UMMS Affiliation

Department of Medicine, Division of Cardiovascular Medicine

Publication Date


Document Type



Health Economics | Health Policy | Public Health


OBJECTIVES: To measure the 'best possible health for all', incorporating sustainability, and to establish the magnitude of global health inequity.

STUDY DESIGN: Observational, retrospective.

METHODS: We identified countries with three criteria: (1) a healthy population-life expectancy above world average; (2) living conditions feasible to replicate worldwide-per-capita gross domestic product (GDP-pc) below the world average; and (3) sustainability-per-capita carbon dioxide emissions lower than the planetary pollution boundary. Using these healthy, feasible, and sustainable (HFS) countries as the gold standard, we estimated the burden of global health inequity (BGHiE) in terms of excess deaths, analyzing time-trends (1950-2012) by age, sex, and geographic location. Finally, we defined a global income 'equity zone' and quantified the economic gap needed to achieve global sustainable health equity.

RESULTS: A total of 14 countries worldwide met the HFS criteria. Since 1970, there has been a BGHiE of approximately 17 million avoidable deaths per year ( approximately 40% of all deaths), with 36 life-years-lost per excess death. Young children and women bore a higher BGHiE, and, in recent years, the highest proportion of avoidable deaths occurred in Africa, India, and the Russian Federation. By 2012, the most efficient HFS countries had a GDP-pc/year of USD$2,165, which we proposed as the lower equity zone threshold. The estimated USD$2.58 trillion economic gap represents 3.6% of the world's GDP-twenty times larger than current total global foreign aid.

CONCLUSIONS: Sustainable health equity metrics provide a benchmark tool to guide efforts toward transforming overall living conditions, as a means to achieve the 'best possible health for all.'


Health equity, Benchmarking, International cooperation, Life expectancy, Sustainability, Gross domestic product

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© 2017 The Authors. Published by Elsevier Ltd on behalf of The Royal Society for Public Health.

DOI of Published Version



Public Health. 2017 Aug;149:149-158. doi: 10.1016/j.puhe.2017.04.015. Epub 2017 Jun 20. Link to article on publisher's site

Journal/Book/Conference Title

Public health

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Creative Commons License

Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.