Beyond Premature Death: Why Global Health Goals Need a Rethink
"Current frameworks undervalue younger lives lost to substance use. Discover how a shift in measurement could save more years of healthy life."
Global health frameworks worldwide currently emphasize preventing premature mortality, often by focusing on extending overall lifespans. This approach treats all premature deaths as equal, regardless of when they occur, and often overlooks the long-term effects of disability. To truly gauge health improvements, benchmarks should be rooted in summary health indicators like disability-adjusted life years (DALYs) or health-adjusted life expectancy (HALE), especially where data on disabling conditions is available. Alternatively, focusing on reducing years of life lost or improving life expectancies can provide useful insights where disability data is lacking.
The current emphasis on premature mortality is evident in the United Nations' Sustainable Development Goals 2030, which aim to reduce premature mortality from non-communicable diseases (NCDs) by one-third. Similarly, the World Health Organization's Global Action Plan for the Prevention and Control of NCDs 2013-2020 targets a 25% relative reduction in premature mortality from cardiovascular diseases, cancer, diabetes, and chronic respiratory diseases. With limited resources, major global health goals need refining.
We argue that global goals should be reformulated to account for non-fatal health outcomes, utilizing summary health measures. Where this isn't feasible, differential weighting of deaths at different ages—measured by years of life lost—is crucial. Equal valuation of deaths disregards the significant health loss when younger people die, particularly from causes like alcohol and illicit drug use. Conversely, tobacco use often impacts older individuals more. Relying solely on premature mortality reductions may not effectively improve population health, especially regarding substance use.
The limits of mortality targets
The WHO’s “25 × 25” strategy set a goal of reducing mortality from non-communicable diseases by 25% by 2025. Its standard approach has the advantage of simplicity, but the source says it also has major weaknesses. A proposed alternative quantitative target is to avoid 40% of premature deaths in each country—defined as under-70 deaths expected in the 2030 population at 2010 death rates—and improve health care at all ages.
The Unequal Impact of Premature Death: Age Matters
To illustrate the discrepancies, data from the Global Burden of Disease study were analyzed across several countries (China, India, Brazil, South Africa, the United Kingdom, and the United States). Globally, a significant proportion of deaths (47.6%) occur in individuals aged 70 and older and are not considered premature within current frameworks. High-income countries show a higher percentage of non-premature deaths compared to lower- and upper-middle-income countries, where infant mortality still accounts for a substantial 9.1% of all deaths.
- Tobacco: Premature deaths primarily affect those aged 40-69 (93.3%).
- Alcohol: Impacts mostly adults (81.0%)
- Illicit Drugs: Significant impact on younger adults (65.2%).
Research tracks child survival and preterm birth
A 2026 Frontiers article defines preterm birth as delivery before 37 completed weeks of gestation and describes it as the leading cause of death among children under five. It says that, despite initiatives including the Every Newborn Action Plan and the Sustainable Development Goals, the absolute burden of preterm birth remains a concern. A separate 2026 study reports that intrapartum-related events and complications of preterm birth remain leading causes of neonatal deaths, while a slowdown in neonatal mortality decline in many low- and middle-income countries threatens progress toward SDG 3.2.
Measure health beyond deaths
The authors argue that limited resources for health make the design of global goals important. They propose that major frameworks account for non-fatal health outcomes using summary health measures. Where that is not feasible, they suggest weighting deaths differently by age, using measures such as years of life lost to premature mortality.
Rethinking Health Priorities: A Call for Nuance
In lower- and middle-income countries, where infant mortality remains a pressing issue, resources may be better allocated to addressing infant health. However, in regions where substance use during pregnancy is prevalent, integrating targeted health policies can yield significant benefits for infants. High-income countries grapple with alcohol and illicit drug-related deaths occurring at younger ages, leading to stagnating or declining life expectancies and growing health inequalities. Prioritizing the prevention of these deaths becomes crucial.
A broader view of health-system goals
The Lancet Commission’s Global Health 2050 report says that countries choosing to do so could halve the probability of premature death—death before age 70—by 2050, relative to 2019 levels. The report also describes health systems as serving several goals: preventing disease and reducing its severity, improving quality of life at all ages, reducing premature mortality, responding to everyday health concerns, and protecting people from catastrophic health-service expenditures. Together, these points frame mortality reduction as one important health-system aim among several.
A 2050 target for premature death
The Lancet Commission on Investing in Health concludes that focused health investments could enable dramatic improvements in human welfare by mid-century. Its Global Health 2050 goal is for countries choosing to pursue it to reduce by 50% the probability of dying before age 70 by 2050, compared with 2019 levels. The source presents this as a possible goal, not a guaranteed outcome.
Mortality goals and people’s lives
The Lancet Commission’s Global Health 2050 report says that focused health investments could bring dramatic improvements in human welfare by mid-century. It reports that countries choosing to act can halve their populations’ probability of premature death, defined in the source as the probability of dying before age 70. Separately, the SDG 3.4 target seeks to reduce premature mortality from non-communicable diseases by one-third between 2015 and 2030.
Given the varying age distributions of deaths and considering the influence of social inequalities (where lower social status correlates with younger mortality), a nuanced approach to health priorities is essential. Current metrics focused solely on premature mortality obscure these critical distinctions.
Alternative benchmarks, such as reducing years of life lost (YLL), offer a more comprehensive view. By capturing the unequal health loss caused by deaths at different ages and factoring in non-fatal outcomes, policymakers can craft more effective and equitable health strategies that address the specific challenges within their populations.