Time for even greater ambition in global health.

Every so often, signifi cant global trends can be traced back to a source. The 1993 World Development Report (WDR) was such a catalyst in global health and development policy, demonstrating to fi nance ministers, economists, and philanthropists that health is an investment with positive economic returns—and not simply a drain on scarce resources. The report helped set the stage for a major scale-up of health investments at global, regional, and national levels. Now, 20 years later, thanks to the conceptual clarity, empirical robustness, and ambitious recommendations of the Lancet Commission on Investing in Health, we have further proof that improvements in human survival have economic value well beyond their direct links to gross domestic product (GDP). A fi tting complement to the landmark WDR 1993, the new report by this Lancet Commission reinforces the case that investing in health is central to development and to achievement of the global goals to end extreme poverty by 2030 and boost shared prosperity. At this moment of opportunity, when global health and development goals are at last within reach, the conclusion that investing in health is key to growth and prosperity is perhaps even more important for policy makers today than in 1993. Today, as a result of rapid growth, the health sector has become a major source of jobs, and is responsible for about 10% of global GDP. Yet this growth has also resulted in tremendous ineffi ciencies in the use of health-care resources that, as the Commission notes, can and should be addressed to realise signifi cant savings and stem health-care infl ation. The growth of the health sector has also come at the expense of the most vulnerable: more than a quarter of a million people are pushed into poverty every day as a result of paying for health care. Indeed, the case for investing in health is not just about economic growth—it’s also about equity. The report of the Lancet Commission rightly focuses on the benefi ts of universal health coverage (UHC) and recommends progressive realisation of UHC with a focus on the poorest populations. Inherent in UHC is the right to health, and in many developing countries this right is being realised through constitutional and health reforms. Countries as diverse as Mexico, Thailand, and Turkey are showing how UHC programmes can improve the health and welfare of their citizens and lay the foundation for inclusive growth. The Lancet Commission correctly argues that, although country pathways to UHC will diff er, all should place special emphasis on the poorest people. The Commission’s report envisions a grand convergence by 2035, when the mortality rates of mothers and children in low-income and middleincome countries will dip to the levels seen in highperforming middle-income countries. I believe it’s time for the global community to be even more ambitious, and to set time-bound targets to measure progress. In my speech to the 2013 World Health Assembly, I set out a vision for global health by 2030: no one should fall into poverty or be kept in poverty as a result of healthcare expenses, and everyone should have access to aff ordable, quality health services. Achieving these goals will require further growth in the health sector. The Commission’s report recommends scaling up government health fi nancing Published Online December 3, 2013 http://dx.doi.org/10.1016/ S0140-6736(13)62374-0