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.”

The U.S. Preventive Services Task Force recommends adults between the ages of 40 and 75 take a cholesterol-lowering statin drug to help prevent heart attacks and strokes if they are at risk of cardiovascular disease.

One in three Americans die of heart attacks or strokes. And those with no signs or symptoms, as well as no past history of cardiovascular disease, can still be at risk.

The independent panel of medical experts from around the nation said in a news release that statins could help those who have a risk factor for cardiovascular disease — such as high cholesterol or blood pressure, diabetes or those who smoke — and have at least a 7.5 percent risk of having a cardiovascular event in the next 10 years.

The task force also called for more research on the use of prescribing statins for children and adolescents who are at risk of heart disease.

The American Heart Association and American College of Cardiology have been recommending statins in adults for several years. The task force is now making a similar recommendation for primary prevention based on the latest clinical trials and research.

“The task force looked carefully at current data to identify who can benefit the most from taking statins,” said task force chair Albert L. Siu, MD, MSPH, who is also chair of the Ellen and Howard C. Katz Mount Sinai Health System.

“People with no signs, symptoms, or history of cardiovascular disease can still be at risk of heart attack or stroke,” said task force member Douglas K. Owens, MD, a Stanford professor of medicine and director of the Center for Health Policy and Center for Primary Care and Outcomes Research at Stanford Health Policy.

“Fortunately, for certain people at increased risk, statins can be very effective at preventing these events,” said Owens, who emphasizes that adults who fall into those risk and age groups must first consult with their physicians.

The task force said all adults could reduce their risk of cardiovascular disease by not smoking, eating a healthy diet, engaging in physical activity and limiting alcohol use. Managing high blood pressure and high cholesterol and taking aspirin when indicated can also help prevent heart attacks and strokes.

Based on the current evidence, the task force said, it is not yet clear whether taking statins is beneficial for people who are older than 75. But they did find the effectiveness of statins is the same for both men and women.

This is the first time the task force has changed its fundamental approach since 2008, when it recommended screening for abnormal amount of lipids in the blood. While screening remains key, most adults are now routinely screened as part of an overall cardiovascular risk assessment.

Therefore, the task force found the more relevant clinical question is no longer whom to screen for elevated cholesterol, but rather whom to treat with preventive medication once increased cardiovascular risk has been identified in an individual.

The Preventive Services Task Force also announced that there is not enough data and evidence to assess the balance of benefits and harms in screening for high cholesterol in children and adolescents up to age 20.

While some experts have recommended lipid screening in children and teens, the task force found that the evidence shows it’s difficult to predict which children who have high cholesterol will continue to have it as they age.

“There is currently not enough research to determine whether screening all average-risk children and adolescents without symptoms leads to better cardiovascular health in adulthood.” said Task Force Vice Chair David C. Grossman, MD, MPH. “In addition, the potential harms of long-term use of cholesterol-lowering medication by children and adolescents are not yet understood.”

The public can review the findings and comment on the task force website.

Other articles on the recommendation include:

The Associated Press

MedPage Today

Reuters

HealthDay

The cold and flu season is upon us — and with that comes the potential overuse of antibiotics. All too often, physicians prescribe antibiotics for viral infections, which typically is ineffectual and can even be dangerous for elderly Medicare patients.

An estimated 2 million Americans are infected with drug-resistant organisms each year, resulting in 23,000 deaths and more than $20 billion in excess costs, according to the Centers for Disease Control and Prevention.

Excessive antibiotic use in cold and flu season is not only costly, but it also contributes to antibiotic resistance, writes Stanford Health Policy's Marcella Alsan and her co-authors in a study published in the December edition of Medical Care. The study’s objective was to develop an index of excessive antibiotic use in cold and flu season and determine its correlation with other indicators of clinically appropriate or inappropriate prescribing.

Alsan and senior author, Dartmouth economist Jonathan Skinner, concluded that flu-related antibiotic use was correlated with prescribing high-risk medications to the elderly.

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A new federal proposal would ban smoking in public housing homes — a move that could impact some 1.2 million households across the nation.

Cigarette smoking kills 480,000 Americans each year, making it the leading preventable cause of death in the United States, according to the Center for Disease Control and Prevention.

The Department of Housing and Urban Development announced last week that the proposal is intended to protect residents from secondhand smoke in their homes, common areas and administrative offices on public housing property.

“We have a responsibility to protect public housing residents from the harmful effects of secondhand smoke, especially the elderly and children who suffer from asthma and other respiratory diseases,” said HUD Secretary Julián Castro in a statement, adding the proposed rule would help public housing agencies save $153 million every year in health-care, repairs and preventable fires.

Stanford Law School professor Michelle Mello, who is also a professor of health research and policy and a core faculty member at Stanford Health Policy, has researched and written about this issue extensively, including in this article in The New England Journal of Medicine.

We asked Mello about her views on the federal smoking ban proposal.

What would be the greatest benefit to banning smoking in public housing?

There are lots of benefits, but to me the greatest benefit is to the 760,000 children living in public housing. Although everyone knows that secondhand smoke exposure is extremely toxic, not everyone knows how much children in multiunit housing are exposed — even when no one in their household smokes. Research shows that smoke travels along ducts, hallways, elevator shafts, and other passages, undercutting parents' efforts to maintain smoke-free homes. Also, chemicals from cigarette smoke linger in carpets and curtains, creating hazardous "third-hand smoke" exposure that especially affects babies and small children.

Do most public housing residents want a ban on smoking?

Yes. Exposure to cigarette smoke is a perennial complaint among public housing residents and surveys of residents show that strong majorities support smoke-free policies. They also show residents frequently report smoke incursions into their living spaces, and that these reports are much lower when multiunit housing buildings have 100 percent smoke-free policies than when they have only partial smoke-free policies or no policies. Secondhand smoke in public housing is also a problem because these residents have few housing choices; they generally can't "vote with their feet" by moving to a smoke-free environment.

Could this help tenants who don't have the political will, time, or financial ability, to sue landlords who ignore their claims of respiratory concerns?

Absolutely — not to mention that those lawsuits, even if they were brought, often would fail.  Generally, tenants' rights are whatever local housing codes and lease agreements say they are, and smoke-free buildings aren't typically part of that package. Smoke-free policies aren't a guarantee, of course, and there have been difficulties enforcing them among some of the local public housing authorities that have implemented them.  But when they're in place, housing authorities have more mechanisms and reason to ensure that residents are protected from smoke exposure than they do without the policies.

Many argue that what they do in their own home is their own business.

That argument fails as soon as a puff of smoke escapes their home and wafts into someone else's air supply.  It also fails whenever there's a dependent in the house, whether a child or an adult relative, who doesn't smoke. Let's not forget, nearly half of all public housing households include children. Finally, most smokers desire to quit. About 7 in 10 say they want to quit completely, and in one study, over 90 percent said they wished they had never started. When we're talking about an addiction, particularly one people generally want to kick, the trope of autonomy doesn't have a lot of traction.

There are those who will say this is another attack on low-income Americans — such as banning sugary drinks or limits to what people can buy with their food stamps — and that this smacks of government shaming the poor.

Although it's reasonable to question policies that disproportionately burden the poor, I don't think this is such a policy. The reason is that only a minority of public housing residents are smokers; most of these low-income residents are benefitted, not burdened, by smoke-free policies.  The majority are vulnerable people, including children and the elderly, who have a higher-than-average incidence of respiratory and other health problems — and who want to breathe clean air in and around their homes.

Could this proposal lead to fewer kids smoking that first cigarette?

Yes. Part of the "tobacco endgame" is to further denormalize smoking, to the point that the next generation of kids will not grow up seeing it as something adults do. This is a hard argument to make when a kid smells smoke every time he walks into the hallway of his building and sees groups of residents smoking on stoops. Smoking bans have really helped to marginalize smoking behavior in other settings, like airports, restaurants, hospitals and schools.  Multiunit housing is the next logical step.

California’s measles epidemic was no fluke; between 2007 and 2013 the percentage of kindergarteners using a “personal belief” exemption to enroll in school without vaccinations doubled.

In that year, 3 percent of kindergarteners entered school unvaccinated. In some schools, the percentage of vaccinated children was so low that it threatened herd immunity, or the ability for a population to keep a pathogen at bay, according to Stanford health-policy researcher Michelle Mello, PhD, JD.

To understand the rapid increase, Mello worked with a team led by Tony Yang, ScD, with George Mason University. Their research is published on Nov. 12 in the American Journal of Public Health.

They found the highest resistance to vaccinations among white, affluent communities. In contrast to previous studies, however, they did not find a correlation between higher levels of education and vaccine exemptions.

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Anna Lembke, Assistant Professor of Psychiatry and Behavioral Sciences at the Stanford University Medical Center, visited SCPKU for two weeks as a faculty fellow in July 2014.  Below are the highlights of a conversation Professor Lembke had with SCPKU in which she shares more details about her research and how SCPKU helped to advance her work in China.

Q: Describe your research and its connection to China

My research focuses on improving the lives of those with addictive disorders. I am especially interested in the intersection between health care systems and culture, and how this intersection impacts addiction treatment. I became interested in studying drug use disorders in China for a number of reasons. First, I spent a year after college living in China (1989-1990) teaching English as part of the Yale China Program. I have followed events in China with keen interest ever since. Second, the total number of drug users in China may be as high as 7 million, with China predicted to have the most heroin users of any country in the world within 5 years. I was curious to find out how China is addressing its burgeoning drug problem, and didn’t just want the “party line.” I wanted to learn about how people addicted to drugs in China are seeking and getting help.

Q: What got you interested in the study of addiction?

When I first began practicing psychiatry, I was not interested in treating addiction. But over time, I came to realize that if I didn’t treat my patients’ drug and alcohol problems, their other mental health issues were unlikely to improve. I also realized that in targeting and treating addiction, I could help patients transform their lives for the better, as well as the lives of those who love them.

Q: Why did you decide to apply for an SCPKU Faculty Fellowship?

SCPKU gave me the financial and logistical support to pursue a research project in China, an opportunity that would not have been possible without their help.

Q: How valuable was SCPKU's team in supporting your fellowship at SCPKU?

The team here at Stanford was helpful with drafting the initial proposal, creating the budget, which was especially challenging, due to my lack of familiarity with what things cost in China, and making contact with the SCPKU staff in Beijing. The team in Beijing was helpful in setting up temporary housing and meals in Beijing, as well as providing maps, information on how to take the subway, and logistical support getting back to the airport.

Q: What were your fellowship objectives and were they met? 

My fellowship objective was to interview treatment-seeking heroin users in China to learn more about the state of addiction treatment in China. My research assistant, Dr. Niushen Zhang, and I planned to publish our findings in a peer-reviewed journal.

We learned that individuals in China addicted to drugs experience intense social stigma. They are reluctant to utilize government-sponsored treatment, because of fear of loss of anonymity and the ensuing social and economic consequences that follow when they are publicly identified as “addicts,” not to mention the potential loss of their personal freedom. (Addicted persons in China are sent against their will to forced detention centers, or “rehabilitation through labor camps.”) As a result, drug addicted persons in China are deeply mistrusting of government-sponsored treatment, and willing to sacrifice large sums of their own money for anonymous, confidential treatment.

Dr. Niushen Zhang and I recently published our findings in Addiction Science and Clinical Practice, 2015, “A qualitative study of treatment-seeking heroin users in contemporary China.” (To access the article online go to http://www.ascpjournal.org/content/10/1/23)

Q: Describe some highlights of your stay in China/SCPKU. 

The highlight for me was hearing the life stories of heroin-addicted patients at New Hospital in Beijing, and attending an Alcoholics Anonymous meeting, conducted entirely in Chinese. The AA members we met told us their participation in this grass-roots 12-step movement literally saved their lives. I also met many wonderful doctors and nurses working with addicted patients in China. Finally, Dr. Zhang and I became good friends. We had hardly known each other before venturing off to do research in China.

Q: List at least THREE words or thoughts that come to mind which best describe your experience at SCPKU. 

Compassion, endurance, overcoming adversity
 

Q: Any future plans in China? 

I’m thinking about taking a group of Stanford residents and/or medical students to China for a total immersion 3-week course to learn about addiction in China.  But not right away.

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.