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In years past, the face of the global burden of disease was a rural child suffering undernutrition and infections in a low-income country. The case for donor intervention—both bilateral and philanthropic—was morally, technically and economically clear. Today, however, it is more commonly an urban adult suffering multiple chronic diseases in a middle-income country. How could donors provide universal health coverage (UHC) or meet such an expansive need for healthcare services? Would they invest in adults who have already had a shot at life and whose lifestyle choices are supposedly to blame? What role could they have in a country with resources? These questions need answers.
In 2013, the Lancet Commission on Investing in Health (CIH) grouped the global health agenda into three categories: the unfinished agenda to reduce disparities in key infectious diseases and reproductive, maternal and child health; the emerging agenda to curb non-communicable diseases (NCDs) and injuries; and the cost agenda to provide universal coverage to high-quality healthcare (figure 1).1 Since that time, pandemic preparedness has yet again emerged as an additional priority. The donor response to these challenges primarily exists on two levels: global functions, which transcend national sovereignty to provide globally dispersible benefits, and country-specific functions, which are targeted interventions that improve the health of any individual country (figure 1).2 3 Overwhelmingly, donors have focused their efforts on country-specific functions for the unfinished agenda, or as of late, on global functions for infectious diseases. Left unreconciled is the pressing need to address the global NCD crisis with strong health systems that equitably cover everyone.
That burden is enormous. NCDs …
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