Title

Universal health coverage and intersectoral action for health: key messages from Disease Control Priorities, 3rd edition

Authors

Dean T. Jamison, University of California, San Francisco
Ala Alwan, University of Washington
Charles N. Mock, University of Washington
Rachel Nugent, RTI International
David Watkins, University of Washington
Olusoji Adeyi, World Bank Group, Washington, DC, USA.
Shuchi Anand, Stanford University
Rifat Atun, Harvard T. H. Chan School of Public Health
Stefano Bertozzi, University of California - Berkeley
Zulfiqar Ahmed Bhutta, The Aga Khan UniversityFollow
Agnes Binagwaho, Harvard Medical School
Robert Black, Johns Hopkins University Bloomberg School of Public Health
Mark Blecher, National Treasury of South Africa
Barry R. Bloom, Harvard T. H. Chan School of Public Health
Elizabeth Brouwer, University of Washington
Donald A.P. Bundy, The Bill & Melinda Gates Foundation
Dan Chisholm, World Health Organization Regional Office for Europe
Alarcos Cieza, World Health Organization, Geneva, Switzerland.
Kristen Danforth, University of Washington
Nilanthi de Silva, University of Kelaniya
Haile T. Debas, University of California
Peter Donkor, Kwame Nkrumah University of Science and Technology
Tarun Dua, World Health Organization, Geneva, Switzerland
Kenneth A. Fleming, University of Oxford
Mark Gallivan, Metabiota, San Francisco, CA, USA.
Patricia J. Garcia, Universidad Peruana Cayetano Heredia, Lima, Peru.
Atul Gawande, Harvard T. H. Chan School of Public Health
Thomas Gaziano, Harvard Medical School
Hellen Gelband, University of Toronto
Roger Glass, Fogarty International Center
Amanda Glassman, Center for Global Development
Glenda Gray, University of the Witwatersrand, Johannesburg
Demissie Habte, International Clinical Epidemiology Network, New Delhi, India
King K. Holmes, University of Washington
Susan Horton, University of Waterloo
Guy Hutton, UNICEF, New York, NY, USA
Prabhat Jha, University of Toronto
Felicia M. Knaul, University of Miami
Olive Kobusingye, Makerere University Medical School
Eric L. Krakauer, Harvard Medical School
Margaret E. Kruk, Harvard T. H. Chan School of Public Health
Peter Lachmann, University of Cambridge
Ramanan Laxminarayan, Center for Disease Dynamics, Economics, and Policy, Washington, DC, USA.
Carol Levin, University of Washington
Lai Meng Looi, University of Malaya
Nita Madhav, Metabiota, San Francisco, CA, USA
Adel Mahmoud, Princeton, University, Princeton, NJ, USA.
Jean Claude Mbanya, University Yaoundé
Anthony Measham, World Bank Group, Washington, DC, USA
María Elena Medina-Mora, National Institute of Psychiatry de la Fuente Muniz
Carol Medlin, Praxis Social Impact Consulting, Washington, DC, USA
Anne Mills, London School of Hygiene & Tropical Medicine, London, UK
Jody-Anne Mills, World Health Organization, Geneva, Switzerland
Jaime Montoya, University of the Philippines
Ole Norheim, University of Bergen
Zachary Olson, University of California
Folashade Omokhodion, University of Ibadan College of Medicine
Ben Oppenheim, Metabiota, San Francisco, CA, USA
Toby Ord, University of Oxford
Vikram Patel, Harvard Medical School
George C. Patton, University of Melbourne
John Peabody, University of California
Dorairaj Prabhakaran, London School of Hygiene & Tropical Medicine
Jinyuan Qi MS, Princeton, University, Princeton, NJ, USA
Teri Reynolds, World Health Organization, Geneva, Switzerland
Sevket Ruacan, Koc University Medical School
Rengaswamy Sankaranarayanan, International Agency for Research on Cancer, Lyon, France
Jaime Sepúlveda, University of California
Richard Skolnik, Yale University
Kirk R. Smith, University of California
Marleen Temmerman, Aga Khan UniversityFollow
Stephen Tollman, University of the Witwatersrand
Stéphane Verguet, Harvard T. H. Chan School of Public Health
Damian G. Walker, The Bill & Melinda Gates Foundation
Neff Walker, Johns Hopkins University Bloomberg School of Public Health
Yangfeng Wu, The George Institute for Global Health at Peking University Health Science Center
Kun Zhao, China National Health Development Research Center

Document Type

Article

Department

Obstetrics and Gynaecology (East Africa)

Abstract

The World Bank is publishing nine volumes of Disease Control Priorities, 3rd edition (DCP3) between 2015 and 2018. Volume 9, Improving Health and Reducing Poverty, summarises the main messages from all the volumes and contains cross-cutting analyses. This Review draws on all nine volumes to convey conclusions. The analysis in DCP3 is built around 21 essential packages that were developed in the nine volumes. Each essential package addresses the concerns of a major professional community (eg, child health or surgery) and contains a mix of intersectoral policies and health-sector interventions. 71 intersectoral prevention policies were identified in total, 29 of which are priorities for early introduction. Interventions within the health sector were grouped onto five platforms (population based, community level, health centre, first-level hospital, and referral hospital). DCP3 defines a model concept of essential universal health coverage (EUHC) with 218 interventions that provides a starting point for country-specific analysis of priorities. Assuming steady-state implementation by 2030, EUHC in lower-middle-income countries would reduce premature deaths by an estimated 4·2 million per year. Estimated total costs prove substantial: about 9·1% of (current) gross national income (GNI) in low-income countries and 5·2% of GNI in lower-middle-income countries. Financing provision of continuing intervention against chronic conditions accounts for about half of estimated incremental costs. For lower-middle-income countries, the mortality reduction from implementing the EUHC can only reach about half the mortality reduction in non-communicable diseases called for by the Sustainable Development Goals. Full achievement will require increased investment or sustained intersectoral action, and actions by finance ministries to tax smoking and polluting emissions and to reduce or eliminate (often large) subsidies on fossil fuels appear of central importance. DCP3 is intended to be a model starting point for analyses at the country level, but country-specific cost structures, epidemiological needs, and national priorities will generally lead to definitions of EUHC that differ from country to country and from the model in this Review. DCP3 is particularly relevant as achievement of EUHC relies increasingly on greater domestic finance, with global developmental assistance in health focusing more on global public goods. In addition to assessing effects on mortality, DCP3 looked at outcomes of EUHC not encompassed by the disability-adjusted life-year metric and related cost-effectiveness analyses. The other objectives included financial protection (potentially better provided upstream by keeping people out of the hospital rather than downstream by paying their hospital bills for them), stillbirths averted, palliative care, contraception, and child physical and intellectual growth. The first 1000 days after conception are highly important for child development, but the next 7000 days are likewise important and often neglected.

Publication

Lancet

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