Paper prepared for the
Dean T. Jamison, T. & G. Angelopoulos Visiting Professor of Public Health and International Development (Harvard Kennedy School and School of Public Health) and Professor, School of Medicine, University of California, San Francisco.
David E. Bloom, Clarence James Gamble Professor of Economics and Demography, and Chair, Department of Population and International Health, Harvard School of Public Health.
October 2007 - Revised, June 3, 2008
Available online PDF [69p.] at: http://www.hsph.harvard.edu/pgda/Working%20Papers/2008/PGDA_WP_35.pdf
“…This paper identifies seven priority interventions in terms of their cost-effectiveness, the size of the disease burden they address, and other criteria. Separate but related papers for CC08 deal with malnutrition (Behrman, Alderman and Hoddinott, 2007), with water and sanitation (Hutton, 2007), with air pollution (Hutton, 2007) and with education (Orazem, 2007). It is worth listing our seven priorities at the outset:
• Tuberculosis treatment;
• Heart attack treatment with generic drugs;
• Malaria treatment and prevention package;
• Increased coverage of childhood immunizations;
• Tobacco taxation and regulation;
• HIV transmission interruption by a “combination prevention” package; and
• Improved surgical capacity at district hospitals to treat trauma and ensure safe childbirth.
We further view the political economy of universalism as enhancing sustainability. Our perspective on public finance in health leads to less relative emphasis on
infectious disease control in our short list of high priorities (although four of our seven priorities do deal with infection).
Our view of the role of international development assistance in health does, in contrast, centrally involve externalities and international public goods. Cross-border transmission of infection or drug resistance involves important negative externalities. R&D constitutes a public good that has been enormously important in health. Likewise, facilitating diffusion of best practice through development assistance or price incentives can be viewed as correction of temporary price distortions and hence a reasonable purpose of aid. (Foreign direct investment in the private sector is often viewed as an important vehicle for transferring technology and, hence, explicit incentives for appropriate technology transfer in health serve a similar purpose.) When we discuss the “best buys” in health we do so principally from the perspective of national authorities. But, for investments that may be of importance to development assistance beyond their importance from a national perspective, for example for R&D, we point to the role of development assistance.
Section 1 of the paper documents the enormous success in much of the world in the past 45 years in improving health in low- and middle-income countries. Its conclusion is that future investments can build on past successes—increasing confidence in the practical feasibility of major additional gains in disease control. Section 2 summarizes evidence that health gains have had major economic impact, and
Section 3 uses this economic context to describe the methods used for the cost-benefit analyses reported.
Sections 4, 5 and 6 discuss problems and opportunities in child health, HIV/AIDS and noncommunicable disease.
Section 7 concludes by identifying the few most attractive options and presenting (very approximate) cost-benefit analyses for them….”
1. Progress and Challenges
1.2 Remaining challenges
2. The Economic Benefits of Better Health
2.1 Health and income
2.2 Health and economic welfare
3. Cost-Benefit Methodology
3.1 Cost-effectiveness analysis broadly and narrowly construed
3.2 Defining and redefining DALYs
3.3 The value of an averted DALY
3.4 The cost of an averted DALY
4. Child Health
4.1 Under-5 health problems and intervention priorities
4.2 Delivering child health interventions
5. HIV/AIDS and Tuberculosis
5.1 Prevention of HIV transmission
5.2 Antiretroviral treatment of AIDS
5.3 Control of tuberculosis
6. Noncommunicable disease
6.1 Cardiovascular disease
6.2 Tobacco addiction
7. Opportunities for disease control
Appendix A: Intervention Cost-effectiveness in South Asia and Sub-Saharan
Appendix B: Sensitivity Analysis
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