifespan is the most cost-effective development investment in the world today.
National health plans and programs should target the leading causes of early death in their respective countries and invest in the most cost-effective solutions to these challenges. In many low-income countries newborn deaths, injuries, and infectious diseases will dominate, while in higher income countries, cancers and heart disease will dominate. In countries where stillbirths and sex selection are major challenges, reductions in pregnancy termination related to sex selection and preventing stillbirth should be national health priorities. In addition to investing to improve the diagnosis and treatment of the leading causes of early deaths, governments and other stakeholders should invest heavily in prevention by reducing population exposure to the major risk factors, especially high blood pressure, household air pollution, tobacco and alcohol use and poor diet.
Finally, we need to invest in solutions that go beyond a single disease or intervention to better integrate the financing and delivery of the products and services with the greatest impact on reducing risk and death among the populations where early deaths are concentrated. We need to aim for the vision outlined by Jim Kim, Paul Farmer and Michael Porter in Redefining Global Health Care Delivery, where the creation of “patient value” is the endgame of healthcare delivery because this is ultimately what will drive populations to seek health care enabling population-wide health improvements and the achievement of global health goals. Solutions also need also to address the underlying political, economic and social causes of early death. As the majority of early deaths occur in countries where people struggle on low incomes, where government is often dysfunctional, where markets are not strong and where women are disempowered, specific health interventions need to be delivered in the context of broader reforms to encourage economic growth and rising incomes, to build stronger democracies and markets, and empower women.