Chapters in this volume convey compact distillations of current knowledge concerning interventions to improve health and the related delivery systems. Chapter 2 summarizes main messages of the chapters dealing with interventions, and chapter 3 summarizes the main messages concerning health systems. Chapter 1 provides context and conveys examples of the range of findings from across the volume. Here, in brief, are the main messages of chapter 1:
-
Average life expectancy in low- and middle-income countries increased dramatically in the past half-century, while cross-country health inequalities decreased. In the countries with the best health indicators, life expectancy increased a substantial two and one-half years per decade since 1960; low- and middle-income countries on average, with life expectancy gains of about five years per decade, have been converging toward the countries with the longest life expectancy. Improvement in average income and education levels contributed to these worldwide gains in health. Of much greater quantitative significance, however, have been the generation and diffusion of new knowledge and of low-cost, appropriate technologies. Increased access to knowledge and technology has accounted for perhaps as much as two-thirds of the impressive 2 percent per year rate of decline in under-five mortality rates.
-
Improved health has contributed significantly to economic welfare. Per capita GNP rose rapidly in developing countries in the decades following 1960, and economic research suggests that health improvements led to perhaps 10 percent to 15 percent of that GNP growth. Although GNP includes the costs of providing medical care and reflects changes in health-related consumption, such as the quantity and quality of food, it omits altogether the value that mortality reduction represents for countries. Recent economic research has extended measurement to a broader indicator, known as full income, that reflects reasonable valuation of changes in mortality. For many countries, recent mortality changes exceed in value the growth of GNP. More widespread use of full-income measures to calculate the rate of return to investments in health—and health research—will almost certainly conclude that, today, most countries substantially undervalue those investments.
-
Although health improvements constituted an enormous success for human welfare in the 20th century, four critical challenges face developing countries (and the world) at the beginning of the 21st century:
-
high levels and rapid growth (for mostly demographic reasons) of noncommunicable conditions in the disease profiles of developing countries
-
the still unchecked HIV/AIDS pandemic
-
the possibility of a successor to the influenza pandemic of 1918
-
the persistence in many countries and many population subgroups of high but preventable levels of mortality and disability from diseases such as malaria, TB, diarrhea, and pneumonia; from micronutrient malnutrition; and, for both mothers and infants, from childbirth.
The main purpose of this volume is to facilitate diffusion of appropriate approaches for addressing those problems.
-
The volume's conclusions concerning interventions include the following:
-
Although 50 percent of deaths (including stillbirths) of children under age five occur at ages younger than 28 days, relatively little attention has been paid to this age group. Cost-effective interventions exist.
-
Treatment of HIV-positive mothers, treatment of sexually transmitted infections, free distribution of condoms, and other interventions can cost-effectively interrupt HIV transmission. These preventive interventions continue to receive inadequate attention from health systems and workers.
-
Controlling tobacco use, particularly through taxation, is feasible in developing countries and is the single most important intervention for reducing noncommunicable disease.
-
Lifelong medical management of risk factors in individuals at high risk for heart attacks or strokes, using aspirin and other drugs, is cost-effective and would benefit tens of millions of individuals.
-
This volume's findings concerning health services and systems include the following:
-
Provider incentives matter. Financial or other recognition for timely, responsive service increases the likelihood of such services. Conversely, financial incentives for excessive or inappropriate use of drugs or diagnostic tests is an all-too-common cause of high costs and poor health outcomes.
-
Provider experience matters. Having providers do a few things frequently, rather than attempting to provide diverse services, facilitates quality improvement with potentially major improvements in health outcomes.
-
Strengthening surgical capacity at district hospitals is likely to be cost-effective and would address broad needs.
-
In low-income countries, targeting the very limited public sector resources for health to control of diseases—such as TB—that particularly affect the poor would be efficient.
-
In middle-income countries, public finance—or publicly mandated finance—of a substantial package of clinical care for all would be not only equitable but also efficient in terms of meeting health needs, controlling costs, and providing financial protection to populations.
-
The generation and diffusion of new knowledge and products underpinned the enormous improvements in health in the 20th century. Every reason exists to believe that continued progress—meeting the challenges of noncommunicable disease, HIV/AIDS, potential pandemics, and neglected populations—will also rely heavily on new knowledge. The rapidly growing commitment of high-income countries to providing development assistance for health would be more effectively used if a larger share were devoted to research and development. Public-private partnerships provide a promising institutional mechanism for new product development. A particularly important—and much neglected—type of knowledge results from tight evaluations of interventions and systems.
This volume represents an attempt to learn systematically from the enormous successes of the past half-century in improving human health. Knowledge that has been gained—and that this volume pulls together—creates a platform for addressing the problems that remain.
Source: Author.
