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10 - Benefits and Costs of the Health Targets for the Post-2015 Development Agenda
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- By Prabhat Jha, Professor of Economics, Canada Research Chair of Health and Development at the University of Toronto, Canada and Founding Director of the Centre for Global Health Research, St. Michael's Hospital, Toronto, Canada, Ryan Hum, Special Lecturer, Faculty of Applied Science and Engineering, University of Toronto, Canada, Cindy L. Gauvreau, Post-Doctoral Fellow/ Economist, Centre for Global Health Research, St. Michael's Hospital, Toronto, Canada, Keely Jordan, Health Policy Analyst, University of California, San Francisco, USA
- Edited by Bjorn Lomborg, Copenhagen Business School
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- Book:
- Prioritizing Development
- Published online:
- 30 May 2018
- Print publication:
- 07 June 2018, pp 219-230
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Summary
Introduction
A variety of development priorities have been proposed for 2030 as Sustainable Development Goals (SDGs) to follow the highly-influential 2015 Millennium Development Goals (MDGs). These proposed goals cover a wide range of development objectives, including SDG3, “Ensure healthy lives and promote well-being for all at all ages.” Within the overarching health goal, many subgoals have been proposed, some of which are realistic and others that are not (Norheim et al., 2014). Common frameworks to evaluate these disparate goals are required by national governments and global agencies.
One proposed method to evaluate goals is benefit-cost analyses (BCAs), expressed as some monetary value of the benefits divided by the costs (benefit-cost ratios, or BCR) of achieving these benefits. A BCR greater than one for an assessed intervention indicates that it is socially beneficial compared to the next best use of the same resources. A ranking of interventions by the size of their BCRs is one step in allowing the prioritization according to the relative benefits they provide to society. (Note that a goal with a high societal benefit, such as universal education of girls, might not necessarily have a higher BCR than other interventions). In the case of health, high coverage of individual interventions are seldom achieved without an extensive delivery system comprising community outreach of services, first referral, and specialty hospitals, as well as supportive services for quality, patient safety, monitoring and evaluation, and other services (Jha and Laxminarayan, 2009). Moreover, some interventions (such as immunization) reduce deaths beyond the specific diseases they cover, by, for example, increasing the nutritional standing of children. The impact of increased access through universal healthcare is also not easily quantified through BCA. Therefore, traditional BCA, applied to individual interventions, fails to fully capture the cumulative and synergistic benefits or costs of implementation within a health system and in tandem with other health-promoting activities.
Thus, overall goals of reducing child and adult mortality are required as an overarching framework target. However, it should also be emphasized that within this framework, careful consideration be given to the specific subpopulation needs for each major age group (0–4, 5–49, and 50–69 years), as they differ in disease patterns.
Chapter 10 - Benefits and Costs of the Health Targets for the Post-2015 Development Agenda
- Edited by Bjorn Lomborg, Copenhagen Business School
-
- Book:
- Prioritizing Development
- Published online:
- 30 May 2018
- Print publication:
- 07 June 2018, pp 219-230
-
- Chapter
- Export citation
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Summary
In this chapter, we attempt to provide a BCR for an overall outcome of reducing premature mortality in low- and lower-middle-income countries by 40% by 2030 (40x30). This method quantifies the value of a broad-based expansion of health care resources for services and interventions rather than an incremental intervention-by-intervention approach. We propose this outcome as a new sub goal of SDG3 (Norheim et al. 2014). By focussing on mortality we do not mean to deny the importance of the sub goals to reduce disability and suffering, such as that aimed at improving mental health or palliative care. However, the burden of disability and suffering as captured in the disability-adjusted life year (DALY) in low- and middle-income countries (LMICs), is relatively smaller than mortality (Jha 2014), especially in lower-income countries (Murray et al. 2012). Because most causes of premature mortality are highly correlated with those of disability, a reduction in the former will result in a reduction of the latter. However, the benefits of healthy years gained takes into account (albeit crudely) the ratio of disability to mortality.
Maternal high-fat diet alters expression of pathways of growth, blood supply and arachidonic acid in rat placenta
- Marloes Dekker Nitert, Kanchan Vaswani, Melissa Hum, Hsiu-Wen Chan, Ryan Wood-Bradley, Sarah Henry, James A. Armitage, Murray D. Mitchell, Gregory E. Rice
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- Journal:
- Journal of Nutritional Science / Volume 2 / 2013
- Published online by Cambridge University Press:
- 02 January 2014, e41
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- Article
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The high fat content in Western diets probably affects placental function during pregnancy with potential consequences for the offspring in the short and long term. The aim of the present study was to compare genome-wide placental gene expression between rat dams fed a high-fat diet (HFD) and those fed a control diet for 3 weeks before conception and during gestation. Gene expression was measured by microarray and pathway analysis was performed. Gene expression differences were replicated by real-time PCR and protein expression was assessed by Western blot analysis. Placental and fetal weights at E17.25 were not altered by exposure to the maternal HFD. Gene pathways targeting placental growth, blood supply and chemokine signalling were up-regulated in the placentae of dams fed the HFD. The up-regulation in messenger RNA expression for five genes Ptgs2 (fatty acid cyclo-oxidase 2; COX2), Limk1 (LIM domain kinase 1), Pla2g2a (phospholipase A2), Itga1 (integrin α-1) and Serpine1 was confirmed by real-time PCR. Placental protein expression for COX2 and LIMK was also increased in HFD-fed dams. In conclusion, maternal HFD feeding alters placental gene expression patterns of placental growth and blood supply and specifically increases the expression of genes involved in arachidonic acid and PG metabolism. These changes indicate a placental response to the altered maternal metabolic environment.
3 - Chronic Disease
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- By Prabhat Jha, University of Toronto, Rachel Nugent, University of Washington, Stéphane Verguet, University of Washington, David Bloom, Harvard University, Ryan Hum, University of Toronto
- Edited by Bjørn Lomborg
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- Book:
- Global Problems, Smart Solutions
- Published online:
- 05 June 2014
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- 14 November 2013, pp 137-185
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Summary
Eighty percent of global deaths from heart disease, stroke, cancer, and other chronic diseases occur in low- and middle-income countries. This chapter discusses priorities for control of these chronic diseases as an input into the 2012 Copenhagen Consensus. This chapter and the accompanying Chapter 7 on infectious disease control build on the results of the 2008 Copenhagen Consensus chapter on disease control (Jamison et al., 2008), and is best read as an extension of the latter chapter.
This chapter also draws on the framework and findings of the Disease Control Priorities Project (DCP2). The DCP2 engaged over 350 authors and among its outputs were estimates of the cost-effectiveness of 315 interventions, including about 100 interventions for chronic diseases. These estimates vary a good deal in their thoroughness and in the extent to which they provide regionally-specific estimates of both cost and effectiveness. Taken as a whole, however, they represent a comprehensive canvas of chronic disease control opportunities. This chapter identifies five key priority interventions for chronic disease in developing countries which chiefly address heart attacks, strokes, cancer, and tobacco-related respiratory disease. These interventions are chosen from among many because of their cost-effectiveness, the size of the disease burden they address, their implementation ease, and other criteria. Separate but related 2008 Copenhagen Consensus chapters dealt with other major determinants of chronic diseases such as nutrition, (Behrman et al., 2007), air pollution (Larsen et al., 2008) and education (Orazem et al., 2008). The health-related chapters for the 2012 Copenhagen Consensus focus on infectious diseases (Jamison et al., 2012), sanitation and water (Rijsberman and Zwane, 2012), education (Orazem, 2012), hunger and undernutrition (Hoddinott et al., 2012) and population growth (Kohler, 2012).