Intro
A girl born in Chile in 1910 could expect to live only to age 33. Since then, her life expectancy has more than doubled to its current level of 78 years. What has this increase meant for her? The probability that she will die before her fifth birthday has declined from 36 percent to less than 2 percent. Throughout middle age the likelihood that she will die is also far lower: death in childbearing or from tuberculosis (TB) as a young adult are no longer threats, and she is less likely to die in middle age from cancer. Mirroring this mortality reduction—but less easily quantified—are marked improvements in health-related quality of life. She will be able to choose to have fewer children and thus spend less time in pregnancy and child rearing. From an average of about 5.3 children at midcentury, Chilean women's fertility rate has dropped to its current level of 2.3. She will have fewer infections, less anemia, greater strength and stature, and a quicker mind. Her life is not only much longer; it is much healthier as well.
Chile's history of health improvements is unusually well documented but typifies changes that have occurred in much of the world. These dramatic improvements in health have, moreover, been possible without major increases in income. In the early 1900s, income levels in the United States were roughly the same as they are in Chile today, yet U.S. life expectancy then was 25 years shorter. New knowledge, new vaccines, and new drugs have inexpensively enabled major gains in health that were not possible before, even for those whose incomes were high. Although those gains are now possible, they do not occur unless health systems and policies effectively realize the available potential.
Although the magnitude of possible gains in health was clear by the early 1990s, it is even clearer today: focused attention by health systems on delivering powerful but often inexpensive interventions can lead to dramatic improvements in health at modest cost. Globalization has helped diffuse knowledge about what those interventions are and how health systems can deliver them. The pace of diffusion of such knowledge into a country—much more than its level of income—determines the pace of health improvement in that country. Our purpose in Disease Control Priorities in Developing Countries, 2nd edition (DCP2), is to help speed the diffusion of policy-relevant knowledge.
This introductory chapter to DCP2 serves two purposes:
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First, it provides the context for the rest of the book by discussing broad trends in health conditions, by summarizing health conditions of the world at the dawn of the 21st century, and by pointing to recent research suggesting that the economic benefits from successful investments in health are likely to be exceptionally high.
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Second, it highlights some of the main messages for policy that emerge from the 37 chapters that deal with conditions and risk factors and the 21 chapters that deal with strengthening health systems. These highlights are deliberately brief because chapters 2 and 3 summarize the remainder of the book: chapter 2 summarizes findings about intervention costzeffectiveness from across the book, and chapter 3 synthesizes findings on strengthening health systems.
Box 1.1 summarizes the main messages of this chapter.
[Box 1.1]
