Putting DCP2 to Use
The research, insight, and analysis undertaken in DCP2 discerns trends in the leading causes of disease and injury over the last decade and has great significance for policy debates on how to respond to and diminish the burden of disease worldwide. Health policy actors and health system decision makers, whether at the level of national health ministries, large regional programs, or smaller programs, will find in DCP2 up-to-date information on the burden of disease, on cost-effective interventions, and on the interplay of prevention and treatment. Together with their own knowledge about local burdens, resources, and institutional capacities, they will be better able to define priorities and select the best interventions to implement in their context. Others more involved in managing and administering health systems will find current best practice in the delivery of health care, recommendations for innovation, ways to improve quality, and strategies to overcome system constraints. Those primarily concerned with financing health care, whether national finance ministries or those involved in international assistance, will gain an appreciation for the role of health in economic growth and find evidence of the great health effect that is possible when resources are applied well. Researchers will learn of key priorities for their fields, while educators in public health will find a useful teaching tool.
The wealth of information and analysis covered in DCP2 is structured into three parts (box 1.1). Part One provides perspective, context, and overview. It articulates the volume's main messages and policy implications. Chapter 1, "Investing in Health," provides historical perspectives; argues for investing in health; and highlights some of DCP2's new findings, such as the unexpectedly high burden of cardiovascular illness in developing countries and the importance of care during a child's first 28 days of life for reducing infant mortality. Chapter 2, "Intervention Cost-Effectiveness," reviews the set of cost-effective interventions for all diseases discussed in DCP2 and then identifies "best buys" among these. Coupled with information on local disease prevalence and health system capacity, readers will be able to use this analysis to decide which interventions are most suitable for their own contexts. While selecting interventions is crucial, no intervention will reach its target without good delivery mechanisms. Chapter 3, "Strengthening Health Systems," therefore reviews the evidence on health systems, identifying aspects of best practice and defining key areas for further research and improvement in the delivery and management of health care. Chapter 4, "Priorities for Global Research and Development of Interventions," examines some of the current gaps in knowledge and urgent priorities for further study and progress.
[Box 1.1 ]
"While selecting interventions is crucial, no intervention will reach its target without good delivery mechanisms."
These 4 initial summary chapters are followed by 11 chapters addressing cross-cutting themes, including the Millennium Development Goals (MDGs), women's health, recent public health successes, ethics of resource allocation, and cost-effectiveness methodology, plus a range of financial and economic issues. These chapters provide further demographic and economic context and general discussion that inform all the subsequent chapters on specific diseases, interventions, and modes of delivery.
Part Two of DCP2 turns to particular diseases, risk factors, and sequelae and the selection of interventions. It is subdivided into four categories, the first of which is "Infectious Disease, Reproductive Health, and Undernutrition." Its 13 chapters include discussions of HIV/AIDS, TB, malaria, diarrhea, tropical diseases, and maternal and neonatal conditions. The second category is "Noncommunicable Disease and Injury," with 12 chapters on cancers, diabetes, psychiatric disorders, cardiovascular disease (CVD), hemoglobinopathies, and intentional and unintentional injuries. The third category, "Risk Factors," provides eight chapters on such topics as air and water pollution, sanitation, obesity, and tobacco and alcohol consumption. The final category, "Consequences of Disease and Injury," offers four chapters that address developmental and sensory disorders, disability and rehabilitation, and pain control.
Finally, part Three of DCP2 turns to health systems. "Strengthening Public Health Services" is its first category, with 11 chapters addressing such topics as family planning, school health programs, adolescent health, and occupational health. The second category, "Strengthening Personal Health Services," provides six chapters on general primary care, district and referral hospitals, surgery, emergency care, and alternative medicine. The concluding category is "Capacity Strengthening and Management Reform," with four chapters tackling quality of care, human resources, essential medicines, and management of clinical services.
In addition to its principal volume, the Disease Control Priorities Project has generated a number of related publications. These include the Global Burden of Disease and Risk Factors volume (Lopez and others 2006), which updates the 1990 global burden of disease study. In the years that have elapsed since that earlier study, methods for measuring the disease burden have improved, new data sets have become available, and means to analyze existing data sets have been modified and strengthened. The Global Burden of Disease and Risk Factors presents these new methods, data sets, and analyses; compiles epidemiological data of deaths and disability for 2001 by age, gender, cause, and region; and includes information on exposure to risk factors.
The Disease Control Priorities Project also generated a review of public health successes that was published as Millions Saved: Proven Successes in Global Health (Levine and others 2004), a special issue of the American Journal of Tropical Medicine and Hygiene entitled "The Intolerable Burden of Malaria: What's New, What's Needed" (Breman, Alilio, and Mills 2004); the Disease Control Priorities Project Working Paper Series and Reprint Series (for a full list, visit the Disease Control Priorities Project Web site at http://www.fic.nih.gov/dcpp), and this volume.
