Saving Millions for Just a Few Dollars

Success Stories

A slimmer book called "Millions Saved" was published last year. It offered 17 case studies of recent global health successes. They include an anti-smoking campaign in Poland that since 1990 has produced a 30 percent drop in lung cancer in middle-age men; measles vaccination campaigns in seven southern African countries that cut the total number of cases from 60,000 in 1996 to only 117 in 2000; and China's introduction of iodized salt in 1995 that cut iodine deficiency in children from 20 percent to 9 percent.

Despite their heft, these books are meant to be highly practical and accessible.

"What difference will this information make at the country level?" asked Sir George Alleyne, former director of the Pan American Health Organization and one of the book's nine editors. "Presidents used to ask me: 'Okay, where's the beef? What should I do?' We can now say: 'You will find information in this volume that will tell you what to do.' "

Given the magnitude of the problems -- the AIDS epidemic, resurgent malaria, increasing obesity and diabetes -- the entire project is surprisingly optimistic. It sends twin messages of encouragement to even the poorest countries: Success is possible, and there is still a lot of low-hanging fruit.

"Money doesn't necessarily buy health," said Dean T. Jamison, a health economist at the University of California at San Francisco who spent much of the past five years at the National Institutes of Health's Fogarty International Center, where he led the project. "But today good health is clearly possible at low cost."

Globally, average life expectancy has gone up about five years every decade for the last 40 years. Over the course of the 20th century, however, many countries' gains have far exceeded that average. Some have literally gone from the back to the front of the pack.

In Chile, for example, a male born in 1910 had a life expectancy of 29 years. His counterpart in the United States could expect to live 49 years. By the 1990s, their life expectancies were virtually the same: 72 for the Chilean, 73 for the American.

Cuba is perhaps the best example that a nation does not need wealth to gain health.

It has a stagnant socialist economy, and most of its citizens have lived under a trade embargo from the United States their entire lifetimes. Nevertheless, the life expectancy of Cuban men was higher in 2001 (75.2 years) than American men's (74.5 years).

How can relatively poor countries do that? In "Millions Saved," health economist Ruth Levine gives the example of Sri Lanka.

In the 1930s, the island nation off the east coast of India had a maternal mortality rate of more than 2,000 deaths per 100,000 live births. That was higher than the countries with the highest rates today (2,000 in Sierra Leone; 1,900 in Afghanistan; 1,700 in Angola).

By the 1950s, Sri Lanka had cut its maternal mortality rate to between 500 and 600. But that was just the start. Today, its rate is 60, in the same ballpark as Europe (24), and far less than Asia overall (330) or the world average (400).