Turning neglected tropical diseases into forgotten maladies.

Because they afflict mostly poor people in poor countries, killing relatively few compared to the many who suffer from severe chronic disabilities, a large cluster of infections deserve the label of neglected tropical diseases (NTDs). That is changing as these diseases' enormous health, educational, and economic toll is better understood, including how they interact with HIV/AIDS, malaria, and other illnesses. Several NTDs could be controlled or even eliminated within a decade, using integrated, highly cost-effective mass drug administration programs together with nondrug interventions.

Protecting households from catastrophic health spending.

Many countries rely heavily on patients' out-of-pocket payments to providers to finance their health care systems. This prevents some people from seeking care and results in financial catastrophe and impoverishment for others who do obtain care. Surveys in eighty-nine countries covering 89 percent of the world's population suggest that 150 million people globally suffer financial catastrophe annually because they pay for health services.

Advancement of global health: key messages from the Disease Control Priorities Project.

The Disease Control Priorities Project (DCPP), a joint project of the Fogarty International Center of the US National Institutes of Health, the WHO, and The World Bank, was launched in 2001 to identify policy changes and intervention strategies for the health problems of low-income and middle-income countries. Nearly 500 experts worldwide compiled and reviewed the scientific research on a broad range of diseases and conditions, the results of which are published this week. A major product of DCPP, Disease Control Priorities in Developing Countries, 2nd edition (DCP2), focuses on the assessment of the cost-effectiveness of health-improving strategies (or interventions) for the conditions responsible for the greatest burden of disease.

The perils of adding up: a cautionary tale about modeling and regression analysis.

To turn incomplete or imperfectly reliable information into estimates useful for policy, some modeling is often necessary or helpful. It does not follow that every statistical relation constitutes a model. There has to be an underlying theory, and the numerical estimates must respect any definitional or accounting identities that constrain the results.

Malnutrition and dietary protein: evidence from China and from international comparisons.

Malnutrition, as measured by anthropometric status, is a powerful risk factor for illness and elevated death rates throughout life. Understanding the relative importance of disease, dietary quantity, and dietary quality in causing malnutrition is therefore of major importance in the design of public policy. This paper contributes to the understanding of the relative importance of quantity and quality of diet by utilizing aggregate data to complement previously reported individual-level studies.

Basic patterns in national health expenditure.

Analysed in this paper are national health accounts estimates for 191 WHO Member States for 1997, using simple comparisons and linear regressions to describe spending on health and how it is financed. The data cover all sources - out-of-pocket spending, social insurance contributions, financing from government general revenues and voluntary and employment-related private insurance - classified according to their completeness and reliability. Total health spending rises from around 2-3% of gross domestic product (GDP) at low incomes (< 1000 US dollars per capita) to typically 8-9% at high incomes (> 7000 US dollars).

[Challenges to Latin-American health systems: what can be learned from the European experience?].

This article compares the challenges of health systems in Latin America and the experience in Europe. The framework is the analysis of four functions: a) to generate resources; b) to produce activities; c) to finance, and d) to exercise stewardship. It is at this level where actors can influence health system responsiveness.

Cost-effectiveness as a criterion for public spending on health: a reply to William Jack's 'second opinion'.

Cost-effectiveness analysis (CEA) deals with the principal health effect that enters any valuation of benefits, without the difficulty of moneterizing health gains or treating differences among individuals in how they value health improvements. Much of Jack's criticism of CEA is based on misunderstanding of how it should be used. It is often an important criterion for determining how to spend public money on health care, but never the only one.

A critical review of 'a critical review': the methodology of the 1993 World Development Report, 'Investing in Health'.

Since its publication in 1993, the World Bank's World Development Report, Investing in Health, has been subjected to much criticism, particularly over the way it proposes to measure the health losses summarized in the concept of the 'burden of disease', and to establish priorities for health interventions according to the reduction in mortality and disability they could produce and what they would cost. Some of these criticisms are justified, and are recognized by the WDR; others arise from misunderstanding or misapplication of the concepts. Sifting these criticisms to arrive at a better understanding requires looking at what kind of analysis is involved, how the subjective elements of the exercise were determined, and how they can be used to choose which interventions deserve priority when a country cannot meet all its citizens' health needs.

Public spending on health care: how are different criteria related?

At least nine different criteria are relevant for decisions about public spending for health care. These include economic efficiency criteria (public goods, externalities, catastrophic cost, and cost-effectiveness), ethical reasons (poverty, horizontal and vertical equity, and the rule of rescue), and political considerations (especially demands by the populace). Sometimes one criterion should be examined before another one is considered; that is, they are hierarchically related.

Cost-effective malaria control in Brazil. Cost-effectiveness of a Malaria Control Program in the Amazon Basin of Brazil, 1988-1996.

Malaria transmission was controlled elsewhere in Brazil by 1980, but in the Amazon Basin cases increased steadily until 1989, to almost half a million a year and the coefficient of mortality quadrupled in 1977-1988. The government's malaria control program almost collapsed financially in 1987-1989 and underwent a turbulent reorganization in 1991-1993. A World Bank project supported the program from late 1989 to mid-1996, and in 1992-1993, with help from the Pan American Health Organization, facilitated a change toward earlier and more aggressive case treatment and more concentrated vector control.