<div><br><span class="gmail_quote">A nice neo-liberal approach in the heels of the Sachs Report?....The human right to health to be seen anywhere?...</span></div>
<div><span class="gmail_quote">Claudio</span></div>
<div><span class="gmail_quote"><br> </span></div>
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<p style="MARGIN-LEFT: 0.5in"><b><font face="Arial" color="#993300" size="3"><span style="FONT-WEIGHT: bold; FONT-SIZE: 12pt; COLOR: #993300; FONT-FAMILY: Arial">DISEASE CONTROL</span></font></b></p>
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<p style="MARGIN-LEFT: 0.5in"><i><font face="Arial" color="navy" size="2"><span style="FONT-SIZE: 10pt; COLOR: navy; FONT-STYLE: italic; FONT-FAMILY: Arial">Paper prepared for the Copenhagen Consensus, 2008</span></font></i></p>
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<p style="MARGIN-LEFT: 0.5in"><b><font face="Arial" color="navy" size="2"><span style="FONT-WEIGHT: bold; FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial">Dean T. Jamison</span></font></b><font face="Arial" color="navy" size="2"><span style="FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial">, </span></font><font face="Arial" color="navy" size="1"><span style="FONT-SIZE: 9pt; COLOR: navy; FONT-FAMILY: Arial">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</span></font><font face="Arial" color="navy" size="2"><span style="FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial">.</span></font></p>
<p style="MARGIN-LEFT: 0.5in"><b><font face="Arial" color="navy" size="2"><span style="FONT-WEIGHT: bold; FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial">Prabhat Jha</span></font></b><font face="Arial" color="navy" size="2"><span style="FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial">, </span></font><font face="Arial" color="navy" size="1"><span style="FONT-SIZE: 9pt; COLOR: navy; FONT-FAMILY: Arial">Canada Research Chair of Health and Development, Centre for Global Health Research, St. Michael's Hospital and University of Toronto, Canada</span></font></p>
<p style="MARGIN-LEFT: 0.5in"><b><font face="Arial" color="navy" size="2"><span style="FONT-WEIGHT: bold; FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial">David E. Bloom</span></font></b><font face="Arial" color="navy" size="2"><span style="FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial">, </span></font><font face="Arial" color="navy" size="1"><span style="FONT-SIZE: 9pt; COLOR: navy; FONT-FAMILY: Arial">Clarence James Gamble Professor of Economics and Demography, and Chair, Department of Population and International Health, Harvard School of Public Health.</span></font><font face="Arial" color="navy" size="2"><span style="FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial"></span></font></p>
<p style="MARGIN-LEFT: 0.5in"><b><font face="Arial" color="navy" size="2"><span style="FONT-WEIGHT: bold; FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial">October 2007 - Revised, June 3, 2008</span></font></b></p>
<p style="MARGIN-LEFT: 0.5in"><b><font face="Arial" color="navy" size="2"><span style="FONT-WEIGHT: bold; FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial"> </span></font></b></p>
<p style="MARGIN-LEFT: 0.5in"><font face="Arial" color="navy" size="2"><span style="FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial">Available online PDF [69p.] at: <a onclick="return top.js.OpenExtLink(window,event,this)" href="http://www.hsph.harvard.edu/pgda/Working%20Papers/2008/PGDA_WP_35.pdf" target="_blank"><font color="navy"><span style="COLOR: navy">http://www.hsph.harvard.edu/pgda/Working%20Papers/2008/PGDA_WP_35.pdf</span></font></a> </span></font></p>
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<p style="MARGIN-LEFT: 0.5in"><font face="Arial" color="navy" size="2"><span style="FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial"><br>"…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 (</span></font><font face="Arial" color="navy" size="1"><span style="FONT-SIZE: 8pt; COLOR: navy; FONT-FAMILY: Arial">Behrman, Alderman and Hoddinott, 2007</span></font><font face="Arial" color="navy" size="2"><span style="FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial">), with water and sanitation (</span></font><font face="Arial" color="navy" size="1"><span style="FONT-SIZE: 8pt; COLOR: navy; FONT-FAMILY: Arial">Hutton, 2007</span></font><font face="Arial" color="navy" size="2"><span style="FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial">), with air pollution (</span></font><font face="Arial" color="navy" size="1"><span style="FONT-SIZE: 8pt; COLOR: navy; FONT-FAMILY: Arial">Hutton, 2007</span></font><font face="Arial" color="navy" size="2"><span style="FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial">) and with education (</span></font><font face="Arial" color="navy" size="1"><span style="FONT-SIZE: 8pt; COLOR: navy; FONT-FAMILY: Arial">Orazem, 2007</span></font><font face="Arial" color="navy" size="2"><span style="FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial">). It is worth listing our seven priorities at the outset:<br>
<br></span></font></p>
<p style="MARGIN-LEFT: 0.5in"><font face="Arial" color="navy" size="2"><span style="FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial">• Tuberculosis treatment;</span></font></p>
<p style="MARGIN-LEFT: 0.5in"><font face="Arial" color="navy" size="2"><span style="FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial">• Heart attack treatment with generic drugs;</span></font></p>
<p style="MARGIN-LEFT: 0.5in"><font face="Arial" color="navy" size="2"><span style="FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial">• Malaria treatment and prevention package;</span></font></p>
<p style="MARGIN-LEFT: 0.5in"><font face="Arial" color="navy" size="2"><span style="FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial">• Increased coverage of childhood immunizations;</span></font></p>
<p style="MARGIN-LEFT: 0.5in"><font face="Arial" color="navy" size="2"><span style="FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial">• Tobacco taxation and regulation;</span></font></p>
<p style="MARGIN-LEFT: 0.5in"><font face="Arial" color="navy" size="2"><span style="FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial">• HIV transmission interruption by a "combination prevention" package; and</span></font></p>
<p style="MARGIN-LEFT: 0.5in"><font face="Arial" color="navy" size="2"><span style="FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial">• Improved surgical capacity at district hospitals to treat trauma and ensure safe childbirth.</span></font></p>
<p style="MARGIN-LEFT: 0.5in"><font face="Arial" color="navy" size="2"><span style="FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial"> </span></font></p>
<p style="MARGIN-LEFT: 0.5in"><font face="Arial" color="navy" size="2"><span style="FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial">We further view the political economy of universalism as enhancing sustainability. Our perspective on public finance in health leads to less relative emphasis on</span></font></p>
<p style="MARGIN-LEFT: 0.5in"><font face="Arial" color="navy" size="2"><span style="FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial">infectious disease control in our short list of high priorities (although four of our seven priorities do deal with infection).</span></font></p>
<p style="MARGIN-LEFT: 0.5in"><font face="Arial" color="navy" size="2"><span style="FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial"><br>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.</span></font></p>
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<p style="MARGIN-LEFT: 0.5in"><font face="Arial" color="navy" size="2"><span style="FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial">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<br>
Section 3 uses this economic context to describe the methods used for the cost-benefit analyses reported. <br>Sections 4, 5 and 6 discuss problems and opportunities in child health, HIV/AIDS and noncommunicable disease.<br>
Section 7 concludes by identifying the few most attractive options and presenting (very approximate) cost-benefit analyses for them…."</span></font></p>
<p style="MARGIN-LEFT: 1in"><font face="Arial" color="navy" size="2"><span style="FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial"> </span></font></p>
<p style="MARGIN-LEFT: 0.5in"><b><font face="Arial" color="navy" size="2"><span style="FONT-WEIGHT: bold; FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial">Contents</span></font></b></p>
<p style="MARGIN-LEFT: 0.5in"><b><font face="Arial" color="navy" size="2"><span style="FONT-WEIGHT: bold; FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial">1. Progress and Challenges</span></font></b></p>
<p style="MARGIN-LEFT: 1in"><font face="Arial" color="navy" size="2"><span style="FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial">1.1 Progress</span></font></p>
<p style="MARGIN-LEFT: 1in"><font face="Arial" color="navy" size="2"><span style="FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial">1.2 Remaining challenges</span></font></p>
<p style="MARGIN-LEFT: 0.5in"><b><font face="Arial" color="navy" size="2"><span style="FONT-WEIGHT: bold; FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial">2. The Economic Benefits of Better Health</span></font></b></p>
<p style="MARGIN-LEFT: 1in"><font face="Arial" color="navy" size="2"><span style="FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial">2.1 Health and income</span></font></p>
<p style="MARGIN-LEFT: 1in"><font face="Arial" color="navy" size="2"><span style="FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial">2.2 Health and economic welfare</span></font></p>
<p style="MARGIN-LEFT: 0.5in"><b><font face="Arial" color="navy" size="2"><span style="FONT-WEIGHT: bold; FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial">3. Cost-Benefit Methodology</span></font></b></p>
<p style="MARGIN-LEFT: 1in"><font face="Arial" color="navy" size="2"><span style="FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial">3.1 Cost-effectiveness analysis broadly and narrowly construed</span></font></p>
<p style="MARGIN-LEFT: 1in"><font face="Arial" color="navy" size="2"><span style="FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial">3.2 Defining and redefining DALYs</span></font></p>
<p style="MARGIN-LEFT: 1in"><font face="Arial" color="navy" size="2"><span style="FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial">3.3 The value of an averted DALY</span></font></p>
<p style="MARGIN-LEFT: 0.5in; TEXT-INDENT: 0.5in"><font face="Arial" color="navy" size="2"><span style="FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial">3.4 The cost of an averted DALY</span></font></p>
<p style="MARGIN-LEFT: 0.5in"><b><font face="Arial" color="navy" size="2"><span style="FONT-WEIGHT: bold; FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial">4. Child Health</span></font></b></p>
<p style="MARGIN-LEFT: 1in"><font face="Arial" color="navy" size="2"><span style="FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial">4.1 Under-5 health problems and intervention priorities</span></font></p>
<p style="MARGIN-LEFT: 1in"><font face="Arial" color="navy" size="2"><span style="FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial">4.2 Delivering child health interventions</span></font></p>
<p style="MARGIN-LEFT: 0.5in"><b><font face="Arial" color="navy" size="2"><span style="FONT-WEIGHT: bold; FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial">5. HIV/AIDS and Tuberculosis</span></font></b></p>
<p style="MARGIN-LEFT: 1in"><font face="Arial" color="navy" size="2"><span style="FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial">5.1 Prevention of HIV transmission</span></font></p>
<p style="MARGIN-LEFT: 1in"><font face="Arial" color="navy" size="2"><span style="FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial">5.2 Antiretroviral treatment of AIDS</span></font></p>
<p style="MARGIN-LEFT: 1in"><font face="Arial" color="navy" size="2"><span style="FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial">5.3 Control of tuberculosis</span></font></p>
<p style="MARGIN-LEFT: 0.5in"><b><font face="Arial" color="navy" size="2"><span style="FONT-WEIGHT: bold; FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial">6. Noncommunicable disease</span></font></b></p>
<p style="MARGIN-LEFT: 1in"><font face="Arial" color="navy" size="2"><span style="FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial">6.1 Cardiovascular disease</span></font></p>
<p style="MARGIN-LEFT: 1in"><font face="Arial" color="navy" size="2"><span style="FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial">6.2 Tobacco addiction</span></font></p>
<p style="MARGIN-LEFT: 0.5in"><b><font face="Arial" color="navy" size="2"><span style="FONT-WEIGHT: bold; FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial">7. Opportunities for disease control</span></font></b></p>
<p style="MARGIN-LEFT: 0.5in"><font face="Arial" color="navy" size="2"><span style="FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial"><br>Appendix A: Intervention Cost-effectiveness in South Asia and Sub-Saharan Africa</span></font></p>
<p style="MARGIN-LEFT: 0.5in"><font face="Arial" color="navy" size="2"><span style="FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial">Appendix B: Sensitivity Analysis</span></font></p>
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