World Health Organization Publication : 9241590130: Improving Health Outcomes of the Poor

By Jeffrey D. Sachs

Book Id: WPLBN0000212008
Format Type: PDF eBook
File Size: 1.1 MB
Reproduction Date: 2005

Title:	World Health Organization Publication : 9241590130: Improving Health Outcomes of the Poor
Author:	Jeffrey D. Sachs
Volume:
Language:	English
Subject:	Health., Public health, Wellness programs
Collections:	Medical Library Collection, World Health Collection
Historic Publication Date:
Publisher:	World Health Organization


Citation APA MLA Chicago Sachs, J. D. (n.d.). World Health Organization Publication : 9241590130. Retrieved from http://gutenberg.us/

Description
Medical Reference Publication

Excerpt
The Commission on Macroeconomics and Health (CMH) was launched in January 2000 by Dr Gro Harlem Brundtland, Director-General of the World Health Organization. Its mission was to analyze the impact of health on development and to examine ways in which health-related investments could spur economic development. The Commission worked to develop specific recommendations that would save lives, reduce poverty, and spur economic growth through a scaling up of investments in the health sector of developing countries. The final report of the Commission, Macroeconomics and Health: Investing in Health for Economic Development, was released in December 2001. The Commission focused its work on the world’s poorest people, in the world’s poorest countries. Millions of impoverished people die every year of conditions that are readily prevented or treated. Technologies exist to avert millions of deaths due to malaria, TB, HIV/AIDS, diarrhoeal disease, respiratory infection, and other killers. These tragic deaths—and the enormous economic and social costs associated with them—reflect the basic fact that essential life-saving health services are out of reach of hundreds of millions of the world’s poor. And yet, without extending these life-saving interventions, poverty is likely to be exacerbated and to be passed to the next generation. The economic costs of ill health, the Commission documented, are enormous and pervasive. The findings of the Commission are both stark and also encouraging. It will take a lot of money and much more political and organizational effort than has been seen in the past generation to accomplish the tasks at hand. Curbing the HIV/AIDS pandemic, or the resurgence of tuberculosis and malaria, or major killers of children such as diarrhoeal disease and vaccine-preventable diseases, will not happen by itself. Yet the task is possible, with breathtaking achievements possible. The Commission calculates that if the donor countries contribute around 0.1% of their GNP—one penny for every $10 of income—and if that effort is matched by a suitable increase in effort within the low-income countries themselves, it should prove possible to avert 8 million deaths per year by the end of this decade. As of 2007, the donor contribution would be around US$ 27 billion per year, or roughly four times the current US$ 6 billion in official development assistance for health. The reduction in human suffer

Table of Contents
Contents Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .vii Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xi Executive Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 1. The Challenge . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5 1.1 The burden on the poor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9 1.2 Targeting the response . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11 1.3 A world half healthy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13 1.4 The current crisis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15 1.5 A new commitment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17 2. The Opportunity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19 2.1 Avoiding death . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19 2.2 Choosing interventions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24 2.3 Maternal and perinatal mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26 2.4 Childhood illness and vaccine-preventable disease . . . . . . . . . . . . . . . . . . .30 2.5 Malnutrition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .34 2.6 Malaria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .37 2.7 Tuberculosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .41 2.8 Smoking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .43 2.9 HIV/AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .44 2.10 The close-to-client health system . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .50 3. Scaling Up Success . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55 3.1 Addressing the constraints . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .58 3.2 Constraints at the grass roots level . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .59 3.3 Local delivery constraints . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .63 3.4 Top-level constraints . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .69 3.5 Buying out and walking around . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .72 4. Costs and Benefits in Context . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .77 4.1 Calculating the costs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .79 4.2 Estimating benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .85 4.3 Long-term impacts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .94 5. Continuing Commitment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .97 5.1 Scaling up through time . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .99 5.2 Creating knowledge . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .103 5.3 Making history . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .108 Bibliographic Note . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .111 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .113