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Lancet. 2018 Mar 17;391(10125):1108-1120. doi: 10.1016/S0140-6736(17)32906-9. Epub 2017 Nov 25.

Universal health coverage and intersectoral action for health: key messages from Disease Control Priorities, 3rd edition.

Author information

1
University of California, San Francisco, San Francisco, CA, USA. Electronic address: djamison@uw.edu.
2
University of Washington, Seattle, WA, USA.
3
RTI International, Seattle, WA, USA.
4
World Bank Group, Washington, DC, USA.
5
Stanford University, Stanford, CA, USA.
6
Harvard T. H. Chan School of Public Health, Boston, MA, USA.
7
University of California, Berkeley, Berkeley, CA, USA.
8
Aga Khan University, Karachi, Pakistan.
9
Harvard Medical School, Boston, MA, USA.
10
Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
11
National Treasury of South Africa, Cape Town, South Africa.
12
The Bill & Melinda Gates Foundation, London, UK.
13
World Health Organization Regional Office for Europe, Copenhagen, Denmark.
14
World Health Organization, Geneva, Switzerland.
15
University of Kelaniya, Kelaniya, Sri Lanka.
16
University of California, San Francisco, San Francisco, CA, USA.
17
Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
18
Center for Global Health, National Cancer Institute, Bethesda, MD, USA; University of Oxford, Oxford, UK.
19
Metabiota, San Francisco, CA, USA.
20
Universidad Peruana Cayetano Heredia, Lima, Peru.
21
Harvard T. H. Chan School of Public Health, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Brigham and Women's Hospital, Boston, MA, USA.
22
Harvard Medical School, Boston, MA, USA; Brigham and Women's Hospital, Boston, MA, USA.
23
University of Toronto, Toronto, ON, Canada.
24
Fogarty International Center, US National Institutes of Health, Bethesda, MD, USA.
25
Center for Global Development, Washington, DC, USA.
26
University of the Witwatersrand, Johannesburg, South Africa.
27
International Clinical Epidemiology Network, New Delhi, India.
28
University of Waterloo, Waterloo, ON, Canada.
29
UNICEF, New York, NY, USA.
30
University of Miami, Miami, FL, USA.
31
Makerere University Medical School, Kampala, Uganda.
32
University of Cambridge, Cambridge, UK.
33
Center for Disease Dynamics, Economics, and Policy, Washington, DC, USA.
34
University of Malaya, Kuala Lumpur, Malaysia.
35
Princeton, University, Princeton, NJ, USA.
36
University Yaoundé I, Yaoundé, Cameroon.
37
National Institute of Psychiatry de la Fuente Muniz, Mexico City, Mexico.
38
Praxis Social Impact Consulting, Washington, DC, USA.
39
London School of Hygiene & Tropical Medicine, London, UK.
40
University of the Philippines, Manila, Philippines.
41
University of Bergen, Bergen, Norway.
42
University of Ibadan College of Medicine, Ibadan, Nigeria.
43
University of Oxford, Oxford, UK.
44
Murdoch Childrens Research Institute, Melbourne, VIC, Australia; University of Melbourne, Melbourne, VIC, Australia.
45
London School of Hygiene & Tropical Medicine, London, UK; Public Health Foundation of India, New Delhi, India.
46
Koc University Medical School, Istanbul, Turkey.
47
International Agency for Research on Cancer, Lyon, France.
48
Yale University, New Haven, CT, USA.
49
Aga Khan University East Africa, Nairobi, Kenya.
50
The Bill & Melinda Gates Foundation, Seattle, WA, USA.
51
The George Institute for Global Health at Peking University Health Science Center, Beijing, China.
52
China National Health Development Research Center, Beijing, China.

Abstract

The World Bank is publishing nine volumes of Disease Control Priorities, 3rd edition (DCP3) between 2015 and 2018. Volume 9, Improving Health and Reducing Poverty, summarises the main messages from all the volumes and contains cross-cutting analyses. This Review draws on all nine volumes to convey conclusions. The analysis in DCP3 is built around 21 essential packages that were developed in the nine volumes. Each essential package addresses the concerns of a major professional community (eg, child health or surgery) and contains a mix of intersectoral policies and health-sector interventions. 71 intersectoral prevention policies were identified in total, 29 of which are priorities for early introduction. Interventions within the health sector were grouped onto five platforms (population based, community level, health centre, first-level hospital, and referral hospital). DCP3 defines a model concept of essential universal health coverage (EUHC) with 218 interventions that provides a starting point for country-specific analysis of priorities. Assuming steady-state implementation by 2030, EUHC in lower-middle-income countries would reduce premature deaths by an estimated 4·2 million per year. Estimated total costs prove substantial: about 9·1% of (current) gross national income (GNI) in low-income countries and 5·2% of GNI in lower-middle-income countries. Financing provision of continuing intervention against chronic conditions accounts for about half of estimated incremental costs. For lower-middle-income countries, the mortality reduction from implementing the EUHC can only reach about half the mortality reduction in non-communicable diseases called for by the Sustainable Development Goals. Full achievement will require increased investment or sustained intersectoral action, and actions by finance ministries to tax smoking and polluting emissions and to reduce or eliminate (often large) subsidies on fossil fuels appear of central importance. DCP3 is intended to be a model starting point for analyses at the country level, but country-specific cost structures, epidemiological needs, and national priorities will generally lead to definitions of EUHC that differ from country to country and from the model in this Review. DCP3 is particularly relevant as achievement of EUHC relies increasingly on greater domestic finance, with global developmental assistance in health focusing more on global public goods. In addition to assessing effects on mortality, DCP3 looked at outcomes of EUHC not encompassed by the disability-adjusted life-year metric and related cost-effectiveness analyses. The other objectives included financial protection (potentially better provided upstream by keeping people out of the hospital rather than downstream by paying their hospital bills for them), stillbirths averted, palliative care, contraception, and child physical and intellectual growth. The first 1000 days after conception are highly important for child development, but the next 7000 days are likewise important and often neglected.

PMID:
29179954
PMCID:
PMC5996988
DOI:
10.1016/S0140-6736(17)32906-9
[Indexed for MEDLINE]
Free PMC Article

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