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Jamison DT, Breman JG, Measham AR, et al., editors. Disease Control Priorities in Developing Countries. 2nd edition. Washington (DC): World Bank; 2006.

Cover of Disease Control Priorities in Developing Countries

Disease Control Priorities in Developing Countries. 2nd edition.

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In the late 1980s, the World Bank initiated a review of priorities for the control of specific diseases and used this information as input for comparative cost-effectiveness estimates of interventions addressing most conditions important in developing countries. The purpose of the comparative cost-effectiveness work was to inform decision making within the health sectors of highly resource-constrained low- and middle-income countries. This process resulted in the 1993 publication of the first edition of Disease Control Priorities in Developing Countries (DCP1) (Jamison and others 1993). That volume's preface stated its purpose as follows:

Between 1950 and 1990, life expectancy in developing countries increased from forty to sixty-three years with a concomitant rise in the incidence of the noncommunicable diseases of adults and the elderly. Yet there remains a huge unfinished agenda for dealing with undernutrition and the communicable childhood diseases. These trends lead to increasingly diverse and complicated epidemiological profiles in developing countries. At the same time, new epidemic diseases like AIDS are emerging; and the health of the poor during economic crisis is a source of growing concern. These developments have intensified the need for better information on the effectiveness and cost of health interventions. To assist countries to define essential health service packages, this book provides information on disease control interventions for the commonest diseases and injuries in developing countries.

To this end, DCP1 aimed to provide systematic guidance on the selection of interventions to achieve rapid health improvements in an environment of highly constrained public sector budgets through the use of cost-effectiveness analysis.

DCP1 provided limited discussion of investments in health system development. Other major efforts undertaken at the World Bank at about the same time, including the World Development Report 1993: Investing in Health, used the findings of DCP1 and dealt more explicitly with the financial and health systems aspects of implementation (Feachem and others 1992; World Bank 1993). Closely related efforts in collaboration with the World Health Organization led to the first global and regional estimates of numbers of deaths by age, sex, and cause and of the burden (including the disability burden) from more than 100 specific diseases and conditions (Murray, Lopez, and Jamison 1994; World Bank 1993).

This second edition of Disease Control Priorities in Developing Countries (DCP2) seeks to update and improve guidance on the "what to do" questions in DCP1 and to address the institutional, organizational, financial, and research capacities essential for health systems to deliver the right interventions. DCP2 is the principal product of the Disease Control Priorities Project, an alliance of organizations designed to review, generate, and disseminate information on how to improve population health in developing countries. In addition to DCP2, the project produced numerous background papers, an extensive range of interactive consultations held around the world, and several additional major publications. The other major publications are as follows:

Each product of the Disease Control Priorities Project marries economic approaches with those of epidemiology, public health, and clinical medicine.

While general lessons emerge from the Disease Control Priorities Project, they result from careful consideration of individual cases. The diversity of health conditions necessitates specificity of analysis. Arrow clearly stated the need for technical analyses to underpin health economics: "Another lesson of medical economics is the importance of recognizing the specific character of the disease under consideration. The policy challenges that arise in treating malaria are simply very different from those attached to other major infectious scourges (Arrow, Panosian, and Gelband 2004, xi–xii)." Chapters in this volume address this need for specificity, yet use cost-effectiveness analysis in a way that makes findings on the relative attractiveness of interventions comparable.

DCP2 goes beyond DCP1 in a number of important ways as follows:

  • While virtually all chapters of DCP1 were structured around clusters of conditions, DCP2 provides integrative chapters—for example, on school health systems, surgery, and integrated management of childhood illness—that draw together the implementation-related responses to a number of conditions. These and other chapters reflect DCP2's inclusion of implementation and system issues.
  • DCP2 includes explicit discussions of research and product development opportunities.
  • Although DCP1 dealt with policy mechanisms to change behavior (or the environment), DCP2 attempts to do so in a more systematic way. In particular, a number of chapters assess in depth the public sector instruments for influencing behavior change that were described briefly in DCP1: information, education, and communication; laws and regulations; taxes and subsidies; engineering design, such as speed bumps; and facility location and characteristics.
  • Different interventions place different levels of demand on a country's health system capacity. DCP2 builds on earlier work (Gericke and others 2005) in attempting, in some chapters, to identify which interventions require relatively less system capacity for scaling up and which require more.
  • Although DCP1 briefly discussed the nonhealth outcomes of interventions, DCP2 does so in a more systematic way, including looking at the consequences of interventions (and intervention financing) for reducing financial risks at the household level. Other important nonhealth outcomes include, for example, the time-saving value of having piped water close to the home, the increased labor productivity of healthy workers, and the amenity value of clean air.
  • An important element of DCP1 was its assumption that to inform broad policy, major changes from the status quo need to be considered, not just marginal ones. For cost-effectiveness analysis, any major change needs to be informed by burden of disease assessments in a way not required for judging the attractiveness of marginal change, because the size of the burden affects total costs and the feasibility of extending the intervention to all who would benefit. This is particularly true when considering research and development priorities, but also applies to control priorities. In this regard, DCP2 continues in the spirit of DCP1 in assessing cost-effectiveness analyses of major changes, but it does so more systematically for each of the six regional groupings of low- and middle-income countries used throughout this volume (see map 1, inside the front cover).

What was becoming clear in 1990 is clearer today: focusing health system attention on delivering efficacious and often relatively inexpensive health interventions can lead to dramatic reductions in mortality and disability at modest cost. A valuable dimension of globalization has been the diffusion of knowledge about what these interventions are and how to deliver them. The pace of this diffusion into a country determines the pace of health improvement in that country much more than its level of income. Our purpose is to help speed this diffusion of life-saving knowledge.

The Editors


  1. Arrow, K. J., C. Panosian, and H. Gelband, eds. 2004. Saving Lives, Buying Time: Economics of Malaria Drugs in an Age of Resistance. Washington, DC: National Academies Press. [PubMed: 25009879]
  2. Breman J. G., Alilio M. S., Mills A. The Intolerable Burden of Malaria: II. What's New, What's Needed. American Journal of Hygiene and Tropical Medicine. 2004;71(2 Suppl):1–282. [PubMed: 15331814]
  3. Feachem, R. G. A., T. Kjellstrom, C. J. L. Murray, M. Over, and M. Phillips, eds. 1992. Health of Adults in the Developing World. New York: Oxford University Press.
  4. Gericke C. A., Kurowski C., Ranson M. K., Mills A. Intervention Complexity: A Conceptual Framework to Inform Priority-Setting in Health. Bulletin of the World Health Organization. 2005;83(4):285–93. [PMC free article: PMC2626218] [PubMed: 15868020]
  5. Jamison, D. T., J. G. Breman, A. R. Measham, G. Alleyne, M. Claeson, D. B. Evans, P. Jha, A. Mills and P. Musgrove, eds. 2006. Priorities in Health. Washington, DC: World Bank.
  6. Jamison, D. T., W. H. Mosley, A. R. Measham, and J. L. Bobadilla, eds. 1993. Disease Control Priorities in Developing Countries. New York: Oxford University Press.
  7. Levine, R., and the What Works Working Group. 2004. Millions Saved: Proven Successes in Global Health. Washington, DC: Center for Global Development.
  8. Lopez A. D., C. D. Mathers, M. Ezzati, D. T. Jamison, and C. J. L. Murray, eds. 2006. Global Burden of Disease and Risk Factors. New York: Oxford University Press. [PubMed: 16731270]
  9. Murray, C. J. L., A. D. Lopez, and D. T. Jamison. 1994. "The Global Burden of Disease in 1990: Summary Results, Sensitivity Analysis, and Future Directions." In Global Comparative Assessments in the Health Sector: Disease Burden, Expenditures, and Intervention Packages, ed. C. J. L. Murray, and A. D. Lopez, 97–138. Geneva: World Health Organization. [PMC free article: PMC2486716] [PubMed: 8062404]
  10. World Bank. 1993. World Development Report 1993: Investing in Health. New York: Oxford University Press.
Copyright © 2006, The International Bank for Reconstruction and Development/The World Bank Group.
Bookshelf ID: NBK11794
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