Global Health 2050: Beyond the Modular Approach

Global Health aspires to improve health outcomes and reduce inequities through two main approaches: one focused on health promotion and universal access to primary healthcare, and the other focused on disease control through a selection of cost-effective interventions. The 2024 Lancet Commission on Investing in Health (LCIH) report aims to halve premature deaths by 2050 by addressing 15 priority diseases with modular interventions. We argue that this modular approach is less likely to yield sustainable and equitable outcomes. We identify important methodological flaws in LCIH’s approach – the overlooking of contextual causes and social determinants of health, narrow and biased use of economic evaluation, and inadequate understanding of the functioning of health systems – and propose alternatives. By prioritising discrete interventions and cost-effectiveness metrics, LCIH risks reinforcing a fragmented, disease-specific perspective, yielding short-term gains while failing to address the underlying vulnerabilities, comorbidities, and social determinants that shape health outcomes. This approach persists not because it is more effective, but because it is more politically tractable in a system that values countable outputs over transformative change. We advocate for reaching global health goals through a systemic and holistic approach, integrating intersectoral policies and health promotion to improve overall health and strengthen health systems based on community needs and local prioritisation exercises. As for official development assistance, it should focus on provision of direct financial and technical support to countries with the least resources to support domestic needs analysis, priority setting exercises and strengthening of social and primary health systems.