Science and common sense tell us that the teenage brain is more vulnerable to peer pressure and susceptible to nicotine addiction than at any other stage of development.

That’s why California legislators recently voted to raise the legal age to buy cigarettes and tobacco products from 18 to 21. If Gov. Jerry Brown signs the bill, California will become the second state, after Hawaii, to raise the age limit on the unhealthy products.

Yet while more than 100 cities around the country have adopted such laws — including New York, Boston and Cleveland — New Jersey Gov. Chris Christie in January vetoed such a bill, despite strong bipartisan support from his state legislators.

Health policy advocates see the Christie veto as a setback in what they believe is an otherwise accelerating movement toward “Tobacco 21” laws as a new tool for curbing young people’s potential addiction to tobacco products and e-cigarettes.

Michelle Mello, a Stanford professor of law and health research and policy, and colleagues from Harvard University and Baylor College of Medicine argue in this New England Journal of Medicine article that there is new evidence to suggest these laws are effective, have great public support and have minimal economic impact in the short term.

“The vast majority of smokers begin smoking during adolescence, a period when the brain has heightened susceptibility to nicotine addiction,” they write. “Nearly everyone who buys cigarettes for minors in the United States is under 21 years of age; raising the sale age prevents high school students from buying tobacco products for their peers.”

In 2013, only eight U.S. municipalities had adopted Tobacco 21 laws. By March 2016, at least 125 localities and the state of Hawaii had done so, and California is on the cusp of following suit. In September 2015, the first federal Tobacco 21 legislation was introduced (Tobacco to 21 Act, S. 2100) by U.S. Senator Brian Schatz (D-HI).

The authors note an analysis of the effects of one such law adopted in Needham, MA, revealed a 47 percent reduction in the smoking rate among high school students, along with a reported decline in area retail tobacco purchases. The decreases were significantly greater than those in 16 comparison communities without Tobacco 21 laws.

And a 2015 report by an Institute of Medicine (IOM) committee provided evidence from two different simulation models that increasing the minimum age to 21 would lead to a 12 percent reduction in smoking prevalence. Another simulation study predicted that there would be an even larger effect: a nearly 60 percent reduction in adolescent smoking within seven years after nationwide implementation of a Tobacco 21 law.

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Two national public opinion studies published in 2015 found that 70 to 75 percent of Americans — including a majority of current smokers — support raising the minimum purchase age to 21. The authors themselves conducted a national survey of 1,125 American adults regarding their attitudes toward various public health laws.

“We found that three in four Americans support the adoption of a federal Tobacco 21 law,” they write. “Majority support extends across all major socio-demographic groups, including 68.3 percent support among young adults 18 to 24 years of age.”

Opponents of the federal and state bills — namely Tobacco interests, convenience store owners and e-cigarette manufacturers — say that states should not be in the business of policing public choice. Store owners contend raising the age limit would hurt sales, as snacks and soft drinks are typically ancillary purchases with cigarettes.

And some veterans’ organizations and Republican legislators have said it is wrong to take away the decision on whether to smoke from young people who are nevertheless old enough to marry, vote and join the military.

But Mello and her coauthors, Stephanie R. Morain, PhD, MPH, and Jonathan P. Winickoff, MD, MPH, say the long-term benefits of raising the age limit far surpass the near-term economic concerns, which they believe are overstated.

Research indicates that in the short term, raising the tobacco-purchasing age to 21 would result in a 2-3 percent annual decrease in total tobacco sales.

“Over the longer term, the revenue loss from decreased smoking prevalence will be substantial,” they concede. “But allowing future generations to become addicted to nicotine in order to preserve tobacco revenue fails the red-face test as an argument against Tobacco 21.”

If a federal law raising the legal age of purchasing cigarettes were implemented today, the Institute of Medicine estimates that would result in 249,000 fewer premature deaths, 45,000 fewer deaths from lung cancer, and 4.2 million fewer lost-life years among Americans born between 2010 and 2019.

“Local and state efforts have succeeded in extending Tobacco 21 protections to more than 16 million Americans,” the authors write. “We believe the time has come to expand this effective, broadly supported approach to a much greater share of the population.”

Nearly 100 health economists from across the United States signed a pledge urging U.S. presidential candidates to make chronic disease a policy priority. Karen Eggleston, a scholar of comparative healthcare systems and director of Stanford’s Asia Health Policy Program, is one of the signatories. 

The pledge calls upon the candidates to reset the national healthcare agenda to better address chronic disease, which causes seven out of 10 deaths in America and affects the economy through lost productivity and disability.

Read the pledge below.

The threat of a pandemic claiming millions of lives and devastating economies around the world is as serious as the potential perils of global climate change, renowned economist Larry Summers told a Stanford audience during a recent visit to campus.

The world is taking dramatic and costly steps to prevent the calamitous impact of climate change on the economies and national security of most countries. Yet preparations for a worldwide pandemic on the scale of the 1918 flu are vastly underfunded and ill-formed.

“My biggest fear is that the world is way short of focus on all the issues associated with pandemic,” said Summers, former treasury secretary in the Clinton administration and Harvard president emeritus, who in recent years has focused on the economics of global health care.

“We are talking about something that could kill surely tens of millions and perhaps 100 million people, and the Stanford football program is substantially more expensive than the WHO budget for pandemic flu,” he said. “It’s just crazy that we are so underinvested and underprepared.”

Summers, the Charles W. Eliot University Professor at Harvard, also served as director of the White House National Economic Council in the Obama administration. He was in conversation with Stanford Health Policy’s Paul Wise for the March 8 event co-sponsored by the Stanford Institute of Economic Policy Research for faculty and students.

The World Health Organization budget for outbreaks and crisis response has been reduced by nearly 50 percent from 2012 to 2015. Some global health experts blame these cuts in part for its slow response to the Ebola outbreak in West Africa and the ongoing Zika crisis in Brazil.

In Brazil, Zika has been linked to a spike in cases of microcephaly, a birth defect marked by small head size and underdeveloped brains. Brazil has confirmed more than 640 cases of microcephaly and is investigating an additional 4,200 suspected cases. Puerto Rico is now preparing for an expected outbreak there.

Summers said the mortality rate from the great flu pandemic was far greater than the recent Ebola outbreak in West Africa, which killed some 11,300 people mostly in Sierra Leone, Liberia and Guinea. Some 50 million people died worldwide during the 1918-1919 flu pandemic.

‘I don’t want to minimize in any way the significance of Ebola, but there are things to worry about that are vastly larger,” said Summers, who gave the keynote address for the January unveiling of the National Academy of Medicine’s report on global health risks.

That report by the Commission on a Global Health Risks Framework for the Future found that, compared with other major threats to global security, the world has “grossly underinvested” in efforts to prevent and prepare for the spread of infectious diseases. The commissioners — some 250 independent experts in health, governance and research and development — estimate $60 billion in annualized expected losses from pandemics.

“Pandemics cause devastation to human lives and livelihoods much as do wars, financial crises and climate change,” the report said. “Pandemic prevention and response, therefore, should be treated as an essential tenet of both national and global security — not just a matter of health.”

Summers estimates that pandemic flu risk is in the same range of global climate change in terms of expected costs over the next century. Yet a potential pandemic is getting only 2 percent of the attention and resources that global climate change has today.

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Summers also chaired the Lancet Commission on Investing in Health, an independent group of 25 leading economists and global health experts from around the world. Their landmark report, Global Health 2035, provides a specific roadmap for this achieving “a grand convergence” in health within our lifetimes. Ahead of the U.N. General Assembly last fall, Summers led a joint declaration together with economists from 44 countries calling on world leaders to prioritize investments in health.

Wise, in the Department of Pediatrics at Stanford and senior fellow at the Freeman Spogli Institute for International Studies, asked Summers how one plans for pandemics when faced with so many failed governments and conflicts around the world.

“One of the central challenges that I worry about a lot in the deliberations of pandemic control is that many of the (regions) of greatest concern are characterized by chronic political instability, conflict and very weak governance,” said Wise, who for more than 30 years has been traveling to rural Guatemala to provide medical care to children there for his Children in Crisis project.

Summers said the world has been fortunate that there are so many brave and devoted medical workers who are trained to go into these conflict regions to try and contain outbreaks.

“But I think it would be disingenuous of me to say that you can solve these problems without in some way containing the failed state,” he said.

Wise then asked Summers what sort of advice he would give to the Stanford students who were trying to decide between a career in which one might use economics to make a fortune on Wall Street, or use economics for the greater good.

“I have always believed that you can count — and you can care,” Summers said. “There is nothing about counting and using numbers and analyzing the math that means you don’t care in a moral way.”

When a physician works with a patient and saves her life, he said, that has a profound and direct impact on both the patient and physician. But working on a vaccination program that has the potential of saving thousands of lives one day comes with delayed gratification.

“But the impact of making the world a better place and enabling people to survive and avoid grieving the loss of of a family member is as great — or greater,” he said.

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Infant deaths in Massachusetts for much of the 1800s accounted for more than 20 percent of all deaths, many due to diarrhea, cholera and other gastrointestinal disorders.

But from 1870 to 1930, the infant mortality rate plummeted from around 1 in 5 white infants to 1 in 16 for both Massachusetts and the entire United States.

Studies have shown that the dramatic decline was due to the impact of a clean-water system in Boston and other major U.S. cities at that turn of the 20^th century.

Now, new research by Stanford Health Policy’s Marcella Alsan indicates that effective sewage systems installed in Boston and surrounding municipalities complemented the water treatment plants and had a significant role in protecting the lives of children.

“We were motivated to investigate this because there was a watershed moment when infant mortality began to decline in the U.S. and Massachusetts that we wanted to understand,” said Alsan, an assistant professor in the Department of Medicine, and the country’s only physician who is a tropical disease expert and economist.

“In retrospect, the daunting challenges these engineers and medical professionals faced in designing, financing and executing such a massive project is incredible,” Alsan said in an interview. “It was really inspiring to read the history of how it all came together.”

She and co-author, Claudia Goldin of Harvard University’s Department of Economics, analyzed about 200,000 of infant death certificates in Boston and 54 other Massachusetts municipalities spanning the years 1880 to 1915.

The impetus behind the creation of the Metropolitan Sewerage District was complaints regarding the stench of sewage among Boston’s upper-class citizens.

“The first of a series of hearings was given by the sewerage commission at the City Hall on Friday night,” read a story in an 1875 edition of the Boston Medical and Surgical Journal. “From the statements made it would appear in various parts of the district including most of the finest streets, the stench is terrible, often causing much sickness.”

A joint engineering and medical commission was appointed in 1875 to devise a remedy and a massive drainage project got underway.

Alsan and Goldin found that an overwhelming number of deaths in the greater metropolitan area were due to gastrointestinal disorders, but that this improved significantly when sanitation canals became part of the overall water systems.

“We find robust evidence that the pure water and sewerage treatments pioneered by far-sighted public servants and engineers in the Commonwealth saved many babies,” they write in a working paper. “It must also have enhanced the quality of life for the citizens of the Greater Boston area even if it did not reduce the non-child death rate by much.”

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They acknowledge that the interpretation of their results is intuitive. But it’s an important one to promote because many developing countries today have yet to heed the lesson of combining safe drinking water and improved sanitation systems.

“Without proper disposal of fecal material, the benefits of clean water technologies for the health of children are likely limited,” they write. “Such a result has relevance for today’s low-and middle- income countries.”

The Millennium Development Goal Target 7.C — to halve by 2015 the proportion of the population without sustainable access to safe drinking water and basic sanitation —was only met for water, but not sanitation. Between 1990 and 2015, 2.6 billion people gained access to improved drinking water sources.

Yet despite that progress, one-third of the global population is still using unimproved sanitation facilities, including nearly 1 billion people who are still forced to defecate in the open. This often leads to cholera, typhoid, hepatitis, polio, and worm infestation.

Diarrhea is the third-largest killer of children under 5 in sub-Saharan Africa, and 44 million pregnant women are infected with worms each year due to open defecation, according to the United Nations. Every minute, 1.1 million liters of human excrement enters the Ganges River in India.

The problem of waste disposal likely will be compounded by rapid urbanization occurring in the developing world, said Alsan, and lack of sanitation and the practice of open defecation costs the world’s poorest countries $260 billion a year.

“We think our findings underscore how complementary these infrastructure investments are, and hope that holds lessons for the developing world,” said Alsan. “In all practicality, it’s very hard to ensure the municipal water supply is not contaminated if the sewage infrastructure is neglected.”

Working Paper: Watersheds in Infant Mortality

Non-smoking campaigns that tell teenage boys they will get lung cancer in 30 years if they don’t stop smoking just don’t work.

“But prevention programs that tell them that girls don’t like smokers make them go pale with fear,” says Keith Humphreys, a professor of psychiatry and behavioral sciences.

Humphreys, an affiliated faculty member of Stanford Health Policy, told an audience at the World Economic Forum in Davos, Switzerland, this January that the better approach to public health campaigns are those tailored to the realities of the human brain.

One of those realities is that our brains have evolved to be vulnerable to addiction, especially if we live in the lower-income tiers of society. An understanding of our evolutionary vulnerability to drugs and alcohol can help us to design effective public policies, Humphreys told the Davos audience.

“Primate research indicates that there may be a political and economic dimension to this,” he said. “When lower primates form a hierarchy, those at the bottom undergo a change in their dopamine system. This makes them more likely to consume drugs in an addictive fashion.”

Addiction can happen to anyone at any level of society — the current opiate epidemic is a case in point — but if you look at wealthy societies, those who have less economic and educational resources are more prone to addiction.

“So as inequality worsens, we really have a risk of creating a disempowered underclass of people who are literally sedated by ever more available psychoactive substances.”

Humphreys is on the NeuroChoice team at the Stanford Neurosciences Institute who attended the forum to present their research into the neural basis of decision-making and how these impact public policy.

He says in this video that neuroscience reveals addictive drugs work on precisely the same brain systems that guide our survival decisions. This is compounded by industrial global capitalism, making the exposure to psychoactive substance nearly universal.

“These two combined realities — our evolutionary conserved vulnerability to addiction and the development of a production and transportation system that can deliver substances worldwide — is why one in six deaths on the planet among adults is attributable to psychoactive substance abuse,” says Humphreys.

Stanford researchers are going after the problem in two ways. First is to use neuroscience to unravel the mechanisms of addiction in the brain. Then, they work directly with public policymakers, such as those who regulate the tobacco, alcohol and pharmaceutical industries, as well as those who oversee health-care and criminal justice systems.

“We communicate to our friends in the policy world what science has to teach about addiction and how you can use that information to do a better job at protecting people and promoting public health,” he said.

He said one of their key messages is that psychoactive substances are not ordinary commodities that should not be regulated.

“That’s probably true for broccoli, but it’s not true for psychoactive substances because they impair our brain’s ability to value things,” he said. And that is why public health policies must take into account the evolutionary-conserved circuits in the brain.

“The magnificent decision-making organ that evolution has bequeathed us is vulnerable to addiction, perhaps particularly if we live on the lower tiers of society. This creates a risk for humanity,” Humphreys said. “Karl Marx was worried that religion would become the opiate of the masses. But if we don’t use neuroscience to make better treatments and better policies regarding addiction, the opiate of the masses will be opiates.”

What is the best way to measure returns on investments in health care?

Does the World Health Organization’s approach help developing countries allocate their limited health-care resources wisely?

What are the economic implications of the global rise in non-communicable diseases?

These are just a few of the global challenges taken up by health economics experts at the third annual Global Health Economics Consortium Colloquium at the University of California, San Francisco.

At the core of the conference is the growing field of health economics, and why cost-effectiveness analysis is fast becoming the underpinning of successful health policies.

Not only is the field expanding, so is the collaboration among researchers and faculty at Stanford Health Policy, UCSF Global Health Sciences, and the UC Berkeley School of Public Health, co-sponsors of the Feb. 12 event.

“It’s been great to see the meeting evolve from a show-and-tell to a platform where we can have nuanced discussions about the challenges and controversies in the field,” said Dhruv Kazi, an assistant professor of medicine at UCSF who helped organize and moderate the event.

Some 180 health policy experts, researchers and speakers representing 11 universities, six non-profit organizations and five for-profit outfits attended the daylong conference on the UCSF Mission Bay campus.

“By building bridges between our universities, we create a space where thought-leaders and students alike can engage in discussions to challenge working assumptions and also spearhead innovate strategies and solutions,” said James Kahn, a professor of health policy and epidemiology at UCSF and the director of the consortium.

The Consortium — known as GHECon — was awarded a five-year cooperative agreement of up to $8 million by the CDC to conduct economic modeling of disease prevention in five areas: HIV, hepatitis, sexually transmitted diseases, tuberculosis and school health.

Taking a break during the third annual Global Health Economics Consortium Colloquium at UCSF on Feb. 13, 2016. Photo by UCSF/Cindy Chew.

As global economies remain turbulent, Kazi said, governments and donors have become increasingly cost-sensitive and want to better understand the societal returns they are getting for their investments in health.

“That enhances the influence of our work, but also increases the scrutiny it receives, creating an opportunity for the community to have an honest discussion about the challenges and opportunities that lie ahead,” he said. “And that is precisely the platform GHECon sees itself becoming.”

Some of the tough challenges consortium members are undertaking:

1. The World Health Organization recommends using per capita GDP as a benchmark for how much money countries should be willing to spend on health-care interventions. GHECon researchers have shown that this approach is problematic and does not always help countries allocate their limited health-care resources optimally.
2. Economic evaluations have typically only considered health-care costs, overlooking the lost income of patients or caregivers during hospital stays. GHECon researchers are working on ways to value this lost productivity in an effort to estimate the true cost of a disease and, conversely, the benefit of its alleviation. 
3. Cost-effectiveness evaluations traditionally are concerned with how efficiently health-care resources are utilized by asking questions like: How many lives can I save per million dollars invested? But society may care about other benefits that go beyond efficient use of resources, such as reducing disparities by helping the most vulnerable sections of society and alleviating poverty.

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Mark Sculpher, one of the leading health economists in the world, gave the keynote address about his efforts in the UK to use cost-effectiveness analysis to inform decisions at the National Institute for Health and Care Excellence.

He said there are two big challenges today: defining cost-effectiveness thresholds that are meaningful, and determining how policymakers, donors and payers make decisions when there are multiple criteria and perspectives.

“The realities of decision-making inevitably involve a whole host of considerations,” said Sculpher, who is director of the Program on Economics Evaluation and Health Technology Assessment at the University of York. “Ultimately it’s about what is this measure of benefit that we want to maximize — and how do we invest in it.”

Stanford Health Policy’s Douglas K. Owens, director of the Center for Health Policy at the Freeman Spogli Institute for International Studies and the Center for Primary Care and Outcomes Research at the Department of Medicine, presented his influential economic modeling research about the need for routine HIV screening.

“We determined that HIV screening is cost-effective in virtually all health-care settings,” Owens told the audience, noting that the findings became policy at the Centers for Disease Control and Prevention and other national health policy organizations. It has become an example of how economic modeling can inform crucial policy decisions — and help save lives.

There were also robust panel discussions about the challenges of doing cost-effectiveness analysis in developing countries with limited resources; the difficult paths to universal health care; and how economics can help address disparities in health care and financial protection.

“The consortium is particularly valuable because it fosters collaborations among a broad group of global health experts,” Owens said.

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This season, “Downton Abbey's” plot line has health policy wonks on the edge of their seats: a heated debate about hospital consolidation that closely parallels what’s going on in the U.S. health care system today.

If you’re not a Downton fan, here’s a quick plot recap by Kaiser Health News reporter Jenny Gold: It’s 1925 for the lords and ladies at Downton Abbey. Think flapper dresses, cocktail parties and women’s rights. And a big hospital in the nearby city of York is making a play to take over the Downton Cottage Hospital next to the posh estate.

As Maggie Smith’s character, the Dowager Countess of Grantham, sees it, “The Royal Yorkshire county hospital wants to take over our little hospital, which is outrageous!”

Stanford Health Policy’s Kathy McDonald — an unabashed fan of the popular PBS period piece — says things haven’t changed that much today. There has been an uptick in hospital consolidations since 2010, with about 100 taking place each year, she says.

You can listen to McDonald’s interview with Gold, who took the Downton debate to the American Public Media radio show, “Marketplace.”

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The prestigious panel of medical experts who provoked a nationwide debate when it suggested fewer mammograms is standing by its recommendation that women 50 and older only get the screening every other year.

The U.S. Preventive Services Task Force issued an update of its 2009 guidelines on Tuesday, noting that women in their 40s with an average risk of breast cancer should discuss mammography with their clinicians and make individual decisions about whether to have the screening.

When the panel made the panel first made the recommendation, it provoked an outcry from some medical associations and cancer-awareness advocates who feared the advice would lead some women to delay having mammograms and put them at greater risk of death.

“In 2015, contentious discussions about breast cancer screening and prevention continued, with physicians, advocates, lawmakers, and scientists all lending their voices to the debate,” the Task Force said in an editorial on its website.

“Many of these stakeholders focused on the need for women to be able to make more informed health care choices about when to start screening without having to worry about the cost of an insurance copayment,” said the panel of experts, including Stanford Health Policy’s Douglas K. Owens, director of the Center for Health Policy and the Center for Primary Care and Outcomes Research.

“The role of the U.S. Preventive Services Task Force (USPSTF) in these discussions has remained unchanged: to empower women with the best scientific data about the benefits and harms associated with breast cancer screening, so they can make an informed decision with their doctor.”

Breast cancer is the second-leading cause of cancer death among women in the United States, according to the National Cancer Institute. In 2015, an estimated 232,000 women were diagnosed with the disease and 40,000 women died. It is most frequently diagnosed among women aged 55 to 64 years, and the median age of death from breast cancer is 68 years.

The task force determined that while screening mammography in women aged 40 to 49 may reduce the risk for breast cancer death, the number of deaths averted is smaller than that in older women and the number of false-positive results and unnecessary biopsies is larger.

The balance of benefits and harms is likely to improve as women move from their early to late 40s, the task force said.

“In addition to false-positive results and unnecessary biopsies, all women undergoing regular screening mammography are at risk for the diagnosis and treatment of noninvasive and invasive breast cancer that would otherwise not have become a threat to their health, or even apparent, during their lifetime,” the Task Force said. “Beginning mammography screening at a younger age and screening more frequently may increase the risk for over-diagnosis and subsequent overtreatment.”

The independent panel of medical experts from around the nation said that women with a parent, sibling, or child with breast cancer are at higher risk for breast cancer and thus may benefit more than average-risk women from beginning screening in their 40s.

Not everyone is pleased with the recommendations.

Florida Congresswoman and chair of the Democratic National Committee, Debbie Wasserman Schultz, issued a statement that suggested the Task Force recommendations could put younger women at risk because their insurance companies may stop paying for their screenings.

“These guidelines indicate that screening for women under 50 is less beneficial in detecting breast cancer than for older women,” said Wasserman Schultz, herself a breast-cancer survivor. “However, because insurance companies often use these guidelines to determine coverage for these critical life-saving screenings, these new recommendations could potentially bar millions of women from getting coverage for screenings they need.”

Judy Salerno, president and CEO of the Susan G. Komen breast cancer charity, said she worries the recommendation could target African-American women in particular.

“A lack of coverage would be most harshly felt in high-risk and underserved populations,” Salerno said. “African-American women, for example, are often diagnosed at younger ages with aggressive forms of breast cancer – and die of breast cancer at rates over 40 percent higher than white women. Screening at younger ages is a critical tool for these women.”

Members of the Task Force, however, emphasized that it was their role to evaluate scientific evidence and not make insurance coverage decisions.

“The USPSTF acknowledges the important role that insurance coverage plays in access to and use of preventive services,” the Task Force said in its editorial. “Coverage decisions are the domain of payers, regulators and legislators. Whatever we may believe about the importance of coverage in shared decision-making about mammography, we cannot exaggerate our interpretation of the science to ensure coverage for a service. This would lead to confusion regarding the state of science versus the politics of coverage.”

Stanford students belong to the first generation that could witness the end of extreme global poverty — in what would be one of humankind's greatest achievements — the head of the World Bank said during a recent talk on campus.

But their generation, he said, is also likely to experience the first global pandemic since the 1918 influenza that killed more than 50 million people.

Jim Yong Kim, president of the World Bank, said innovations in health, education and finance are behind the World Bank's twin goals of ending extreme poverty and boosting shared prosperity for the bottom 40 percent of the global population.

Speaking at the inaugural conference of the Stanford Global Development and Poverty Initiative on Oct. 29, Kim lauded faculty and students for their multidisciplinary approach in tackling poverty and improving public health. He is an infectious disease physician who oversaw World Health Organization initiatives on HIV/AIDS.

"Seeking transformative solutions to challenges of development and poverty that are necessarily cross-disciplinary is exactly what a great university should be doing," Kim said in his speech at Stanford.

The World Bank announced last month that the number of people living on less than $1.90 a day is expected to drop to 9.6 percent of the global population by the end of the year. That is down from 36 percent in 1990.

The bank has pledged to cut that rate to 3 percent by 2030.

"We expect the extreme poverty rate to drop below 10 percent for the first time in human history," he said. "This is the best news in the world today. And this is the first generation in human history that has been able to see that potential outcome." 

Promoting prosperity

One of the co-founders of Partners in Health, Kim was the keynote speaker at the daylong conference, "Shared Prosperity and Health," which drew together Stanford faculty and researchers, plus government and NGO officials from around the world.

Stanford's global development and poverty effort is a university-wide initiative of the Stanford Institute for Innovation in Developing Economies, known as Stanford Seed, and the Freeman Spogli Institute for International Studies. The conference was held at Stanford's Graduate School of Business, which was a partner in the event.

Kim's talk was optimistic about the newly adopted U.N. Sustainable Development Goals, with an ambitious agenda to end poverty and hunger, ensure healthy lives, empower women and girls and attain quality education for all children by 2030.

While those goals seem lofty, Kim pointed to the accomplishment of bringing down extreme poverty to 10 percent, a figure many had once said was impossible.

Ninety-one percent of children in developing countries now attend primary school, up from 83 percent in 2000, he said. And the number of people on antiretroviral drugs for treatment of HIV in sub-Saharan Africa has increased eightfold in the last decade.

"But we're humbled by the challenges ahead," Kim said. "Rising global temperatures will have devastating impacts on poor countries and poor people – and, as we saw with Ebola, major pandemics are likely to disproportionately affect the poor."

Pandemic threats

Kim said that most virologists and infectious disease experts are certain a pandemic will sweep the world in the next 30 years. He said that would lead to more than 30 million deaths and anywhere from 5 to 10 percent of lost GDP.

He blasted the global community for taking eight months to respond to the Ebola crisis in West Africa, noting that Guinea, Sierra Leone and Liberia had among the fastest growing economies in Africa before the outbreak killed more than 11,000 people – most of whom were poor.

In an effort to speed up financial aid the next time such an outbreak occurs, the World Bank is developing the Pandemic Emergency Facility, which would disburse funding immediately to national governments and responding agencies.

Rajiv Shah, the administrator for the U.S. Agency for International Development from 2010-2015, spoke earlier at the conference about his work leading the U.S. efforts to contain Ebola.

"Three small countries with total population of maybe 30 million people had such weak health systems with so little domestic investment – in one country $6 per capita health investment per year – that when Ebola became a crisis there was no first-line of defense," he said.

By October 2014, the U.S. was pouring hundreds of millions of dollars into containment efforts, including the establishment of a 2,500-personnel military deployment to hit Ebola on the ground. Shah said President Obama "stayed extraordinarily true to the science" of containment at the source.

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Stunted children 

Moving beyond containment of epidemics, Kim said the most important investment developing countries could make in their people starts when a woman becomes pregnant. Using a combination of health, nutrition and education will have lifelong benefits for each child, as well as for the country in which each prospers.

The World Bank estimates that 26 percent of all children under age 5 in developing countries are stunted, which means they are malnourished and under-stimulated, risking a loss of cognitive abilities that lasts a lifetime. The number climbs to 36 percent in sub-Saharan Africa, giving those children limited prospects in life."This is a disgrace, a global scandal and, in my view, akin to a medical emergency," Kim said. "Children who are stunted by age 5 will not have an equal opportunity in life. If your brain won't let you learn and adapt in a fast-changing world, you won't prosper and, neither will society. All of us lose."

From 2001 to 2013, the World Bank invested $3.3 billion in early childhood development programs in poor countries. Kim said innovative policymaking and financial tools allowed the bank to help Peru cut its rate of child stunting in half to 14 percent in just eight years.

"Progress is possible – and it can happen quickly. But we must do even more,"he said.

Kim said the world set a target in 2012 to reduce stunting in children by 40 percent. But that would still leave 100 million children malnourished and undereducated. The bank and world leaders should pledge to end stunting for all children by 2030, he said.

"With partners like the Global Development and Poverty Initiative and the entire Stanford community, I'm full of hope that we can indeed be the first generation in human history to end extreme poverty and create a more just and prosperous world for everyone on the planet."

Read more here about another innovation to improve health in the developing world.