Since the 1950s, global life expectancy has risen by more than 150%.1 This can be attributed to medical and public health advances as well as social and political changes that have contributed to improved health outcomes.2 However, these changes have also been accompanied by shifts in key epidemiological and demographic trends, such as the rising prominence of non-communicable diseases (NCDs) across countries of all income levels, and the emergence of urban health with an increasing volume of migrants and rapid urbanization. Therefore, assessing the future of global health must address these changing health needs to enable a comprehensive approach.
Along with increasing life expectancies, the global fertility rate has halved since 1950.3 This has resulted in population aging in many countries and regions, a trend that is expected to continue into the coming decades. With an aging population, the demands on the health sector are shifting to emphasize geriatric care and the management and prevention of comorbidities. This is further enhanced by the epidemiologic shift of disease burden and mortality from infectious diseases towards NCDs such as cancer, cardiovascular diseases, and mental illnesses. Together, these highlight the increasing role of both modifiable and extrinsic lifestyle factors (such as air quality), and the social determinants of health in regulating health outcomes.
As the influence of media, technology, and globalized corporations have intensified over time, the commercial determinants of health are increasingly of concern. These are driven by intensive advertisements and social norms promoted by the profit-driven private sector that encourage health-harming consumer behaviours. Notable examples include the various advertisement platforms and strategies used by the fast food, sugar-sweetened beverages, alcohol, and tobacco industries to promote their products despite ample evidence of their adverse health effects. On a larger level, the fossil fuel industry is a major commercial determinant of health that contributes to ill health on multiple fronts, including, but not limited to, poor air quality and global warming. These commercial determinants of health, which are already significant contributors to the rising incidence of NCDs, will likely play an increasingly bolder role unless action is taken to hold these industries accountable.
Superimposed on this is the emerging field of urban health. With populations increasingly concentrated in urban areas, up by more than 3 billion people in 2017 compared to 1960,4 additional considerations must be given to safe housing, green spaces, proper nutrition and food security, physical activity, and accident and injury prevention within these communities. Other social determinants of health, such as education, employment opportunities, and access to healthcare must also be addressed through adequate physical, social, and healthcare infrastructure. Furthermore, where disparities in access to new and costly health technology and services exist, the gap between those who can afford to pay and those who cannot would continue to grow. To mitigate this, strong social health security systems are required to ensure equitable access to health services. Overall, a future of global health that is prepared for these epidemiological and demographic shifts will require adaptability in both the health and social systems to simultaneously respond to changing health needs and social determinants of health. Especially for the latter, intersectoral collaboration will be critical. As social determinants of health are governed by all aspects of daily life, from education to physical environment and social and economic systems, a “Health in All Policies” approach that considers the health impacts of a given policy will be beneficial to maximize on co-benefits across sectors. To promote this, UHF is pursuing a multi-pronged approach to health, such as raising a health and development focus on fossil fuel policies, providing economic arguments for health and development policies, and supporting the integration of health- and development-related goals in national and private sector strategies.