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Universal health coverage and intersectoral action for health: key messages from Disease Control Priorities, 3rd edition
Lancet
  • Dean T. Jamison, University of California, San Francisco
  • Ala Alwan, University of Washington
  • Charles N. Mock, University of Washington
  • Rachel Nugent, RTI International
  • David Watkins, University of Washington
  • Olusoji Adeyi, World Bank Group, Washington, DC, USA.
  • Shuchi Anand, Stanford University
  • Rifat Atun, Harvard T. H. Chan School of Public Health
  • Stefano Bertozzi, University of California - Berkeley
  • Zulfiqar Ahmed Bhutta, The Aga Khan University
  • Agnes Binagwaho, Harvard Medical School
  • Robert Black, Johns Hopkins University Bloomberg School of Public Health
  • Mark Blecher, National Treasury of South Africa
  • Barry R. Bloom, Harvard T. H. Chan School of Public Health
  • Elizabeth Brouwer, University of Washington
  • Donald A.P. Bundy, The Bill & Melinda Gates Foundation
  • Dan Chisholm, World Health Organization Regional Office for Europe
  • Alarcos Cieza, World Health Organization, Geneva, Switzerland.
  • Kristen Danforth, University of Washington
  • Nilanthi de Silva, University of Kelaniya
  • Haile T. Debas, University of California
  • Peter Donkor, Kwame Nkrumah University of Science and Technology
  • Tarun Dua, World Health Organization, Geneva, Switzerland
  • Kenneth A. Fleming, University of Oxford
  • Mark Gallivan, Metabiota, San Francisco, CA, USA.
  • Patricia J. Garcia, Universidad Peruana Cayetano Heredia, Lima, Peru.
  • Atul Gawande, Harvard T. H. Chan School of Public Health
  • Thomas Gaziano, Harvard Medical School
  • Hellen Gelband, University of Toronto
  • Roger Glass, Fogarty International Center
  • Amanda Glassman, Center for Global Development
  • Glenda Gray, University of the Witwatersrand, Johannesburg
  • Demissie Habte, International Clinical Epidemiology Network, New Delhi, India
  • King K. Holmes, University of Washington
  • Susan Horton, University of Waterloo
  • Guy Hutton, UNICEF, New York, NY, USA
  • Prabhat Jha, University of Toronto
  • Felicia M. Knaul, University of Miami
  • Olive Kobusingye, Makerere University Medical School
  • Eric L. Krakauer, Harvard Medical School
  • Margaret E. Kruk, Harvard T. H. Chan School of Public Health
  • Peter Lachmann, University of Cambridge
  • Ramanan Laxminarayan, Center for Disease Dynamics, Economics, and Policy, Washington, DC, USA.
  • Carol Levin, University of Washington
  • Lai Meng Looi, University of Malaya
  • Nita Madhav, Metabiota, San Francisco, CA, USA
  • Adel Mahmoud, Princeton, University, Princeton, NJ, USA.
  • Jean Claude Mbanya, University Yaoundé
  • Anthony Measham, World Bank Group, Washington, DC, USA
  • María Elena Medina-Mora, National Institute of Psychiatry de la Fuente Muniz
  • Carol Medlin, Praxis Social Impact Consulting, Washington, DC, USA
  • Anne Mills, London School of Hygiene & Tropical Medicine, London, UK
  • Jody-Anne Mills, World Health Organization, Geneva, Switzerland
  • Jaime Montoya, University of the Philippines
  • Ole Norheim, University of Bergen
  • Zachary Olson, University of California
  • Folashade Omokhodion, University of Ibadan College of Medicine
  • Ben Oppenheim, Metabiota, San Francisco, CA, USA
  • Toby Ord, University of Oxford
  • Vikram Patel, Harvard Medical School
  • George C. Patton, University of Melbourne
  • John Peabody, University of California
  • Dorairaj Prabhakaran, London School of Hygiene & Tropical Medicine
  • Jinyuan Qi MS, Princeton, University, Princeton, NJ, USA
  • Teri Reynolds, World Health Organization, Geneva, Switzerland
  • Sevket Ruacan, Koc University Medical School
  • Rengaswamy Sankaranarayanan, International Agency for Research on Cancer, Lyon, France
  • Jaime Sepúlveda, University of California
  • Richard Skolnik, Yale University
  • Kirk R. Smith, University of California
  • Marleen Temmerman, Aga Khan University
  • Stephen Tollman, University of the Witwatersrand
  • Stéphane Verguet, Harvard T. H. Chan School of Public Health
  • Damian G. Walker, The Bill & Melinda Gates Foundation
  • Neff Walker, Johns Hopkins University Bloomberg School of Public Health
  • Yangfeng Wu, The George Institute for Global Health at Peking University Health Science Center
  • Kun Zhao, China National Health Development Research Center
Publication Date
3-1-2018
Document Type
Article
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.

Citation Information
Dean T. Jamison, Ala Alwan, Charles N. Mock, Rachel Nugent, et al.. "Universal health coverage and intersectoral action for health: key messages from Disease Control Priorities, 3rd edition" Lancet Vol. 391 Iss. 10125 (2018) p. 1108 - 1120
Available at: http://works.bepress.com/marleen_temmerman/177/