世界経済・社会統計 = World development indicators

Investing in Health

New evidence coupled with a wider perspective suggest sizable economic returns to better health

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Health, Wealth, and Welfare

There are two approaches to reducing the burden of sickness and death associated with the human immunodeficiency virus (HIV), which leads to acquired immunodeficiency syndrome (AIDS): treatment and prevention. Treatment for HIV/AIDS involving antiretroviral therapy has been proven effective, even in resource-poor settings, in delaying the decline in the immune system, the onset of opportunistic infections, and death—and in extending the life expectancy of those infected by around four years (Ivers, Kendrick and Doucette, 2005). Prevention measures to limit the transmission of AIDS include mass media campaigns; condom distribution; peer education of prostitutes; the prevention of mother-to-child transmission; voluntary counseling and testing; and diagnosis and treatment of other sexually transmitted diseases (since the symptoms of these diseases can make it easier for the HIV virus to spread). Despite large international aid flows for HIV/AIDS, the needs for prevention and treatment in low- and middle-income countries outstrip the resources available (Joint United Nations Program on HIV/AIDS, 2005a). Thus, it becomes necessary to set priorities. The standard policy prescription is that, in order to maximize health with a limited budget, funds should first be allocated to more cost-effective interventions and only then to interventions with lesser cost effectiveness. With limited resources, should the focus of efforts to combat HIV/AIDS be on prevention or treatment? Antiretroviral treatment is complex and requires regular monitoring of adherence, efficacy and side effects, with consequent changes in treatment regime when needed, requiring large inputs from local health services. Such treatment is expensive. Studies by Marseille, Hofmann and Kahn (2002) and Creese, Floyd, Alban and Guinness (2002) make highly favorable assumptions about the costs and benefits of

https://pubs.aeaweb.org/doi/pdfplus/10.1257/jep.20.3.121

The Economics of HIV/AIDS in Low - Income Countries: The Case for Prevention

Funding for the reproductive health agenda agreed at the 1994 International Conference on Population and Development has fallen short of estimated requirements. In the changed funding environment, stronger evidence on the links between reproductive health and poverty reduction is needed. This paper reviews the evidence base on three reproductive health outcomes: early childbearing, maternal survival, and unintended pregnancy. Building on the “capacities” approach to poverty assessment advocated by Amartya Sen, this evidence is organized in a framework that includes health and education outcomes for mothers and children as well as household consumption and production effects. Generally speaking, the evidence on health effects is strongest, household well-being weakest, and education in between. Causal relationships are difficult to establish because reproductive health outcomes and other household-level explanatory variables are influenced by each other. An important finding is that relationships are context specific and that one cannot look at individual characteristics without reference to contextual variables. One reason why much existing research has not effectively addressed the effects of poor reproductive health on poverty is that studies have relied on survey data for a single point in time. Longitudinal surveys offer greater promise. Rather than propose new surveys, initial research could work with existing data resources. Frankenberg and colleagues (2005) have identified and catalogued 40 survey programs that are potentially useful for this purpose. Research should focus on a country or countries where (1) there has been social and economic change over time, (2) rich-poor differences in reproductive health outcomes persist, and (3) obtaining and working with promising datasets is feasible. Pursuit of causal relationships between poor reproductive health outcomes and poverty should not paralyze efforts to make better use of existing country-level evidence in Poverty Reduction Strategies and other documents that guide resource allocation.

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Poverty reduction : does reproductive health matter?

ii 1. Background 2 2. Methods: Assessing the Impact of Mortality Change on Change in Economic Welfare 4 3. Mortality Change and Economic Welfare in Africa 7 4. The Effect of AIDS on Lifetime Earnings and the Returns to Education in Botswana 9 References 13

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Dean T. Jamison

Papers

The Effect of the AIDS Epidemic on Economic Welfare in Sub-Saharan Africa