Thursday, August 14, 2008

[EQ] Disease Control

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

 

 

 

 

*      *      *     *

This message from the Pan American Health Organization, PAHO/WHO, is part of an effort to disseminate
information Related to: Equity; Health inequality; Socioeconomic inequality in health; Socioeconomic
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Information Technology - Virtual libraries; Research & Science issues.  [DD/ IKM Area]

“Materials provided in this electronic list are provided "as is". Unless expressly stated otherwise, the findings
and interpretations included in the Materials are those of the authors and not necessarily of The Pan American
Health Organization PAHO/WHO or its country members”.

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[EQ] Ethics in American Health 1: Ethical Approaches to Health Policy - 2. Ethical Framework for Health System Reform

Ethics in American Health 1: Ethical Approaches to Health Policy


Jennifer Prah Ruger, Yale University School of Medicine

Am J Public Health published 13 August 2008, 10.2105/AJPH.2007.121343

http://www.ajph.org/cgi/content/abstract/AJPH.2007.121343v1?papetoc



“…..I trace the evolution of ethical approaches to health policy in the United States and examines a number of critical unresolved issues pertaining to the current set of frameworks. Several themes emerge.

 

·         First, fair resource-allocation procedures claim more attention than substantive and procedural principles.

·         Second, in the case of public deliberation, more focus has been placed on factors such as procedural mechanisms than on understanding how individuals and groups value different aspects of health and agree on health-related decisions.

·         Third, the nation needs workable frameworks to guide collective choices about valuable social ends and their tradeoffs; purely procedural strategies are limited in illuminating overarching health policy and ethics questions. There is a need to integrate consequential and procedural approaches to health ethics and policy….”



Ethics in American Health 2: An Ethical Framework for Health System Reform


Jennifer Prah Ruger, Yale University School of Medicine

Am J Public Health published 13 August 2008, 10.2105/AJPH.2007.114124

http://www.ajph.org/cgi/content/abstract/AJPH.2007.114124v1?papetoc



“…..I argue that an ethical vision resting on explicitly articulated values and norms is critical to ensuring comprehensive health reform. Reform requires a consensus on the public good transcending self-interest and narrow agendas and underpinning collective action for universal coverage. In what I call shared health governance, individuals, providers, and institutions all have essential roles in achieving health goals and work together to create a positive environment for health. This ethical paradigm provides

(1) reasoned consensus through a joint scientific and deliberative approach to judge the value of a health care intervention;
(2) a method for achieving consensus that differs from aggregate tools such as a strict majority vote;
(3) combined technical and ethical rationality for collective choice;
(4) a joint clinical and economic approach combining efficiency with equity, but with economic solutions following and complementing clinical progress; and
(5) protection for disabled individuals from discrimination.

 

 

 

*      *      *     *

This message from the Pan American Health Organization, PAHO/WHO, is part of an effort to disseminate
information Related to: Equity; Health inequality; Socioeconomic inequality in health; Socioeconomic
health differentials; Gender; Violence; Poverty; Health Economics; Health Legislation; Ethnicity; Ethics;
Information Technology - Virtual libraries; Research & Science issues.  [DD/ IKM Area]

“Materials provided in this electronic list are provided "as is". Unless expressly stated otherwise, the findings
and interpretations included in the Materials are those of the authors and not necessarily of The Pan American
Health Organization PAHO/WHO or its country members”.

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[EQ] Evidence and Healthy Public Policy: Insights from Health and Political Sciences

Evidence and Healthy Public Policy: Insights from Health and Political Sciences

 

Patrick Fafard, Assistant Professor, Graduate School of Public and International Affairs, University of Ottawa
 Research Fellow, Canadian Policy Research Networks

National Collaborating Centre for Healthy Public Policy - May 2008

 

Available online as PDF file [33p.] at: http://www.cprn.org/documents/50036_EN.pdf

 

“……This paper focuses on the requirements of healthy public policy, and more importantly the role of evidence, especially scientific evidence in the development of such policies. Simply put, this paper offers a critical account of the extent to which scientific evidence can have an impact on public policy. Drawing on health sciences literature on healthy public policy and political science literature on policy-making, this paper seeks to build a bridge between the worldview of health

sciences4 and the worldview of political (and policy) science in order to offer some insight into how policy gets made and thereby offer some guideposts to those who wish to develop and promote healthy public policy. In particular, this paper focuses on two linked questions.

 

First, in order to provide advice to those who might wish to promote healthy public policies, what do we know about how policy gets made and how and where evidence is most effectively used? Specifically, what are some of the available theories, or absent formal theories, models and frameworks, of the policy process and what role does evidence play in each?

 

Second, building on the contemporary preoccupation with evidence-based decision-making (and, at least in some quarters, evidence-based public policy), in thinking about how public policy is made, what constitutes “evidence” and what is the role of evidence in the policy process?.........”

 

 

TABLE OF CONTENTS

INTRODUCTION

1 MODELS OF POLICY-MAKING — THE VIEW FROM HEALTH SCIENCES 4

2 MODELS OF POLICY-MAKING — THE STAGES MODEL

2.1 Evidence and agenda setting

2.2 Evidence and policy formulation

2.3 Evidence and decision-making

2.4 Evidence and policy implementation

2.5 Evidence and policy-making in a stages model — General observations

3 MODELS OF POLICY-MAKING — THE ADVOCACY COALITION FRAMEWORK AND THE ARGUMENTATIVE TURN

3.1 Advocacy coalition framework

3.2 Evidence in advocacy coalition frameworks

3.3 The argumentative turn and a deliberative approach to policy-making

3.4 Evidence in discursive policy-making

CONCLUSIONS

REFERENCES

 

 

 

*      *      *     *

This message from the Pan American Health Organization, PAHO/WHO, is part of an effort to disseminate
information Related to: Equity; Health inequality; Socioeconomic inequality in health; Socioeconomic
health differentials; Gender; Violence; Poverty; Health Economics; Health Legislation; Ethnicity; Ethics;
Information Technology - Virtual libraries; Research & Science issues.  [DD/ IKM Area]

“Materials provided in this electronic list are provided "as is". Unless expressly stated otherwise, the findings
and interpretations included in the Materials are those of the authors and not necessarily of The Pan American
Health Organization PAHO/WHO or its country members”.

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EQUITY List - Archives - Join/remove: http://listserv.paho.org/Archives/equidad.html

 

 

 

    IMPORTANT: This transmission is for use by the intended recipient and it may contain privileged, proprietary or confidential information. If you are not the intended recipient or a person responsible for delivering this transmission to the intended recipient, you may not disclose, copy or distribute this transmission or take any action in reliance on it. If you received this transmission in error, please notify us immediately by email to infosec@paho.org, and please dispose of and delete this transmission. Thank you.