Improving the Health of Populations: Lessons of Experience

Washington (DC)
In book: Disease Control Priorities in Developing Countries, Edition: 2nd, Chapter: Chapter 8, Publisher: World Bank, Editors: Dean T Jamison, Joel G Breman, Anthony R Measham, George Alleyne, Mariam Claeson, David B Evans, Prabhat Jha, Anne Mills, Philip Musgrove
Source: PubMed


In the past 50 years, the world has experienced enormous and unprecedented gains in the health of human populations. Progress has been especially apparent in developing countries. Average life expectancy has risen by more than 60 percent, from 40 years in 1950 to 65 years today. In 1950, roughly 28 percent of children died before their fifth birthday, but by 1990, this number had fallen to 10 percent. Furthermore, many of the world's most deadly and debilitating diseases, including leprosy, measles, poliomyelitis (polio), and many childhood illnesses, have been effectively contained in most areas and virtually eliminated in others. Smallpox, a highly contagious and deadly disease that affected more than 50 million people a year prior to 1950, has been completely eradicated. Researchers have identified economic growth, rising incomes, and better living conditions brought about by rapid social and political transformations in many societies as major contributors to these impressive health gains. However, in recent years, the role of scientific and technological progress has emerged as a crucial, but little understood, factor underlying these gains. As Davis (1956, 306–7) observes,"It seems clear that the great reduction of mortality in underdeveloped areas since 1940 has been brought about mainly by the discovery of new methods of disease treatment applicable at reasonable cost [and] by the diffusion of these new methods." New research has sought to validate, and indeed quantify, this basic intuition. For example, Jamison, Lau, and Wang (2005) show that technological progress (which is broadly defined as the generation or adoption of new technologies), together with education, has been a far more important contributor to declining infant mortality rates in developing countries than income growth. Furthermore, improvements in health brought about by investments in technological progress generate an important and positive feedback loop favoring economic growth and development in these countries. An important question that follows is what can be done to further consolidate these gains and ensure that the fruits of scientific and technology progress are placed in the hands of the people in developing countries who stand to benefit most? Because the work of the Disease Control Priorities Project (DCPP) focuses primarily on identifying the most cost-effective interventions for diseases and conditions affecting the health of populations in developing countries, this work provides the starting point for analysis. The goal is to isolate the critical factors—in particular those "actionable" through specific public policies—that have contributed to the effective deployment and scaling up of proven cost-effective technologies and services in low-income settings. To address this question, the DCPP joined forces with the Center for Global Development in Washington, DC, to create the What Works Working Group, which was funded by the DCPP and the Bill & Melinda Gates Foundation. DCPP authors were asked to identify outstanding examples of successful implementation of programs and projects geared toward the deployment of proven cost-effective interventions in their respective fields of international health and to speculate on what kinds of programmatic aspects and broader public policy decisions might have contributed to their success. From an initial set of nominations, the What Works Working Group selected a subset of cases that conformed to strict selection criteria, researched them thoroughly, and produced a report to be widely disseminated to policy makers and leading health experts in both developed and developing countries. In parallel, the DCPP initiated a systematic review of the case materials to identify commonalities or factors that may have contributed to the deployment and scaling up of those interventions. The objective was to identify a set of specific policy levers and programmatic decisions that could facilitate the transplantation of those and other cost-effective interventions to new and different settings. This chapter presents the results of that study.

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