RESUMO
Developing country governments and aid agencies face difficult decisions on how best to allocate their finite resources. Investments in many different sectors -including education, water and sanitation, transportation, and health- can all reap social and economic benefits. This report focuses specifically on the health sector. It presents compelling evidence of the value of scaling-up health investments. The economic case for increasing these investments in health has never been stronger. Having made progress in reducing maternal and child mortality, and deaths from infectious diseases, it is essential that policymakers do not become complacent. These gains will be quickly reversed without sustained health investments. Scaled-up investments will be needed to tackle the emerging non-communicable disease (NCD) burden and to achieve universal health coverage (UHC). The value of investment in health far beyond its performance is reflected in economic prosperity through gross domestic product (GDP). People put a high monetary value on the additional years of life that health investments can bring -an inherent value to being alive for longer, unrelated to productivity. Policymakers need to do more to ensure that spending on health reflects people's priorities. To make sure services are accessible to all, governments have a clear role to play in financing health. Without public financing, there will be some who cannot afford the care they need, and they will be forced to choose sickness -perhaps even death- and financial ruin; a devastating choice that already pushes 150 million people into poverty every year. In low-income countries (LICs) and middle-income countries (MICs), public financing should be used to achieve universal coverage with a package of highly cost-effective interventions ('best buys'). Governments failing to protect the health and wealth of their people in this way will be unable to reap the benefits of long-term economic prosperity and growth. Public financing has the benefit of being more efficient and better at controlling costs than private financing and is the only sustainable way to reach UHC. In addition, people put a high economic value on the protection against financial risk that public financing provides. This report addresses three key questions: 1) What is the economic rationale for investing in health?; 2) what is the best way to finance health?, and 3) which interventions should be prioritized?
Assuntos
Promoção da Saúde/economia , Investimentos em Saúde , HumanosRESUMO
Resumen: Los gobiernos de los países en desarrollo y los organismos de ayuda internacional enfrentan decisiones difíciles en cuanto a la mejor manera de asignar sus recursos limitados. Las inversiones en distintos sectores -incluyendo educación, agua y saneamiento, transporte y salud- pueden generar beneficios sociales y económicos. Este informe se enfoca específicamente en el sector salud. Presenta evidencia contundente sobre el valor de ampliar las inversiones en salud. El argumento económico para incrementar estas inversiones en salud nunca ha sido más sólido. Con el progreso que se ha logrado en la reducción de la mortalidad materna e infantil y de las muertes por enfermedades infecciosas, es esencial que los responsables de la formulación de políticas no se vuelvan complacientes. Estos logros se revertirán rápidamente sin inversiones sostenidas en salud. Será necesario ampliar las inversiones para hacer frente a la carga generada por las enfermedades no transmisibles (ENT) emergentes y para alcanzar la cobertura universal de salud (CUS). El valor de la inversión en salud va mucho más allá de su rendimiento reflejado en la prosperidad económica a través del producto interno bruto (PIB). Las personas dan un gran valor monetario a los años de vida adicionales que las inversiones en salud pueden proporcionar -un valor inherente a permanecer con vida por más tiempo, que no tiene que ver con la productividad. Los encargados del diseño de políticas deben esforzarse más para asegurar que el gasto en salud refleje las prioridades de la gente. Para asegurar que los servicios sean accesibles para todos, la función del gobierno en el financiamiento de la salud es muy clara. Sin financiamiento público, habrá quienes no podrán costear los servicios que requieren y se verán forzados a elegir la enfermedad -o incluso la muerte- y la ruina económica, una elección devastadora que ya está llevando a 150 millones de personas a la pobreza cada año. En países de bajos ingresos (PBI) y países de ingresos medios (PIM), el financiamiento público debería ser utilizado para alcanzar la cobertura universal con un paquete de intervenciones altamente costo-efectivas (mejores inversiones u opciones). Los gobiernos que no protejan la salud y el patrimonio de su pueblo de esta manera serán incapaces de obtener los beneficios de una prosperidad económica y un crecimiento a largo plazo. El financiamiento público tiene el beneficio de ser más eficiente y capaz de controlar los costos que el financiamiento privado, y es la única manera sostenible de lograr una CUS. Además, la gente atribuye un alto valor económico a la protección que le provee el financiamiento público contra los riesgos financieros. Este informe aborda tres preguntas clave: 1) ¿Cuál es el fundamento económico para invertir en salud?; 2) ¿cuál es la mejor manera de financiar la salud?, y 3) ¿cuáles son las intervenciones que deben tener prioridad?
Abstract: Developing country governments and aid agencies face difficult decisions on how best to allocate their finite resources. Investments in many different sectors -including education, water and sanitation, transportation, and health- can all reap social and economic benefits. This report focuses specifically on the health sector. It presents compelling evidence of the value of scaling-up health investments. The economic case for increasing these investments in health has never been stronger. Having made progress in reducing maternal and child mortality, and deaths from infectious diseases, it is essential that policymakers do not become complacent. These gains will be quickly reversed without sustained health investments. Scaled-up investments will be needed to tackle the emerging non-communicable disease (NCD) burden and to achieve universal health coverage (UHC). The value of investment in health far beyond its performance is reflected in economic prosperity through gross domestic product (GDP). People put a high monetary value on the additional years of life that health investments can bring -an inherent value to being alive for longer, unrelated to productivity. Policymakers need to do more to ensure that spending on health reflects people's priorities. To make sure services are accessible to all, governments have a clear role to play in financing health. Without public financing, there will be some who cannot afford the care they need, and they will be forced to choose sickness -perhaps even death- and financial ruin; a devastating choice that already pushes 150 million people into poverty every year. In low-income countries (LICs) and middle-income countries (MICs), public financing should be used to achieve universal coverage with a package of highly cost-effective interventions ('best buys'). Governments failing to protect the health and wealth of their people in this way will be unable to reap the benefits of long-term economic prosperity and growth. Public financing has the benefit of being more efficient and better at controlling costs than private financing and is the only sustainable way to reach UHC. In addition, people put a high economic value on the protection against financial risk that public financing provides. This report addresses three key questions: 1) What is the economic rationale for investing in health?; 2) what is the best way to finance health?, and 3) which interventions should be prioritized?
Assuntos
Humanos , Promoção da Saúde/economia , Investimentos em SaúdeRESUMO
BACKGROUND: The United Nations Sustainable Development Goal for health (SDG3) poses complex challenges for signatory countries that will require clear roadmaps to set priorities over the next 15 years. Building upon the work of the Commission on Investing in Health and published estimates of feasible global mortality SDG3 targets, we analysed Mexico's mortality to assess the feasibility of reducing premature (0-69 years) mortality and propose a path to meet SDG3. METHODS: We developed a baseline scenario applying 2010 age-specific and cause-specific mortality rates from the Mexican National Institute of Statistics and Geography (INEGI) to the 2030 UN Population Division (UNPD) population projections. In a second scenario, INEGI age-specific and cause-specific trends in death rates from 2000 to 2014 were projected to 2030 and adjusted to match the UNPD 2030 mortality projections. A third scenario assumed a 40% reduction in premature deaths across all ages and causes. By comparing these scenarios we quantified shortfalls in mortality reductions by age group and cause, and forecasted life expectancy pathways for Mexico to converge to better performing countries. FINDINGS: UNPD-projected death rates yield a 25·9% reduction of premature mortality for Mexico. Accelerated reductions in adult mortality are necessary to reach a 40% reduction by 2030. Mortality declines aggregated across all age groups mask uneven gains across health disorders. Injuries, particularly road traffic accidents and homicides, are the main health challenge for young adults (aged 20-49 years) whereas unabated diabetes mortality is the single most important health concern for older adults (aged 50-69 years). INTERPRETATION: Urgent action is now required to control non-communicable diseases and reduce fatal injuries in Mexico, making a 40% reduction in premature mortality by 2030 feasible and putting Mexico back on a track of substantial life expectancy convergence with better performing countries. Our study provides a roadmap for setting national health priorities. Further analysis of the equity implications of following the suggested pathway remains a subject of future research. FUNDING: Mexico's Ministry of Health, University of California, San Francisco, and Bill & Melinda Gates Foundation.
Assuntos
Diabetes Mellitus/mortalidade , Prioridades em Saúde , Expectativa de Vida , Mortalidade Prematura , Ferimentos e Lesões/mortalidade , Adolescente , Adulto , Idoso , Causas de Morte , Criança , Pré-Escolar , Conservação dos Recursos Naturais , Feminino , Objetivos , Humanos , Lactente , Recém-Nascido , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Doenças não Transmissíveis/mortalidade , Fatores de Risco , Adulto JovemRESUMO
Prompted by the 20th anniversary of the 1993 World Development Report, a Lancet Commission revisited the case for investment in health and developed a new investment framework to achieve dramatic health gains by 2035. The Commission's report has four key messages, each accompanied by opportunities for action by national governments of low-income and middle-income countries and by the international community. First, there is an enormous economic payoff from investing in health. The impressive returns make a strong case for both increased domestic financing of health and for allocating a higher proportion of official development assistance to development of health. Second, modeling by the Commission found that a "grand convergence" in health is achievable by 2035-that is, a reduction in infectious, maternal, and child mortality down to universally low levels. Convergence would require aggressive scale up of existing and new health tools, and it could mostly be financed from the expected economic growth of low- and middle-income countries. The international community can best support convergence by funding the development and delivery of new health technologies and by curbing antibiotic resistance. Third, fiscal policies -such as taxation of tobacco and alcohol- are a powerful and underused lever that governments can use to curb non-communicable diseases and injuries while also raising revenue for health. International action on NCDs and injuries should focus on providing technical assistance on fiscal policies, regional cooperation on tobacco, and funding policy and implementation research on scaling-up of interventions to tackle these conditions. Fourth, progressive universalism, a pathway to universal health coverage (UHC) that includes the poor from the outset, is an efficient way to achieve health and financial risk protection. For national governments, progressive universalism would yield high health gains per dollar spent and poor people would gain the most in terms of health and financial protection. The international community can best support countries to implement progressive UHC by financing policy and implementation research, such as on the mechanics of designing and implementing evolution of the benefits package as the resource envelope for public finance grows.
Assuntos
Saúde Global , Saúde Pública , Planejamento em Saúde Comunitária , Países em Desenvolvimento , Financiamento Governamental , Organização do Financiamento , Objetivos , Política de Saúde , Promoção da Saúde , Humanos , Cooperação Internacional , Investimentos em Saúde , Serviços Preventivos de Saúde , Cobertura Universal do Seguro de SaúdeRESUMO
Con motivo del 20º aniversario del Informe sobre el Desarrollo Mundial 1993, una Comisión de la revista The Lancet reconsideró el argumento a favor de la inversión en salud y desarrolló un nuevo marco de inversión para lograr mejoras dramáticas en materia de salud para el año 2035. El informe de la Comisión contiene cuatro mensajes clave, cada uno acompañado de oportunidades para los gobiernos nacionales de países de ingresos bajos y medios y para la comunidad internacional. En primer lugar, invertir en salud acarrea enormes rendimientos económicos. Las impresionantes ganancias son un fuerte argumento a favor de un aumento en el financiamiento nacional de la salud y de asignar una mayor proporción de la asistencia oficial al desarrollo de la salud. En segundo lugar, en el modelo creado por la Comisión se encontró que es posible lograr para el año 2035 una "gran convergencia" en salud, consistente en la reducción de las tasas de mortalidad materna, infantil y por infecciones a niveles universalmente bajos. Tal convergencia requeriría la ampliación de las herramientas de salud existentes y un incremento agresivo de nuevas herramientas, y podría ser financiada en su mayor parte con recursos derivados del crecimiento económico esperado de los países de ingresos bajos y medios. La mejor manera en que la comunidad internacional puede apoyar la convergencia es financiando el desarrollo y suministro de nuevas tecnologías de salud, y frenando la resistencia a los antibióticos. En tercer lugar, las políticas fiscales -tales como los impuestos al tabaco y al alcohol- son una palanca poderosa y subutilizada que los gobiernos pueden emplear para detener el avance de las enfermedades no transmisibles (ENT) y las lesiones, a la vez que elevan los ingresos públicos para la salud. La acción internacional sobre las ENT y lesiones debería enfocarse en proporcionar asistencia técnica sobre políticas fiscales, en cooperación regional para el combate al tabaquismo y en financiar investigación sobre políticas e implementación para ampliar las intervenciones que enfrenten estos problemas. En cuarto lugar, la universalización progresiva -una vía hacia la cobertura universal de salud (CUS) que incluya desde el comienzo a los pobres- es una manera eficiente de lograr la protección a la salud contra riesgos financieros. Para los gobiernos nacionales, la universalización progresiva produciría elevadas ganancias en salud por cada dólar que se gaste en ésta, y los pobres serían quienes más ganarían en términos tanto de salud como de protección financiera. La mejor manera en que la comunidad internacional puede brindar apoyo a los países para implementar una CUS progresiva es financiando la investigación sobre políticas e implementación, por ejemplo, sobre la mecánica del diseño e instrumentación de la evolución del paquete de beneficios conforme crezca el presupuesto para las finanzas públicas.
Prompted by the 20th anniversary of the 1993 World Development Report, a Lancet Commission revisited the case for investment in health and developed a new investment framework to achieve dramatic health gains by 2035. The Commission's report has four key messages, each accompanied by opportunities for action by national governments of low-income and middle-income countries and by the international community. First, there is an enormous economic payoff from investing in health. The impressive returns make a strong case for both increased domestic financing of health and for allocating a higher proportion of official development assistance to development of health. Second, modeling by the Commission found that a "grand convergence" in health is achievable by 2035-that is, a reduction in infectious, maternal, and child mortality down to universally low levels. Convergence would require aggressive scale up of existing and new health tools, and it could mostly be financed from the expected economic growth of low- and middle-income countries. The international community can best support convergence by funding the development and delivery of new health technologies and by curbing antibiotic resistance. Third, fiscal policies -such as taxation of tobacco and alcohol- are a powerful and underused lever that governments can use to curb non-communicable diseases and injuries while also raising revenue for health. International action on NCDs and injuries should focus on providing technical assistance on fiscal policies, regional cooperation on tobacco, and funding policy and implementation research on scaling-up of interventions to tackle these conditions. Fourth, progressive universalism, a pathway to universal health coverage (UHC) that includes the poor from the outset, is an efficient way to achieve health and financial risk protection. For national governments, progressive universalism would yield high health gains per dollar spent and poor people would gain the most in terms of health and financial protection. The international community can best support countries to implement progressive UHC by financing policy and implementation research, such as on the mechanics of designing and implementing evolution of the benefits package as the resource envelope for public finance grows.
Assuntos
Humanos , Saúde Pública , Saúde Global , Serviços Preventivos de Saúde , Planejamento em Saúde Comunitária , Cobertura Universal do Seguro de Saúde , Países em Desenvolvimento , Financiamento Governamental , Organização do Financiamento , Objetivos , Política de Saúde , Promoção da Saúde , Cooperação Internacional , Investimentos em SaúdeRESUMO
La evaluación integral de la salud precaria (muerte prematura y discapacidad) atribuible a enfermedades y traumatismos particulares es un requisito básico para determinar la efectividad en función del costo de las intervenciones de salud. Se creó un nuevo indicador, el número de años de vida ajustados en función de la discapacidad (AVAD), para determinar la carga de enfermedad y lesiones ocasionada en 1990 por más de 100 causas, por edad, sexo y región. El concepto de AVAD ofrece un método integrado y amplio para captar en su totalidad la proporción de salud precaria que, en promedio, sufrirá una persona durante toda la vida por nuevos casos de enfermedad y lesiones ocurridos en 1990. Este indicador difiere en muchos aspectos de los intentos realizados con anterioridad para evaluar la situación de salud mundial y regional, cuyo alcance siempre ha sido mucho menor y menos detallado y se ha limitado a un reducido grupo de causas. En el presente artículo se resumen las estimaciones de los AVAD por causa, edad, sexo y región para 1990. Por primera vez, los responsables de determinar las prioridades en el sector salud tienen acceso a un conjunto desagregado de estimaciones que, además de facilitar el análisis de la efectividad en función del costo, se pueden emplear para monitorizar los avances logrados a nivel mundial y regional en relación con más de 100 enfermedades. Este documento muestra también cómo dependen las estimaciones de valores particulares de los parámetros que intervienen en el cálculo
Publicado en inglés en el Bull. WHO. Vol. 72(3):495-509, 1994