Helping Save 1 Million More Lives

Every Year. By 2030.

This is the audacious goal Laerdal has established. Nothing less.

The key word is “helping”. No-one at Laerdal would claim they were saving lives; their role is to develop educational and therapy solutions and services that help train and equip those who do from lay people, ambulance dispatchers, and community first responders through to healthcare workers on ambulances and in hospitals. Laerdal can only do this by working with partners in professional associations, NGOs and government bodies to develop the necessary programs and actions for widespread implementation.

The guiding stars for this collaboration are the Sustainable Development Goals (SDGs), established by the UN in 2016, with SDG3 for good health and well-being at its core.

In addition to having a goal of reducing maternal, neonatal and child mortality, SDG3 also addresses accidents and non- communicable diseases including sudden cardiac arrest.

SDG 3 goals* - extracts

By 2030, reduce the global maternal mortality ratio to less than 70 per 100,000 live births.
By 2030, end preventable deaths of newborns and children under 5 years of age, with all countries aiming to reduce neonatal mortality to at least as low as 12 per 1000 live births and under 5 mortality to at least as low as 25 per 1000 live births.
By 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being.
By 2020*, halve the number of global deaths and injuries from road traffic accidents.
Achieve universal health coverage, including financial risk protection, access to quality essential healthcare services and access to safe, effective, quality and affordable essential medicines and vaccines for all.
By 2030, substantially reduce the number of deaths and illnesses from hazardous chemicals and air, water and soil pollution and contamination.

*See sdg-tracker.org/good-health

Illustration of Good health and well-being ensure healty lives and promote well being for all at all ages

A Changing World

When Laerdal was established in 1940, the world’s population was just over 2 billion. Today it exceeds 7.5 billion. By 2030 it is projected to reach 8.5 billion – with 5 billion living in Asia and 1.7 billion in Africa.

And the age distribution of the population is changing. In 2017 there were about 960 million people aged 60 years and over, more than double the number in 1980, and this number is expected to double again by 2050 to over 2.2 billion with 80% living in developing regions. This ever-ageing population with numerous health problems places increasing stress on health and social care systems.

These demographic changes are faster than at any time in history. To deal with these and to meet people’s increased expectations with advances in medical care, healthcare expenditure in OECD countries has had to grow at an average rate of 4%, double that of the growth in national income. This is not sustainable. The resources are just not there to meet future demand. New approaches are needed. There are even severe challenges now in the richest country in the world, the USA. Even though the USA spends 18% of its national income on health care, the maternal mortality rate has more than doubled from 10.3 per 100,000 live births in 1991 to 23.8 in 2014: over 700 deaths per annum, and of these two thirds are preventable. Also, deaths from medical errors in US hospitals are estimated to exceed 250,000 per annum.

"I envision a world where everyone can live healthy and productive lives, regardless of who they are or where they live."

Tedros Adhanom
WHO Secretary General

Quality in Health Care

In a landmark paper published in the Lancet medical journal in 2018, researchers estimated that 8.6 million deaths per year in 137 low- and middle-income countries (LMICs) are due to inadequate access to quality health care. Of these, 40% are people who did not access the health system, but 60% (5.0 million) are people who sought access but received poor-quality health care.

Such poor-quality health care resulted in 82 deaths per 100,000 people in LMICs: an enormous and preventable burden. And because deaths in LMICs occur at a younger age, poor-quality health care takes a large toll on years of life lost, estimated at 224 million, about 50% of which are in Asia.

Cardiovascular disease made up 33% of the preventable deaths (2.8 million) of which 84% were caused by use of poor-quality health services. Deaths from neonatal conditions and road accidents were second and fourth highest.

Trends and Opportunities

Trends in health care and education and advances in technology and delivery models all feed into improved opportunities for lifesaving.

Examples described in later chapters include:

digital advances in training products and methodologies and the widespread use of mobile phones and Artificial Intelligence to maximise the impact of the first resuscitation team in the community;
mobile apps to enrol and activate a community of first responders;
low-dose, high-frequency educational programs to move health care away from big-dose, infrequent training to focusing on continuous improvement of competence;
tailored refresher training based on individual healthcare workers’ needs;
on-site training with high fidelity simulators to improve the quality of the team response to emergencies;
development of digital platforms and lifesaving medical devices to collect data on more than 27,000 live births for analysis and improvement of the care of babies.

Description of Lifesaving Opportunities. Healthcare trends, Educational trends, Delivery models, Enabling technologies

Well-Being for All

SDG 3 reads Health and well-being for all. Well-being relates to quality of life, and outcome should thus not be confined to whether a patient lives or dies, but should also include quality of life.

This aspect is being addressed by measurements that have come more into use in recent years:

DALY (Disability-Adjusted Life Year) is a measure of overall disease burden, expressed as the number of years lost due to ill-health, disability or early death. It was developed in the 1990s as a way of comparing the overall health and life expectancy of different countries.

HALE (Health-Adjusted Life Expectancy) is a measure of population health that takes into account mortality and morbidity. It adjusts overall life expectancy by the amount of time lived in less than perfect health. The American Heart Association has defined its 2030 goal as helping increase global health-adjusted life expectancy from 66 to at least 68 years across the US and from 64 to at least 67 years across the world.

Graph of Deaths cause by cardiovascular diseases

Reaching One Million Lives and 50 Million Life Years

According to estimates, each of three categories – cardiac arrest, accidents and births – accounts for about 5 million untimely deaths, every year. In total, this corresponds to every fourth death globally. An estimated 90% of these 15 million fatalities occur in low- and middle-income countries (LMICs): 98% of the birth-related deaths, 88% of the accidental deaths, and – contrary to common impressions – 86% of deaths due to cardiac arrest.

Cardiac arrest has long been associated with lifestyles in affluent societies and still is. But over 60 years since the implementation of modern cardiac resuscitation began in 1960, emphasis on factors such as preventive medicines, exercise, reduction in smoking, controlling blood pressure, and obesity have helped cut the rate of fatalities from sudden cardiac arrest in these parts of the world by an astonishing 60%.

Now, research shows a dramatically different pattern on the world map, where the rates of such fatalities in Asian and some African nations keep increasing. At the same time, unnecessary deaths from accidents are developing in a similar way.

Helping save about 5% of the lives lost at birth and due to cardiac arrests and accidents amounts to 800,000 extra lives saved per year. Added to these numbers comes the vision of progress in fields that lie outside SDG3: helping save 100,000 of the millions of lives that are now lost each year because of medical errors in hospital care or through lack of access to safe anaesthesia and surgery in LMICs; and helping save 100,000 lives in other areas where timely interventions are critical, e.g. stroke and sepsis. This brings the total goal up to one million extra lives saved by 2030. Ambitious but achievable.

	Lives per year	Years per patient	Life years
Newborn	500 000	70	35 000 000
Maternal	50 000	50	2 500 000
Cardiac arrest	150 000	17	2 500 000
Accidents	100 000	50	5 000 000
Other time-critical emergencies, including stroke and sepsis	100 000	25	2 500 000
Patient safety, including global surgery and anesthesia	100 000	25	2 500 000
Total	1 000 000		50 000 000

Chart of Reaching one million lives and 50 million life years

Focussing for Success

To maximise the chance of success, Laerdal with its partners will focus on helping to improve the coverage, quality and efficiency, safety, and equity of health care through:

Early interventions with high lifesaving potential and lower cost to society;
Leveraging enabling technologies to improve translation of learning to patient outcome;
Collaborative initiatives for the scale-up and implementation of developments.

Illustration of discovery x development x Delivery = impact

There are four entities to support achievement of the goal: Laerdal Medical with its 1,600 people in 25 countries; the Laerdal Foundation which has funded 2,000 research projects in acute medicine and global health; the not-for-profit company Laerdal Global Health; and the impact investment Millions Lives Fund supporting implementation and scaling of transformative innovations.

The total commitment of resources (excluding the Laerdal Foundation) over the next ten years will amount to $500m with an additional $100m in matching funds being sought from other investors.