Between 2010 and 2015, development assistance for health (DAH) reached over US$30 billion a year,1 and the Millennium Development Goals (MDGs)2 helped drive unprecedented gains in development and health equity.3 While those accomplishments are cause for celebration,4 DAH budgets have tightened1 as the world confronts new health challenges, and the global health community is worried about human rights reversals by recently elected populist governments.5 Health financing at the country level looks more promising and could be the basis for a new world health era.
AN ECONOMIC TRANSITION IN HEALTH
After centuries of flat incomes per capita, the world has experienced a 20-fold increase in gross domestic product (GDP) during the last 50 years.6,7 The majority of countries that were considered low-income in 1990, including Bolivia, Bangladesh, and the Republic of Congo, have moved to lower-middle or middle-income status.8
Health spending is very closely correlated with GDP and it accounts for an expanding fraction of any growing economy.9 While that is often a fiscal and political headache for richer countries, for a growing number of lower-income countries the increase in health resources has the potential to cover the average cost per capita of essential lifesaving commodities and services.9
Health spending accounts for an expanding fraction of total spending for any growing economy.
As …