Chapter 002. Global Issues in Medicine (Part 3)

The Economics of Global HealthPolitical and economic concerns have often guided global health interventions. As mentioned previously, early efforts to control yellow fever were tied to the completion of the Panama Canal. However, the precise nature of the link between economics and health remains a matter for debate. Some economists and demographers argue that economic development is the key to improving the health status of populations, while others maintain that ill health is the chief barrier to development in poor countries. In either case, investment in health care, and especially in the control of communicable diseases, should lead to...
Nội dung trích xuất từ tài liệu:
Chapter 002. Global Issues in Medicine (Part 3) Chapter 002. Global Issues in Medicine (Part 3) The Economics of Global Health Political and economic concerns have often guided global healthinterventions. As mentioned previously, early efforts to control yellow fever weretied to the completion of the Panama Canal. However, the precise nature of thelink between economics and health remains a matter for debate. Some economistsand demographers argue that economic development is the key to improving thehealth status of populations, while others maintain that ill health is the chief barrierto development in poor countries. In either case, investment in health care, andespecially in the control of communicable diseases, should lead to increasedproductivity. The question is where to find the necessary resources to start thepredicted virtuous cycle. International financial institutions, including the World Bank and the IMF,have counseled limited investments and the capping of social expenditures inhealth and education. The socioeconomic argument was that a balanced budgetand a friendly investment climate—that is, privatization, deregulation, decreasedtrade barriers, devalued currencies, and debt repayment—would favordevelopment and thus improve health outcomes. The limitations on social-sectorspending recommended for many poor countries by the World Bank and the IMFfrom the 1970s through the 1990s tended to confirm the opposite view. In thepoorest countries, already-tiny health-sector budgets were further constricted.Moreover, health-sector spending in many poor countries channeled a majority ofresources toward city hospitals that served mostly élites who were able to pay;consequently, in the past quarter-century, little spending went toward addressingthe problems that most affected poor people in poor countries. Since 1999, spurred by the leadership of the Gates Foundation and thegrowing interest in addressing novel and persistent challenges such as AIDS,spending on health in poor countries has increased, with $40 billion in new fundsearmarked for the discovery and development of drugs and diagnostics targetingdiseases of the poor; for comprehensive responses to the AIDS, TB, and malariaepidemics; for vaccine development and delivery; and even for improved methodsof data collection in resource-poor settings. Nevertheless, in order to reach theUnited Nations Millennium Development Goals, which include targets for povertyreduction, universal primary education, and gender equality, spending in the healthsector will have to be further increased and sustained. To determine by how muchand for how long, it is imperative that we improve our ability to assess the globalburden of disease (GBD) and to plan interventions that more precisely match theneed, which is glaring but often poorly understood. Refining metrics is animportant task for global health: only recently have we had solid assessments ofthe GBD. Such assessments may serve as preliminaries or as correctives toeffective interventions among the poor. Life Expectancy and Global Burden of Disease Since the late 1980s, serious efforts have been made to calculate the GBD.The first GBD study, conducted in 1990, laid the foundation for the first report onDisease Control Priorities in Developing Countries (DCP1) and for the WorldBanks 1993 World Development Report entitled Investing in Health. Theseefforts represented a major advance in our understanding of health status indeveloping countries. Investing in Health has been especially influential: itfamiliarized a broad audience with cost-effectiveness analysis for specific healthinterventions and with the notion of disability-adjusted life years (DALYs). TheDALY, which has become a standard measure of the impact of a specific healthcondition on a population, combines in a single measure both absolute years of lifelost and years lost due to disability for incident cases of a condition. The second GBD analysis was carried out on health data from 2001. Thelatter report reflects growth in the available data on health in the poorest countriesand in our capacity to measure the impact of specific conditions on a population.Yet, even in 2001, only 107 of 192 nations surveyed had reliable information onthe causes of deaths within their own borders. It is essential to expand efforts tocollect the most basic health data; this task falls to the WHO, nationalgovernments, and certain academic institutions. The lack of complete data has ledto considerable uncertainty in estimates of overall mortality. The level ofuncertainty ranges from as low as 1% for estimates of all-cause mortality indeveloped countries to well over 50% for disability resulting from diseases forwhi ...