The Challenge of Financing Global Health

Please join the CSIS Bipartisan Alliance for Global Health Security on Tuesday, May 14 from 10:30 to 11:30 AM ET for a discussion on the Institute for Health Metrics and Evaluation (IHME)’s annual report, Financing Global Health 2023. The report details worrisome trends in worldwide health spending, particularly the impact of debt and declining development spending, post-Covid, on health in low- and middle-income countries. From 2021 to 2023, development assistance for health dropped from $84 billion to $64.6 billion in low- and middle-income countries, just as those same countries faced the pressures of sharply rising interest payments, which have more than doubled since 2019. Following opening remarks on IHME’s research from Angela Apeagyei, IHME Research Assistant Professor, CSIS Senior Vice President and Global Health Policy Center Director J. Stephen Morrison will moderate a fireside chat with IHME Director Christopher Murray to discuss their findings. What does the report reveal about the current financial landscape, and how could we think more pragmatically and creatively about the looming challenge of sustaining global health investments?

This event is made possible by the generous support of the Bill & Melinda Gates Foundation.

———————————————
A nonpartisan institution, CSIS is the top national security think tank in the world.
Visit www.csis.org to find more of our work as we bring bipartisan solutions to the world’s greatest challenges.

Want to see more videos and virtual events? Subscribe to this channel and turn on notifications: https://cs.is/2dCfTve

Follow CSIS on:
• Twitter: www.twitter.com/csis
• Facebook: www.facebook.com/CSIS.org
• Instagram: www.instagram.com/csis/

good morning good afternoon good evening I’m J Steven Morrison I’m senior vice president here at the center for strategic and international studies csis in Washington D.C this is a program of the csis bipartisan Alliance for Global Health security we’re delighted today to be able to host Angel Angela aiji and Chris Murray from The Institute for health metrics and evaluation at the University of Washington I’ll introduce them momentarily and and to welcome their colleagues who are here um we have been in the habit for several years this is the 15th year of the financing Global Health Report uh from ihme congratulations to Angela and Chris and the team for this report this as we’ll hear this is the 15th year we were in the habit preco of hosting the annual rollout uh of the report Co got in the way and now we’re back in the swing and so we’re very happy that we’ve been able to resume this this partnership we typically do this with the Kaiser Family Foundation and Jennifer Kates Jennifer can’t be with us today send her regards um in the future I’m sure we’ll be able to bring Kaiser Family Foundation back uh to the stage with us special thanks to my colleagues uh mlan spear Sophia hman Michaela Simo Carolina andrada from our production team special thanks to Theo Mitchell Dwight gladen and she you for all their great work and pulling this whole thing together and on the side of ihme we’re very grateful to Ronda Stewart for helping us pull the pieces together for today’s event and and delighted to see Joel DM on back here with us Angela PJ is a research assistant professor at ihme in Seattle she co-leads the development assistance for Health Resources tracking team which is a very important team within the IM ihme ranks uh and and and fundamental to the production of this report she holds a PhD in global Health Management uh and policy from Tain School of Public Health has a master’s International uh development economics from Yale and graduated with a degree in economics from from Oberland Chris Murray uh is a professor and chair of Health metric Sciences at the University of Washington and Seattle and director there at the institute for health metrics and evaluation he’s a physician and a health Economist he’s pioneered the work of the global burden of disease injuries and risks gbd which is on as I as I understand approaching its 28th or 29th year is that correct more than 30 years uh and uh has has been uh uh obviously at the center of the production of the financing Global Health reports and during Co we worked very closely with him uh as he spearheaded uh new modeling approaches to the covid uh to the co management so what we’re going to do here today Angela is going to come forward and present uh an overview with some slides of the uh of the report and then we’re going to uh gather here and have a conversation for the balance of the hour and we’ll leave some space towards the end for those in the audience who care to pose some remarks and questions there’s a microphone right here please do join us uh in that f those who are here in person and just keep your your interventions uh brief please thank you so Angela please come and join us thank you so much for being with us thank you Steve I’m delighted to be able to uh be part of this in-person public lunch for the financing Global Health Report it’s not showing okay before I get into the details of the results uh from our analysis I would like to acknowledge three important groups of people Steve and uh everyone at csis who has contributed to the strong partnership with ihme thank you uh it’s indeed an honor to be back uh here today to The Gates Foundation who have funded ihme generously and funded this work thank you and most importantly but certainly not the least to the team at ihme who are behind this important Global public good um including Joe dman and Chris Murray who have led this work in the past this year marks the 15th year uh of IHM publication of the financing Global Health reports this is the flagship report at ihme that looks at the global Health spending at Trends and levels uh especially in low and middle income countries this year we focused on the important topic of debt burden and development assistance for health covid-19 opended most of Our Lives as we know it and had a huge economic and social tool many countries took out loans in order to show up the economy in the next few slides I will go over what has happened with development assistance for health during uh and after the pandemic uh and what is currently happening as well as the implications for Rising interest rates on development assistance for health as well as government spending on Health in 2023 a total of 64 billion was contributed towards development assistance for health and this is uh financial and non-financial resources uh transferred through International Development agencies to low middle- inome countries primarily with the intention of improving or maintaining Health the slide uh you see tells three two important stories one the evolution of development assistance uh for health over time particularly highlighting the dramatic increase uh in year onye development assistance for health as a result of the health related response to the covid pandemic as well as the subsequent decline uh towards prepandemic levels in uh the levels of development assistance for health suggesting uh that the response uh has was similar to the panic and neglect approach that has been used in the past uh and so as the emergency phase of the pandemic has ended resources are now being redirected towards other areas secondly the figure highlights the different areas of Health activities that this funding has uh supported again uh related to the covid-19 pandemic we see that a lot of the funding in 2020 and 2021 uh went towards the covid related uh response uh we also see that other disease areas such as HIV 8 uh may have suffered some reductions around uh those times we do note that uh current data for 2023 suggests that as the pandemic response has died down uh the as resurgent in funding uh for HIV AIDS and the other areas moving on to the implications of this uh in relation to the rising interest rates in up until recent times the interest rates in most advanced countries had been at historic lows and this figure highlights how interest payments have increased in relation to levels uh in 202 in 2019 we see from the figure that in relation to 2019 across all income groups interest payments have increased especially for lwi income countries that’s highlighted in the green line and this pattern has implications for both development assistance uh for health and government spending uh for health going forward we unpack these Pathways in these next two slides so to start with what we did to understand the implications of the increased interest payments for government Health spending uh We examined this through uh estimating expected increases or growth in government Health spending going forward and the figure highlights the results of that analysis we can see uh from the results that in general the expected growth in government Health spending is rather tpid especially for low-income countries we have only about a dollar increase uh in expected Health spending when compared to uh the perant spending in 2000 this is all quite concerning for understanding development assistance for health and what we can expect there we looked at two different scenarios one scenario looking at the implication uh if governments or Duna countries uh maintain the levels of support they have in the past and that’s reported in the black line and here we see that if donors continue to maintain that support we expect that uh an about 50 billion in will be raised for development assistance for health uh in 2030 however if donors reprioritize other sectors and reallocate resources away from Health we risk we at risk of uh we seeing only about 307 billion do being allocated to health and what does this all mean uh for for the future of global Health financing we see that there are eminent threats to the availability of uh Financial Resources for Global health and this is both domestically and internationally and in order to be able to maintain or secure the gains in global Health that have been made uh intentional advocacy will be prudent going forward thank you thank you Angela thank you and congratulations again I mean the picture that you’re painting in this report is quite mixed I mean there’s a there’s a certain realism to it in terms of uh the scenarios you know the optimistic scenario is still quite modest right 4.9% growth over the next 11 years that’s not much and then the the more pessimistic one is one of regression by 11.5 billion so and the it’s very cautionary very realistic in that regard and the on the other hand you’re saying that we went from 2020 2019 was at 49.3 billion we jumped to 84 that was massive expansion and then as covid faded there was a sharp contraction but that contraction brought us down to almost 65 so that contraction brought us down to a level today that’s a 33% higher than what it was in 19 so it says that something stuck right that we there’s been a a jump up a bump up on the Investments but I also sense that in the report that you’re suggesting well you know maybe that’s not secure maybe climate is going to take a bigger and bigger bite out of resources maybe we have other forces the interest putting such emphasis on interest uh on the debt uh that’s novel that’s surprising I think for a lot of us to put so much emphasis on that was really quite Illuminating so Chris tell us your tell us your Reflections on filling in on what we’ve just heard from from Angela uh you know I think the there there could be scope to be somewhat even more pessimistic than what Angela showed us in those graphs because I you know we haven’t been reminding people of the extraordinary success around Global Health Investments of the last two or three decades where there’s just been you know if you take the graph of under five mortality despite Co has just kept marching down uh go back to when ner had a under five mortality rate of 350 and now there’s a essentially almost nowhere on the planet that’s above a 100 per thousand live births so huge progress It’s continued even in the poorest parts of the world yet there’s this sense that other problems particularly when you step outside the US uh are more important more urgent and particularly climate um and now add to that Wars and and and humanitarian crisis so I unless we make a very good case on what the world uh gets from these critical Investments that seems like there’s there’s real risk on the horizon for for Global Health um we had talked a little earlier about you know uh a pessimistic scenario would be one where you say you know the uh the interest in in global Health has peaked we’re in a we’re in a Twilight period we’re in the period of multiple replenishment coming forward in this year and next some new ones some big ones um we’ve already seen the difficulty in getting a five-year reauthorization of pepar the best that could be accomplished was one was a very ominous signal so we may be heading into some rude surprises in terms of the gap between what is really what the aspirations are across Global fund and Gaby and the new new funding mechanisms for who the World Bank Ida replenishment versus what’s what’s really possible and we’re in a period of a populist critique of foreign aid right we’re in a period of multiple elections happening uh in which there’s questions being raised about what’s the value what’s the end game how does this fit a national security strategy that has Us in you know a strategic competition with with China and other adversaries so there’s a lot swirling around there the I I take your point that the the approach Angela closed with we need we need a better advocacy which begs the question of okay what would the elements of that look like and you’re suggesting one is come back to reminding our all of us of the remarkable gains I think that’s a very important that’s a very important Point we’ve we’re aware of that but I don’t think that’s being advertised and introduced but what are some of the other elements that you think should be put put into a an updated strategy in order to be more optimistic and leaning leaning forward more positively and not just being pessimistic here because it’s not pre-ordained that we’re going to see that decline but there’s this distinct possibility of that your thoughts Angela sure thanks Steve um I think one one way in which we can make make sure that the gains that have been made uh in global Health as sustained a strengthening our argument including providing more data that links how important it is for National Security I think coming off of the covid pandemic uh response uh there’s enough evidence of how important it is to make sure that Health Systems around the world are robust and can uh detect some of these emerging uh pathogens and so uh I I I would say getting more data that helps us make that link uh in a self-interest kind of way uh to to to the citizens it’s an important approach thank you Chris your thoughts you know I think there’s still an an ongoing set of um new intervention strategies that are coming from investments in R&D you know we obviously saw during the co pandemic the roll out of mRNA vaccines but it’s not the only Innovation that’s out there for Global health so I think part of the argument is we have some new opportunities to to make improvements and to do that at an even more attractive uh coste effective uh framework so that’s part of it I I I do think we should because I think it’s true link uh investments in health to um helping the hardest hit countries in the future from climate change manage their health problems particularly the food security part of it and so that can be an an argument as well for managing those two problems uh in in some sort of joint way so climate’s not necess not strictly a threat to health it to health funding it’s it’s generating Health implications and we’ll be seeing this in terms of increased migration we’ll be seeing it in terms of infectious disease extreme weather impacts and all like and you’re saying the mitigation agenda is one where there’s going to need much more attention on what the health impacts are careful of the language because I think some people hear mitigation they think it’s just about greenhouse gas but uh you know from the modeling it seems like the biggest pathway for climate on health is actually the food security pathway and there’s a lot of role for intervening on malnutrition both in children and adults uh to help avoid that Health burden and so yes it could be a if you if we Marshall the evidence and we uh figure out how to make that case it can actually help on the health side tying uh the point uh Chris just made about food security to uh the an earlier point that the area with both the remaining highest sped it’s around the Sahel and the desert areas uh I I I see the great opportunity there in making that case related to providing more support to resolve the food security issues and helping uh simultaneously deal with the health uh limitations uh in in the Sahel and other areas that still have heavy burdens of disease now we are in a period of very large geopolitical Wars right we are in the period of Ukraine we we’re seeing the continued War Hamas Israel the possibility of it widening with the Iranian confrontation we just saw the passage of the $95 billion uh pack uh package of assistance that included eight or n billion on humanitarian assistance so these wars are longlasting they’re longlasting they’re big they’re generating huge human costs and the price of of of addressing those is turning out to be uh very high now when the global fund was launched when pepar was launched that was the period of the Iraq War and the period of Afghanistan War I mean we had the what seemed then to become the forever Wars but we were able to to to deal with those realities simultaneously how how do you see dealing with the pressures coming out of these big geopolitical Wars on budgets on attention spans and the like how do you see what’s the way to navigate that reality today it’s part of it is the the numbers uh because we think of wars and and all the terrible destruction associated with them but still uh there’s far more people who are dying from some of the major Global health challenges every day than than are dying from the conflict so you sort of got to make the case not to ignore the conflicts or the humanitarian uh imperative but if you care about saving lives and and preventing harm there is this huge still unfinished agenda and so it’s back to sort of reminding people of the Core case that was made more than two decades ago to expand Global Health uh and we’ve made progress the Investments have been successful but there is this need to keep going and and get the job done Angel your thoughts uh I think given what you you you said about uh limited resources limited attention uh it might be useful to find areas of synergy and opportunities where we we can be a little more efficient with the resour The Limited very limited resources that are available and trying to solve both perhaps humanitarian health problems in humanitarian concept uh context right uh in that sense leveraging the same dollars to try and address issues that are intersectoral mhm the climate issue is going to be a tricky one right I mean the we’re we’re launching some work on climate and health this summer for the next couple of years and when we look at this Consciousness around the connection between climate and health has risen uh but we don’t have a clear strategy there’s scattered initiatives here and there it’s not clear what which which interventions are going to be the most effective with regard to health and then we as a country we’re very divided about what clim climate about climate change so you’re sort of pushing you’ve got the notion of creating a bipartisan consensus around climate and health it’s going to be a challenge trying to do that uh because people are understandably a little hesitant to sort of take this on at this point in time say a bit about the complexities of climate and climate Health well we are spending a lot of time thinking about this because uh for two reasons first you know as part of not the financing work but part part of the global burden of disease work we forecast out into the future we’re actually publishing this week our Global forecast around U the burden of disease from everything out to 2050 and as you go farther out which the climate Community you know uh does out to 2100 you have to ask all what are all the pathways by which climate change it can and is likely to influence health and so the Direct effects of heat are pretty straightforward to capture you know heat waves and the and sort of increased risk of ncds and other other diseases it gets trickier when you get into things like floods storms you know wildfires uh but again there’s climate modelers who tell us about some trajectories for that and we can figure out the health risks uh and they’re important but they’re not huge the big the big pathway that we our attention is drawn to is this pathway through some places becoming unlivable and therefore uh people either stay in those environments this is in the Sahel in parts of India the Middle East uh Central America uh and end up with greatly elevated rates of child an adult malnutrition or they migrate and so there’s a lot of work to be done to figure that out but either way there’s a potentially pretty big Health effect through the pathway of malnutrition increasing infectious disease deaths and or large numbers of people moving new stress on the on the health systems and infrastructure for schools uh where they move to in in shorter periods of time than people are normally you know think of public infrastructure adjusting to it so early days I think to figure out all these different Pathways but when you see the pl like the floods right now in Brazil uh I think that we will see more in the public Consciousness the sort of immediate effects of some of the climate changes uh or potentially you know because of attribution issues um and it’ll just keep coming back into the public Consciousness and as we were discussing earlier and I think you made reference this Angela some of the areas like West Africa frankil and West Africa are in fact really in the firing line on these phenomenon but there’re places where we’ve disinvested or not invested historically as a priority and the security environment’s deteriorated the governing environment has deteriorated the US has been thrown out of ner in terms of its security engagement the French have been thrown out Russians are back in in back in spades uh how are we supposed to think and and yet that’s sort of a showcase when you think about climate and health that’s sort of a Showcase of what we what the future may look like the barriers the obstacles politically and and in terms of security fairly formidable say a bit about that like how do you begin to make the case for taking another look at what it means for these these parts of the world I think our best case is being made uh in the real implications of inactions that we can see MH right uh over time in uh the Sahel and some of these other areas that you already highlighted um and so finding a way to bring it’s it’s easy I think for us to be removed from the direct impact of of of some of these activities because we’re not closely engaged and so finding a way to bring some of this reality into the corridors that we we we live in uh I think will will help bring back the focus bring back the agency uh of the importance of addressing some of these issues thank you I want to shift the conversation to the to the political environment here I mean a couple things that have happened of late have sort of drawn our attention to uh the question of trying to sustained bipartisan support for Global health I mean the the success of over 20 years of investing in pepar investing Global fund investing increasingly in Gaby other areas has rested on a on a a foundation of strong bipartisan support and support coming from foundations from industry from public health Advocates uh from the faith community um some of that is really starting to unravel I mean we the one-year reauthorization for pepar was a reflection of several things one was post dos the abortion debate comes forward as a as a a vehicle for critiquing inaccurately but critiquing and that gained political will we’ve seen the changes in the Republican Party itself and and there’s been a generational change many of the folks who were present as advocates president as members of Congress president as as as uh leaders are are are retiring and and there’s so there’s a generational shift there’s the polarization and part partisanship that came out of Co around many of the interventions around Co that there was a bit of a spillover effect there too on onto Global health so all these things have created a a more difficult environment many of the conservative critics of uh foreign aid are emphasizing now how does this investment fit with our confrontation with China what is the end game do we have a long-term ingame and um and and how do we begin to update our understanding of what the value um uh of the investment is over over the long term um so it would seem when you look at the environment here in the United States and you look at these critiques that there’s a need to kind of update the rationale in the dialogue if we’re going to keep a bipartisan basis we’re going to have to have a different kind of conversation ation around these investments in order to move things forward uh into this next phase Angela your thoughts I think I would go back to a uh strategy Chris mentioned earlier which is that we do have new interventions we’ve also made a lot of progress in the recent past and to a certain degree it’ll be unfortunate if we not able to find a way to work together to sustain all these gains so that the gains will be lost and whenever the environment changes will have to start a little from the scratch and reinvest and so I think highlighting how much progress has been made with all the previous investment as well as the new opportunities we have given all the improvements in technology um to do even more good will be an important uh way to try and bring Renewed Energy into bipartisan engagement Chris you think we have an opening for a different kind of dialogue with conservatives around the future so I think there if you uh maybe we need to focus more on the problems that you can only solve if you have a Global Response MH you know obviously climate um antimicrobial resistance pandemics you can’t solve those problems sort of country by country uh and there you can start to make a case for some of the other big uh challenges that are out there but those are most people would understand that that has to be a sort of coordinated Global Response and I wonder if that’s the area to look for some sort of bipartisan support of those um um but it might mean if you do that if you go the route of where you know some sort of car I’ll use the word with trepidation Collective response uh is required uh that might actually lead you down a path of of of different priorities U than than we currently have on global Health but maybe that’s one strategy for building bip partners and engagement yeah um I was struck in reading your in reading your report uh no reference to China in that really um and uh uh why is that and what where does China fit in this in this conversation well Angela will answer on your take on Chinese Investments yeah um we do we do in the reports we we do not call out China and that’s true but uh China is included in the estimates that we generate in the overall calculation of development assist and support so that’s one area uh I think in terms of the challenges we have going forward you’re right uh China’s engagement with low and middle inome countries is one area that I think in most circles have been thought of as being a little controversial that said I think a lot of their investment are related to infrastructure structural activities uh they do have some significant interest uh thinking of the uh Silk Road initiative here in in in health as well uh but I think in the in the short in the short interim the the focus is more on uh the infrastructural investment and perhaps the inroad there uh will be finding ways to equip uh National governments to manage that that relationship do you think we need a a new dialogue with China on some of these things I think it’s very hard to ignore China just in terms of its size its increasing footprint in research Ai and you know they’re trying to um convince people of their success around covid management a separate debate is to that success uh in reaching out to other countries and so yeah we need to have a strategy of how we think about engagement with China you know the one of the this is part of the work of our alliance is looking at the the in terms of us China dialogue around Health Global health and Global Health security at a senior level at a ministerial level there has been no dialogue now for five years that’s a kind of profound reality and with the deadlock over Co Origins and Wuhan and the politics in this town around China breaking that and getting back into a dialogue that would clearly serve the self-interest of both countries that’s in their security interest is proving to be really difficult we’ve got 10 different working groups operating now between the Chinese and the and in the US on very sensitive and complicated areas where there’s not a lot of trust but 10 working groups Health there is no working you know there’s been a conscious decision to say nope we’re not going to go there we’ll go there on Military cyber trade investment many other things but um but we got this void we got this Gap um that’s emerged out of Co that’s sort of blocking this sort of uh senior level dialogue let’s talk about the DI diplomatic environment we’re on the edge we’re heading towards the World Health assembly we’ll see what happens in the pandemic treaty negotiations what outcomes there are the negotiations over the international Health regulations we have that coming forward we have the antimicrobial resistance high level meeting and a bunch of other meetings that you’re involved in that are the Prelude to that uh should we be hopeful in this phase about what my may come these negotiations have been hardfought difficult uh they’ve gone on for over twoyear period on the pandemic treaty and the IH but we’ll soon be seeing uh what may come out of it are you opt are you optimistic Ang I I am generally an optimistic person but in this instance I want to say I am yeah cautiously optimistic it’s a hard word to even come out only because the the news coming out of uh some of these meetings and uh dialogue doesn’t give much hope for optimism here so what do you think is the is the blockage on progress I think um at least related to the pandemic treaty I think countries are still vested in their own self-interest and not seeing uh the value that may be in uh externalities and connecting and collaborating uh for the global interest okay yeah so we’re at a certain risk that this investment of diplomacy this is a big diplomatic Enterprise right coming out of this historic Co experience may may or may not generate results what’s your thoughts I think it’s we we’re missing a a key ingredient um in in throughout the whole process uh which is a shared understanding of what went wrong during Co in fact it’s really hard to imagine you can uh get a lot of meaningful consensus on action when people have very different views of of the mistakes how do you describe the chasm well there’s you know the the view that it was the failure of early detection and sort of traditional um finding cases and isolating them early on and therefore the solution is early detection and what I would think of as traditional epidemic response would would be and coordination in in that task and then hopefully in that vein you don’t have to worry about uh non-pharmaceutical interventions and you know did mandates work or or not and some of the sort of controversy swirling around those and you don’t have to go down the route of um some of the more contentious issues around uh mandates to get vaccinated right so there’s that side you know focus on the early you know the sort of 7 by seven by seven type Mantra uh and then there are people who I think are convinced you know maybe inappropriately uh that we there was this huge over response on terms of um the non-pharmaceutical interventions and they weren’t really well Justified scientifically and broke trust with the public and so I think underneath the controversy obviously there’s issues of sovereignty is people’s interpretation of what would we have done differently in December of 2019 into January that would have changed the outcome um and so I I think you just end up moving down to this less and less content in in what people can agree on because of that difference of analysis of what happened and what can we hope for out of the high level meeting on antimicrobial resistance what do you think Angela this is going to be on on the margins of the UN General Assembly in September I think Chris is more involved in that should I put that question to him okay okay over to you Chris uh you know the aspirations are lower than a treaty uh I’m pretty hopeful actually that uh the work is being done to bring AMR to people’s attention uh you know there’s some package around um antibiotic stewardship one Health and maybe most importantly expanding access generally to antibiotics not just about AMR uh and and also the Innovation pipeline so I I think it will have a positive outcome uh in the sense but you know it’s relative to a lower bar of expectation than other people have for the pandemic treaty good I’m glad to hear that um so let’s while we’re on the optimism side of the equation here which is where how we want to close this conversation I want to invite anyone from our audience who cares to offer a a question or comment there’s a microphone there um we’ve got a few more minutes here in this program what should we be focused on in terms of sources of optimism and hope in this period looking ahead again the the new tools in the uh toolbook um what specifically gives you the most help in terms of new new technologies or new approaches uh I mean this is not just new but the HPV vessel um which is getting a resurgent or resurgent levels of commitment and interest because that provides some opportunities for hopefully um having a generation that doesn’t have to have um hepatitis C and things like that um in addition to that I think there are opportunities for AI I’m not as well uh invested in that space to know the exact way uh but I think there there’s a lot of investment that are happening to especially that may be more applicable in lwi income situations with less resources uh and being able to leverage uh leverage a lot of the current technology to Leap Frog on some of the interventions that uh have already existed but have faced challenges in optic uh as well so Chris your thoughts is AI G to offer a counterbalancing positive impact to the greater stress over resource levels and political commitments I think AI will just have huge effects uh many will be enormously positive right we should be able to deliver even to you know anywhere where there’s connectivity and that’s also something that’s increasingly ail available um AIDS and diagnosis treatment treatment planning um it’ll accelerate quite likely some of the biological Innovation pipeline um so simplify Imaging you know remotely all these things that’ll come pretty steadily I think over the next 5 10 years uh and then there’s all the risks with with AI so it’ll it’ll be a it is both in huge potential accelerator of progress and also a huge potential risk for you know uh malicious use of AI for biot terrorism for other for other things yeah while we’ve got a few minutes left I’d like you to talk a little bit about some of the other important related work that’s coming forward you’ve got a blizzard of work coming out so tell us a few of the give us a few of the Top Line sure uh well thanks Steve the we are at the end of a sequence of uh what we call the Capstone papers on the the current cycle of the global burden of disease study so gbd 2021 started publishing in March on demography on fertility which is its own interesting topic and then on causes of death um you know the full burden in terms of D and now risk factors this week and forecasting uh will come out uh Thursday Friday and what can we expect in that well I think the forecasting a preview really really interesting because we’ve built up you know we started forecasting interestingly the first forecast around burden were in 1997 using a super simplistic model where there was income education in tobacco that was the only drivers of Health outcomes and then again who we did another round uh but was there’s never been another set of full burden forecasts since 2004 so 20 years in the making uh a interesting modeling framework that answers both what we think is likely to occur and then a huge what if platform where you can turn the dials and say what if we had a New Zealand former New Zealand style tobacco free cohort uh what if we did a much better job air pollution Etc so what’s in the actual paper is the reference or probabilistic forecast for every country out to 2050 by by cause and then there is a small number of scenarios just sort of getting at the potential to alter the trajectory that small number of scenarios includes a big NCD package uh which has huge potential benefits and then others around environmental risks the the headline message is despite all the Doom and Gloom that we’ve been about despite capturing the effects of heat uh the Direct effects of heat we do expect continued progress just as we’ve had for the last um you know 70 years and that progress will be slower than in the past uh we’ll come back to what what’s driving that and but progress nevertheless there will still be large disparities in 2050 between the poorest countries and the rich richest but narrowing right so it’s it’s generally pretty positive right if compared to some people who are coming at these issues thinking we are going to see no progress big caveats um The Slowdown where is it coming from big chunk of that is the Nexus of diet physical activity obesity and and blood sugar driving huge expansion of diabetes um and then there’s a component around drug use which in some countries is exploding and and related and then a component around Rising mental disorders and um other forms of addiction that all make the progress that we will see less than it could have been and so you know that’s the the flavor and I think the thing I’m most excited about is that uh we’re now already lining up a series of other wh if type analyses you know a more comprehensive view of all the pathways for climate coming L later this year we hope uh what about AMR Trends building that into the forecasts we have some US policy related forecasts for the for the us across States and already getting requests from different governments for tailored what if to their their context thank you Angela closing words on the pipeline for your work things that you’ve got in the works that we haven’t talked about um we we’re hoping we can do some work uh trying to understand understand how climate uh change issues will impact development assistance for health support as well so um given the interest at least uh globally I think that should be meaningful uh going forward when when will we see that would you guess cautiously maybe next year on The Y too we still need to locate some funding uh for that work so okay M well this has been great thank you both thank you both for coming to CSI as to be with us today congratulations on the on the report it’s a terrific piece of work as usual and uh congratulations on all the other great work that i& is doing and uh come back soon thank you Steve thank you [Music]