Showing papers by "Dean T. Jamison published in 2017"

Disease control priorities: Improving health and reducing poverty

Abstract: As the culminating volume in the DCP3 series, volume 9 will provide an overview of DCP3 findings and methods, a summary of messages and substantive lessons to be taken from DCP3, and a further discussion of cross-cutting and synthesizing topics across the first eight volumes. The introductory chapters (1-3) in this volume take as their starting point the elements of the Essential Packages presented in the overview chapters of each volume. First, the chapter on intersectoral policy priorities for health includes fiscal and intersectoral policies and assembles a subset of the population policies and applies strict criteria for a low-income setting in order to propose a "highest-priority" essential package. Second, the chapter on packages of care and delivery platforms for universal health coverage (UHC) includes health sector interventions, primarily clinical and public health services, and uses the same approach to propose a highest priority package of interventions and policies that meet similar criteria, provides cost estimates, and describes a pathway to UHC.

Ranking 93 health interventions for low- and middle-income countries by cost-effectiveness

Abstract: Background Cost-effectiveness rankings of health interventions are useful inputs for national healthcare planning and budgeting. Previous comprehensive rankings for low- and middle- income countries were undertaken in 2005 and 2006, accompanying the development of strategies for the Millennium Development Goals. We update the rankings using studies published since 2000, as strategies are being considered for the Sustainable Development Goals. Methods Expert systematic searches of the literature were undertaken for a broad range of health interventions. Cost-effectiveness results using Disability Adjusted Life-Years (DALYs) as the health outcome were standardized to 2012 US dollars. Results 149 individual studies of 93 interventions qualified for inclusion. Interventions for Reproductive, Maternal, Newborn and Child Health accounted for 37% of interventions, and major infectious diseases (AIDS, TB, malaria and neglected tropical diseases) for 24%, consistent with the priorities of the Millennium Development Goals. More than half of the interventions considered cost less than $200 per DALY and hence can be considered for inclusion in Universal Health Care packages even in low-income countries. Discussion Important changes have occurred in rankings since 2006. Priorities have changed as a result of new technologies, new methods for changing behavior, and significant price changes for some vaccines and drugs. Achieving the Sustainable Development Goals will require LMICs to study a broader range of health interventions, particularly in adult health. Some interventions are no longer studied, in some cases because they have become usual care, in other cases because they are no longer relevant. Updating cost-effectiveness rankings on a regular basis is potentially a valuable exercise.

Universal Health Coverage and Essential Packages of Care

Abstract: Health systems have several key objectives; the most fundamental is to improve the health of the population. In addition, they are concerned with the distribution of health in the population—for example, with health equity—and they strive to be responsive to the needs of the population and to deliver services efficiently (WHO 2007). Notably, they also seek to provide protection against the financial risks that individuals face when accessing health services. Ideally, this financial risk protection (FRP) is accomplished through mechanisms such as risk pooling and group payment that ensure prepayment of most, if not all, health care costs (Jamison and others 2013).An effective health system is one that meets these objectives by providing equitable access to affordable, high-quality health care—including treatment and curative services as well as health promotion, prevention, and rehabilitation services—to the entire population. Unfortunately, most countries lack health systems that meet this standard. Shortfalls in access, quality, efficiency, and equity have been documented extensively, both in low- and middle-income countries (LMICs) and in some high-income countries (HICs) (WHO 2010). In addition, in many countries, households routinely face catastrophic or impoverishing health expenditure when seeking acute or chronic disease care (Xu and others 2007). These financial risks can result in further health loss and reduced economic prosperity for households and populations (Kruk and others 2009; McIntyre and others 2006).The current universal health coverage (UHC) movement emerged in response to a growing awareness of the worldwide problems of low access to health services, low quality of care, and high levels of financial risk (Ji and Chen 2016). UHC is now a core tenet of United Nations (UN) Sustainable Development Goal (SDG) 3. UHC was preceded by the aspirational notion of a minimum standard of health for all, enshrined in the Universal Declaration of Human Rights (adopted by the UN General Assembly in 1948) and the declaration of Alma-Ata in 1978, and many HICs have provided universal coverage for decades. The World Health Assembly endorsed the modern concept of UHC as an aspiration for all countries in 2005. Subsequent World Health Reports by the World Health Organization (WHO) expanded on various technical aspects of UHC, and in 2015, UHC was adopted as a subgoal (target 3.8) of SDG 3 (UN 2016; WHO 2013b).Mechanisms and approaches, summarized elsewhere (WHO 2010; WHO 2013b), have been proposed or attempted as specific means of achieving UHC, but the objectives of UHC are the same in all settings, regardless of approach: improving access to health services (particularly for disadvantaged populations), improving the health of individuals covered, and providing FRP (Giedion, Alfonso, and Diaz 2013). There are three fundamental dimensions to UHC—proportion of population covered, proportion of expenditures prepaid, and proportion of health services included in UHC—that any given health care reform strategy seeks to achieve in some prioritized order (Busse, Schreyogg, and Gericke 2007). Recent reports, including the Lancet Commission on Investing in Health and the WHO Making Fair Choices consultation, have endorsed a “progressive universalist” approach to public finance of UHC (Jamison and others 2013; WHO 2014). Progressive universalism makes the case, on the basis of efficiency and equity, for an expansion pathway through the three UHC dimensions that prioritizes full population coverage and prepayment, albeit for a narrower scope of services than could be achieved at lower coverage levels or through cost-sharing arrangements. (It has been argued that full population coverage and full prepayment are necessary conditions to ensure that UHC leaves no one behind [WHO 2014].)If progressive universalism is the preferred approach to UHC, then a critical question for health planners is which health interventions should be included. HICs are able to provide a wide array of health services, but LMICs have the resources to deliver a smaller set of services, necessitating a more explicit and systematic approach to priority setting (Glassman and others 2016). In this spirit, the Making Fair Choices report recommended that UHC focus on interventions that are the most cost-effective, improve the health of the worst off, and provide FRP (WHO 2014). The extended cost-effectiveness analysis (ECEA) approach developed for this third edition of Disease Control Priorities (DCP3) assesses policies in these dimensions and can help identify efficient, fair pathways to UHC. Chapter 8 of this volume provides an overview of ECEA methods and results of ECEAs undertaken in conjunction with DCP3 (Verguet and Jamison 2018).The set of prioritized health services publicly financed through a UHC scheme has been termed a health benefits package (Glassman and others 2016). The limited experience of LMICs with benefits packages suggests that such packages can be part of a coherent and efficient approach to health system strengthening, but many countries lack the technical capacity to review a broad range of candidate interventions and summarize the evidence for their effectiveness or cost-effectiveness. In this regard, DCP3 provides guidance on priority health interventions for UHC in LMICs in the form of a model health benefits package that is based on DCP3’s 21 essential packages (see chapter 1 of this volume, Jamison and others 2018).This chapter proposes a concrete set of priorities for UHC that is grounded in economic reality and is intended to be appropriate to the health needs and constraints of LMICs, particularly low-income countries and lower-middle-income countries. It develops a model benefits package referred to as essential UHC (EUHC) and identifies a subset of interventions termed the highest-priority package (HPP). The chapter presents a case that all countries, including low-income countries, could strive to fully implement the HPP interventions by the end of the SDG period (2030), and many middle-income countries could strive to achieve full implementation of EUHC. The chapter also presents estimates of the EUHC and HPP costs and mortality consequences. It concludes with a discussion of measures that improve the uptake and quality of health services and with some remarks on the implications of EUHC and the HPP for health systems.The chapter does not, however, prescribe one correct approach to UHC, nor does it attempt to review the wide array of delivery mechanisms, policy instruments, and financial arrangements that support the transition to UHC; these have been covered in detail elsewhere (WHO 2010; World Bank 2016). Rather, this chapter stresses that the UHC priority-setting process is contextual, depending on political economy as well as local costs, budgets, and demographic and epidemiological factors—all of which influence the value for money of specific interventions.Because the development and refinement of a benefits package is an incremental and iterative process, many ministries of health probably will not use DCP3’s recommendations as a template for their packages but rather as an aid in reviewing existing services, identifying outliers, and considering services that are not currently provided. The DCP3 model benefits package can thus serve as a starting point for deliberation on a new health benefits package or refinement of an existing package. However, as construed here, it would not be a perfect package for a particular country. To translate the DCP3 findings into an actionable UHC agenda at the national or subnational level will require context-specific technical analyses and public consultation, ideally as part of a clearly articulated political agenda and an institutionalized priority-setting process that can govern public and donor resource allocation in the health sector.

The Effects of Education Quantity and Quality on Child and Adult Mortality: Their Magnitude and Their Value

Abstract: This chapter analyzes the economic returns to education investments from a health perspective. It estimates the effects of education on under-five mortality, adult mortality, and fertility. It calculates the economic returns to education resulting from declines in under-five mortality and adult mortality, while considering the effects of education investments on income. It also develops policy-relevant recommendations to help guide education investments.Our study adds to the evidence that education is a crucial mechanism for enhancing the health and well-being of individuals. The relationship between education and health is bidirectional, because poor health could affect educational attainment (Behrman 1996; Case, Fertig, and Paxson 2005; Currie and Hyson 1999; Ding and others 2009). Historical findings in the education and health literature have highlighted the strong association between education and health. Recent literature has exploited natural experiments to provide causal evidence of the impact of education on health. Studies show that education plays a critical role in reducing the transmission of human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) in women by improving prevention and treatment. Keeping adolescent girls in secondary school significantly attenuates the risk of HIV/AIDS infection (Baird and others 2012; Behrman 2015; De Neve and others 2015). Early child development has a lifelong impact on the mental and physical health of individuals. Other studies have demonstrated that progress in education can increase positive health-seeking behaviors (such as accessing preventive care) and reduce overall dependency on the health system (Cutler and Lleras-Muney 2010; Feinstein and others 2006; Kenkel 1991; Sabates and Feinstein 2006).Previous literature on education, health, and economic productivity suggests that the impact of education is more significant in times of rapid technological progress (Preston and Haines 1991; Schultz 1993). The morbidity and mortality differentials across levels of schooling are significant in the presence of increasing scientific knowledge about diseases and behaviors, as well as access to medicines and vaccines. Additionally, analysis by Jamison, Murphy, and Sandbu (2016) shows that most variation in under-five mortality can be explained by heterogeneities in the speed at which countries adopt low-cost health technologies to increase child survival.Different studies that have assessed the effects of education on mortality and fertility show an association between educational attainment and reductions in both outcomes. This chapter goes beyond previous work by using improved and updated data, and by controlling tightly for country-specific effects in both levels and rates of change of mortality. Although several studies have examined the effects of female schooling on child mortality, we are aware of only one other cross-national study (Wang and Jamison 1998) that estimated the macro effects of schooling on adult mortality. Other studies have focused on the relationship between schooling and adult health, but they primarily do so for a single country or small set of countries. Some key findings from our study are highlighted in box 30.1.Our study comes at a critical juncture for education and health, as the global community moves forward in the context of the Sustainable Development Goals, which stress the importance of taking into account the cross-sectoral nature of global development challenges.This chapter is organized into three broad sections: The first section presents the results of our regression analysis, which examines the effects of increases in mean years of schooling, as well as schooling quality, on under-five mortality, adult female mortality, adult male mortality, and fertility. We also decompose the changes in mortality between 1970 and 2010, and estimate the mortality impact of education gains in the Millennium Development Goal (MDG) period. The findings from our regression inform the subsequent sections, which use the estimated effect size to determine the rates of return to and benefit-cost ratios (BCRs) of education. The second section explores the effects of augmenting the traditional rates of return analysis for education with its mortality-related health effects. We also estimate the BCR of education from earnings-only and health-inclusive perspectives, and address the question: What would be the returns to investing US$1 in education in low-, lower-middle-, and upper-middle-income countries? Finally, we discuss our findings, present recommendations, and consider the next steps the global education community might take to ensure that all countries make substantial progress toward global education targets.

Household Energy Interventions and Health and Finances in Haryana, India: An Extended Cost-Effectiveness Analysis

Abstract: Approximately 40 percent of the world’s population relies on solid fuels, including wood, dung, grass, crop residues, and coal, for cooking (Bonjour and others 2013). Household air pollution (HAP) arising from this use of solid fuels results in 3 million to 4 million deaths yearly from acute lower respiratory infection (ALRI) in children and chronic obstructive pulmonary disease (COPD), ischemic heart disease (IHD), stroke, and lung cancer in adults. This burden constitutes approximately 5 percent of global mortality, ranking highest among all environmental risk factors contributing to global ill health (Forouzanfar and others 2015; Smith and others 2014).In India, the reliance on solid fuels and the estimated related burden of disease are pronounced. An estimated 770 million individuals—approximately 70 percent of the total population (Government of India 2011)—living in 160 million households continue to use solid fuels as a primary energy source for cooking (Venkataraman and others 2010). Among all risk factors contributing to ill health in India, exposure to HAP from cooking ranks second for mortality, with approximately 925,000 premature deaths yearly; it ranks third for lost disability-adjusted life years (DALYs), amounting to approximately 25 million lost DALYs per year (Forouzanfar and others 2015). An estimated 4 percent of the deaths occur in children under age five years because of pneumonia, which overall accounts for 12 percent of total child deaths in India.Attempts to reduce this burden fall into two primary categories: (1) those that seek to make biomass combustion cleaner and more efficient, and (2) those that seek to replace biomass use with liquid fuels or electricity (Foell and others 2011; Smith and Sagar 2015). Private and public sector actors have taken action in India to reduce this large burden of disease. Private sector endeavors include research, development, marketing, and distribution of biomass stoves by large multinational corporations, such as Philips and BP, and smaller Indian and international firms, such as Envirofit, Greenway, First Energy, BioLite, and Prakti. In all cases, the evaluations of the viability of these interventions for long-term use, which would be required to reduce exposures and thus the health burden, have been mixed (Brooks and others 2016; Pillarisetti and others 2014; Sambandam and others 2015).The government of India has undertaken a number of policy initiatives to address HAP through improved biomass combustion, beginning in the 1980s with a failed National Programme on Improved Chulhas (Kishore and Ramana 2002) and continuing in 2010 with a National Biomass Cookstoves Initiative. More recently, two innovative programs—the Give It Up (GIU) and Smokeless Village (SV) campaigns—are seeking to bring clean cooking via liquefied petroleum gas (LPG) to the rural poor (Smith and Sagar 2015). Both GIU, which encourages better-off Indian households to voluntarily give up their LPG subsidies and redirects those subsidies one-for-one to below-poverty-line (BPL) families, and SV, which connects every household in a village to LPG, occur in close collaboration with India’s three national oil companies. In mid-2016, Indian Prime Minister Narendra Modi introduced Pradhan Mantri Ujjwala Yojana (Ujjwala), a program to extend the GIU and SV campaigns by making free LPG connections available to all BPL households. This policy will affect approximately 50 million households. These programs have the potential to substantially reduce the mortality and morbidity associated with the use of solid fuels for cooking, if one assumes near-complete transitions to clean fuels (Smith and Sagar 2015).This chapter describes an extended cost-effectiveness analysis (ECEA) of policies designed to promote uptake of hypothetical HAP control interventions aligned with three national government programs: A low-cost, mud chimney stove, as was promoted in the National Programme on Improved Chulhas that operated from about 1983 to 2002 (We evaluate this program under the same current conditions as the other programs.) An advanced combustion cookstove, like that being promoted in the current National Biomass Cookstoves Initiative A transition to LPG being promoted in the national Give It Up campaign. Our scenarios simplify complex behavioral issues by assuming full use of all intervention stoves in order to estimate best-case health and welfare benefits of clean cooking transitions. We evaluate the sensitivity of our use assumption in annex 12A. Our goal is to indicate the types of policy-relevant analyses that are possible using ECEA and the magnitude of potential benefits of LPG adoption.Traditional economic cost-effectiveness analyses, such as that by Mehta and Shahpar (2004), focus on the U.S. dollars spent per death or per DALY averted. ECEA also considers the financial implications of policies across wealth strata of a population (introduced in Verguet, Laxminarayan, and Jamison 2015), in this case, by income quintile. ECEAs assess the consequences of financial or other policies that influence the aggregate uptake of an intervention and its health and financial consequences across income groups. Verguet, Laxminarayan and Jamison (2015), for example, looked at public finance and enhanced borrowing capacity as policies to affect tuberculosis treatment in India. Verguet and others (2015) assessed the consequences of a policy to increase tobacco taxes in China. Including distributional analysis by income quintile enables novel policy evaluations, as well as an evaluation of the GIU campaign.This ECEA focuses on policies to reduce exposure to HAP in Haryana, India. This state has a population of 20 million, about 55 percent of whom use solid fuels for cooking, although significant heterogeneity exists between both rural and urban areas and between available datasets for analyses. In addition, we benefit from the availability of published continuous exposure-response relationships for HAP-related diseases and a fuel gathering–based time metric, allowing us to quantify the potential earnings gained by use of a stove that improves fuel efficiency.

Comparative effectiveness of two disparate policies on child health: experimental evidence from the Philippines.

Abstract: Background Should health systems invest more in access to care by expanding insurance coverage or in health care services including improving the quality of care? Comparing these options experimentally would shed light on the impact and cost-effectiveness of these strategies. Methods The Quality Improvement Demonstration Study (QIDS) was a randomized policy experiment conducted across 30 districts in the Philippines. The study had a control group and two policy intervention groups intended to improve the health of young children. The demand-side intervention in QIDS was universal health insurance coverage (UHC) for children aged 5 years or younger, and a supply-side intervention, a pay-for-performance (P4P) bonus for all providers who met pre-determined quality levels. In this paper, we compare the impacts of these policies from the QIDS experiment on childhood wasting by calculating DALYs averted per US$spent. Results The direct per capita costs to implement UHC and P4P are US$4.08 and US$1.98 higher, respectively, compared to control. DALYs due to wasting were reduced by 334,862 in UHC and 1,073,185 in P4P. When adjustments are made for the efficiency of higher quality, the DALYS averted per US$ spent is similar in the two arms, 1.56 and 1.58 for UHC and P4P, respectively. Since the P4P quality improvements touches all patients seen by qualifying providers (32% in UHC versus 100% in P4P), there is a larger reduction in DALYs. With similar programmatic costs for either intervention, in this study, each US$spent under P4P yielded 1.52 DALYs averted compared to the standard program, while UHC yielded only a 0.50 DALY reduction. Conclusion P4P had a greater impact and was more cost-effective compared to UHC as measured by DALYs averted. While expanded insurance benefit ceilings affected only those who are covered, P4P incentivizes practice quality improvement regardless of whether children are insured or uninsured.

Intersectoral Policy Priorities for Health

Abstract: Many aspects of population health can be addressed solely by services delivered through the health sector. These services include health promotion and prevention efforts as well as treatment and rehabilitation for specific diseases or injuries. At the same time, policies initiated by or in collaboration with other sectors, such as agriculture, energy, and transportation, can also reduce the incidence of disease and injury, often to great effect. These policies can make use of several types of instruments, including fiscal measures (taxes, subsidies, and transfer payments); laws and regulations; changes in the built environment (roads, parks, and buildings); and information, education, and communication campaigns (see chapter 1 of this volume, Jamison and others 2018). In addition, a range of non–health sector social services can mitigate the consequences of ill health and provide financial protection. These intersectoral policies that promote or protect health, when implemented as part of a coherent plan, can constitute a whole-of-government approach to health (UN 2012).Ideally, a whole-of-government approach to health would involve the systematic integration of health considerations into the policy processes of all ministries. This collaborative approach is often termed Health in All Policies (Khayatzadeh-Mahani and others 2016). Some governments have achieved such collaboration by employing ministerial commissions or other mechanisms comprising top-level policy makers to enable health-related decisions to be made across government sectors (Buss and others 2016). The goal is to create benefits across sectors by taking actions to support population health and beyond that, to ensure that even “nonhealth” policy decisions and implementation have beneficial, or at least neutral, effects on determinants of health. Intersectoral involvement increases the arsenal of available tools to improve health, helps ensure that government policies are not at cross-purposes to each other, and can generate sizable revenue (as in the case of tobacco and alcohol taxes).Many countries do not practice a Health in All Policies approach, and doing so is especially challenging when there are extreme resource constraints, low capacity, and weak governance and communication structures (Khayatzadeh-Mahani and others 2016), as in many low- and middle-income countries (LMICs). As an alternative in these settings, a ministry of health could engage other sectors opportunistically and strategically on specific issues that are likely to produce quick successes and have substantial health effects (WHO 2011a). Thus, a concrete menu of policy options that are highly effective, feasible, and relevant in low-resource environments is needed. This need is particularly relevant in light of the ambitious targets specified in the United Nations Sustainable Development Goals (SDGs) for 2030 (UN 2015).The Disease Control Priorities series has consistently stressed the importance of intersectoral action for health and the feasibility of intersectoral action in LMICs. Disease Control Priorities in Developing Countries, second edition (DCP2) (Jamison and others 2006), included chapters that emphasized intersectoral policies for specific diseases, injuries, and risk factors, and it also included a chapter devoted to fiscal policy (Nugent and Knaul 2006). Disease Control Priorities, third edition (DCP3), has reinforced many of these messages—usually with newer and stronger evidence—and has also explored some emerging topics and new paradigms, particularly for control of noncommunicable disease risk factors. Volume 7 of DCP3 is especially noteworthy in this respect: it provides a list of 111 policy recommendations for prevention of injuries and reduction of environmental and occupational hazards, 109 of which are almost entirely outside the purview of health ministers to implement (Mock and others 2017).Despite the political barriers to developing an intersectoral agenda for health, this chapter contends that not only is intersectoral action a good idea for health—it is a must. Much of the reduction in health loss globally over the past few decades can be attributed to reductions in risk factors such as tobacco consumption and unsafe water that have been implemented almost exclusively by actors outside the health sector (Hutton and Chase 2017; Jha and others 2015). An environment that increases health risks at early stages of industrial and urban growth often, although not always, gives way to a cleaner natural environment at higher levels of per capita income. Yet these risks can be associated with dramatic health losses along the way (Mock and others 2017). Furthermore, the health risks produced by advanced industrialization—such as unhealthy diet and physical inactivity—require policy interventions across multiple sectors if they are not to worsen substantially with economic development.This chapter is based on a close look at the intersectoral policies recommended across the DCP3 volumes, and it proposes 29 concrete early steps that countries with highly constrained resources can take to address the major risks that can be modified. The chapter also touches on broader social policies that address the consequences of ill health and stresses that the need for such policies will increasingly place demands on public finance. This chapter can be viewed as a complement to chapter 3 of this volume (Watkins and others 2018) concerning health sector interventions in the context of universal health coverage. It also provides illustrative examples of successful health risk reduction through intersectoral policy and discusses various aspects of policy implementation. By synthesizing non–health sector policies separately and in greater depth in this chapter, DCP3 seeks to reinforce the importance of these policy instruments and provide a template for action for ministers of health when engaging other sectors and heads of state.

Palliative Care and Pain Control

Abstract: Palliative care has been shown to provide significant and diverse benefits for patients with serious, complex, or life-limiting health problems. Such benefits include the following: Reduced physical, psychological, and spiritual suffering (Abernethy and others 2003; Gwyther and Krakauer 2011; Higginson and others 2014; Krakauer 2008; Singer and others 2016; Temel and others 2010; WHO 2008; Zimmerman and others 2014) Improved quality of life (Singer and others 2016; Zimmerman and others 2014) Prolonged survival in some situations (Connor and others 2007; Temel and others 2010). Palliative care also can lower costs to health care systems (Chalkidou and others 2014; DesRosiers and others 2014; Gomez-Batiste and others 2012; Jamison and others 2013; Knaul and others 2017; Summers 2016). For these reasons, it is recognized globally as an ethical responsibility of all health care systems and a necessary component of universal health coverage (World Health Assembly 2014). Yet palliative care is rarely accessible in low- and middle-income countries (LMICs). This chapter describes an essential package (EP) of palliative care services and treatments that could and should be accessible to everyone everywhere, as well as the sites or platforms where those services and treatments could be offered. Thus, it was necessary to make a preliminary estimate of the burden of health-related suffering requiring palliative care.To roughly estimate the need for palliative care, we identified the serious, complex, or life-limiting conditions listed in the International Classification of Diseases (ICD)-10 that most commonly result in physical, psychological, social, or spiritual suffering (WHO 2015a). We then estimated the types, prevalence, and duration of suffering resulting from each condition. On the basis of this characterization of the burden of suffering, we propose an EP of palliative care and pain control designed to do the following: Prevent or relieve the most common and severe suffering related to illness or injury. Be affordable, even in LMICs. Provide financial risk protection for patients and families by providing a realistic alternative to expensive, low-value treatment. We costed the EP in one low-income country (Rwanda), one lower-middle-income country (Vietnam), and one upper-middle-income country (Mexico) and projected these costs for LMICs in general (Knaul and others 2017). At the conclusion of this chapter, we provide guidance on how to integrate the EP into health systems as an essential element of universal health coverage (UHC) in LMICs. We also discuss how to augment the EP as soon as is feasible to further prevent and relieve suffering.This chapter draws directly on the work of the Lancet Commission on Global Access to Palliative Care and Pain Control (the Lancet Commission) (Knaul and others 2017).

The Loss from Pandemic Influenza Risk

Abstract: The 2014–16 Ebola virus outbreak in West Africa reminded the world that enormous economic and human losses result from the uncontrolled spread of a deadly infection. Less noticed was the likelihood that a pandemic with characteristics similar to the 1918 influenza pandemic would have killed about 10 times as many people in Liberia, Guinea, and Sierra Leone as did Ebola. The global death total from such a pandemic could be 2,500 times higher than the World Health Organization’s (WHO) estimate of 11,300 deaths from Ebola through March 16, 2016 (WHO 2016a).

Invirtiendo en salud: el argumento económico. Informe del Foro sobre Inversión en Salud de la Cumbre Mundial sobre Innovación para la Salud 2016

Abstract: Resumen: Los gobiernos de los paises en desarrollo y los organismos de ayuda internacional enfrentan decisiones dificiles en cuanto a la mejor manera de asignar sus recursos limitados Las inversiones en distintos sectores -incluyendo educacion, agua y saneamiento, transporte y salud- pueden generar beneficios sociales y economicos Este informe se enfoca especificamente en el sector salud Presenta evidencia contundente sobre el valor de ampliar las inversiones en salud El argumento economico para incrementar estas inversiones en salud nunca ha sido mas solido Con el progreso que se ha logrado en la reduccion de la mortalidad materna e infantil y de las muertes por enfermedades infecciosas, es esencial que los responsables de la formulacion de politicas no se vuelvan complacientes Estos logros se revertiran rapidamente sin inversiones sostenidas en salud Sera necesario ampliar las inversiones para hacer frente a la carga generada por las enfermedades no transmisibles (ENT) emergentes y para alcanzar la cobertura universal de salud (CUS) El valor de la inversion en salud va mucho mas alla de su rendimiento reflejado en la prosperidad economica a traves del producto interno bruto (PIB) Las personas dan un gran valor monetario a los anos de vida adicionales que las inversiones en salud pueden proporcionar -un valor inherente a permanecer con vida por mas tiempo, que no tiene que ver con la productividad Los encargados del diseno de politicas deben esforzarse mas para asegurar que el gasto en salud refleje las prioridades de la gente Para asegurar que los servicios sean accesibles para todos, la funcion del gobierno en el financiamiento de la salud es muy clara Sin financiamiento publico, habra quienes no podran costear los servicios que requieren y se veran forzados a elegir la enfermedad -o incluso la muerte- y la ruina economica, una eleccion devastadora que ya esta llevando a 150 millones de personas a la pobreza cada ano En paises de bajos ingresos (PBI) y paises de ingresos medios (PIM), el financiamiento publico deberia ser utilizado para alcanzar la cobertura universal con un paquete de intervenciones altamente costo-efectivas (mejores inversiones u opciones) Los gobiernos que no protejan la salud y el patrimonio de su pueblo de esta manera seran incapaces de obtener los beneficios de una prosperidad economica y un crecimiento a largo plazo El financiamiento publico tiene el beneficio de ser mas eficiente y capaz de controlar los costos que el financiamiento privado, y es la unica manera sostenible de lograr una CUS Ademas, la gente atribuye un alto valor economico a la proteccion que le provee el financiamiento publico contra los riesgos financieros Este informe aborda tres preguntas clave: 1) ?Cual es el fundamento economico para invertir en salud?; 2) ?cual es la mejor manera de financiar la salud?, y 3) ?cuales son las intervenciones que deben tener prioridad?

Injury Prevention and Environmental Health: Key Messages from Disease Control Priorities, Third Edition

Abstract: Injury Prevention and Environmental Health identifies essential prevention strategies and related policies that address substantial population health needs and that are cost-effective and feasible to implement. This volume addresses diverse conditions that arise from exposure to outside forces, such as chemicals and toxins, kinetic energy, or thermal energy. These conditions require similar policy approaches to reducing risk and mandate involvement of multiple sectors. Included in this group of conditions are injuries attributable to unintentional mechanisms (road traffic crashes, falls, burns, and drowning); injuries attributable to intentional mechanisms (interpersonal violence); disorders caused by or aggravated by exposure to airborne toxins (air pollution); occupational issues (injuries and disorders caused by or aggravated by toxins in the workplace); and waterborne infectious diseases. This volume focuses exclusively on interventions to prevent these conditions. Treatment for health conditions resulting from injury and environmental risk factors is covered in other volumes of the third edition of Disease Control Priorities (DCP3), as are immunizations and prevention of suicide (Black, Laxminarayan, and others 2016; Black, Levin, and others 2016; Bundy and others 2017; Debas and others 2015; Mock and others 2015; Patel and others 2015; Patel and others 2016; Prabhakaran and others 2017).In this review, we identify several key messages. First, there is a large health burden from injury, occupational risk factors, air pollution, unclean water, and poor sanitation. These conditions are major global health problems to which inadequate attention has been directed. Second, these disorders and the risk factors that cause them have predictable patterns across stages of national development. Understanding these patterns can assist with the planning of prevention efforts. Third, cost-effective and cost-beneficial interventions that can address these conditions already exist and are in established use in most high-income countries (HICs). In most low- and middle-income countries (LMICs), these interventions have been implemented only to a modest extent or not at all. On the basis of these interventions’ cost-effectiveness and their potential to lower the disease burden, we propose a package of policy interventions (box 1.1).