PHA-Exch> Disease Control as per the Copenhagen Consensus

[Claudio Schuftan]

A nice neo-liberal approach in the heels of the Sachs Report?....The human
right to health to be seen anywhere?...
Claudio



*DISEASE CONTROL*



*Paper prepared for the Copenhagen Consensus, 2008*



*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.

*Prabhat Jha*, Canada Research Chair of Health and Development, Centre for
Global Health Research, St. Michael's Hospital and University of Toronto,
Canada

*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…."



*Contents*

*1. Progress and Challenges*

1.1 Progress

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
Africa

Appendix B: Sensitivity Analysis

References



* *





*      *      *     *

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