Six Actions that can Prevent 21 million Premature Deaths

RTI International, a leading independent, non-profit research institute, estimates that a package of just six policy interventions could avert premature death for 21 million of today’s 5-19 year olds.

The study, which was supported by a grant from the AstraZeneca Young Health Programme (YHP), was commissioned by Plan International and used statistical modelling to assess the potential worldwide health and economic gains and financial costs of the package of measures if they were implemented at scale.

The RTI research breaks new ground with its focus on adolescence and how full implementation of these measures would affect their life courses.

The study focused on three risk factors associated with non-communicable disease: daily tobacco smoking, heavy episodic drinking and mean body-mass index (BMI) and collated data for these across 70 countries - which represented 86% of the total global population in 2015. It then examined a series of policy options before refining this to the six most likely to generate a significant effect – these were tax rises (on tobacco, alcohol and sugar-sweetened beverages); advertising bans (on tobacco and alcohol) and a school-based intervention to promote physical activity and healthy diet. Tax rises and advertising controls had already been assessed as ‘Best Buys’1 in tackling NCDs by the World Health Organisation.

It then assumed that these were operated to the maximum – so that, for example, tobacco excise tax rose to 75% of the retail price as recommended by the WHO; and 100% of the target age group participated in the school programme.

The model projected the ‘business as usual’ level of premature mortality that would be occur – assuming that absolute rates of death for specific causes would remain unchanged at 2016 levels and then the likely effects of the interventions. The ‘business as usual scenario’, using the United Nations population projections, estimated 210 million (19%) of these young people would die prematurely before the age of 70 from a range of causes, over the next 50 years.

With full implementation of the six measures 21 million premature deaths would be prevented (9.8% of deaths from all causes), including 15 million attributable to smoking, 4 million deaths attributable to alcohol misuse, and 1.6 million deaths attributable to high BMI.

The estimated cost of achieving this level of impact was $1.4 Billion a year, approximately the same as that of the 862 bed Parkland Memorial public hospital in Dallas ($1.3 billion), with the great majority of the costs being accounted for by the schools programme.

The resulting ‘return on investment’ calculation suggested that measures to reduce premature smoking-related deaths were by far the most cost-effective (at $70 per $1 invested); with alcohol at $26. They also indicated that lower middle-income countries would account for approximately 50% of the deaths averted overall.

Rachel Nugent Vice President, Global Noncommunicable Diseases at RTI International, said “the potential cost-benefits from these measures are huge. This is a really important finding for policy makers throughout the world who are battling the fast-rising costs of healthcare. We can transform the life prospects of today’s young people, and save millions of lives and billions of dollars by enacting this relatively simple series of policy measures on tobacco and alcohol to the fullest possible extent.

‘There are fewer robust studies on the cost-effectiveness of interventions on obesity, especially in low and middle-income countries, so the evidence is weaker – but this is an area of increasing importance and we expect more and higher quality data on the effect of soda taxes and schools programmes to inform future research‘. 



1. WHO, 2017, ‘Best buys’ and other recommended interventions for the prevention and control of noncommunicable diseases. Available at;jsessionid=1333C798AC815E220167ED14C6D2F9A1?sequence=1