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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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- Chapter
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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
-
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.