Universal health coverage and intersectoral action for health: key messages from Disease Control Priorities, 3rd edition.
Universal health coverage and intersectoral action for health: key messages from Disease Control Priorities, 3rd edition.
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DOI：
10.1016/s0140-6736(17)32906-9
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发表时间：
2018-03-17
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影响因子：
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通讯作者：
Zhao K
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作者：
Jamison DT;Alwan A;Mock CN;Nugent R;Watkins D;Adeyi O;Anand S;Atun R;Bertozzi S;Bhutta Z;Binagwaho A;Black R;Blecher M;Bloom BR;Brouwer E;Bundy DAP;Chisholm D;Cieza A;Cullen M;Danforth K;de Silva N;Debas HT;Donkor P;Dua T;Fleming KA;Gallivan M;Garcia PJ;Gawande A;Gaziano T;Gelband H;Glass R;Glassman A;Gray G;Habte D;Holmes KK;Horton S;Hutton G;Jha P;Knaul FM;Kobusingye O;Krakauer EL;Kruk ME;Lachmann P;Laxminarayan R;Levin C;Looi LM;Madhav N;Mahmoud A;Mbanya JC;Measham A;Medina-Mora ME;Medlin C;Mills A;Mills JA;Montoya J;Norheim O;Olson Z;Omokhodion F;Oppenheim B;Ord T;Patel V;Patton GC;Peabody J;Prabhakaran D;Qi J;Reynolds T;Ruacan S;Sankaranarayanan R;Sepúlveda J;Skolnik R;Smith KR;Temmerman M;Tollman S;Verguet S;Walker DG;Walker N;Wu Y;Zhao K
世界银行将在2015年至2018年期间出版9卷《疾病控制优先事项》第3版（DCP 3）。第9卷，《改善健康和减少贫困》，总结了所有卷的主要信息，并包含交叉分析。本评论借鉴了所有九卷来传达结论。DCP 3中的分析是围绕九卷中开发的21个基本软件包构建的。每一个基本的一揽子计划都涉及一个主要专业团体的关切（例如儿童保健或外科手术），并包含一系列部门间政策和卫生部门干预措施。共确定了71项部门间预防政策，其中29项是尽早实行的优先政策。卫生部门内的干预措施分为五个平台（以人口为基础、社区一级、保健中心、一级医院和转诊医院）。DCP3界定了基本全民健康覆盖的模式概念，其中有218项干预措施，为针对具体国家的优先事项分析提供了一个起点。假设到2030年实现稳态实施，EUHC在中低收入国家每年将减少约420万例过早死亡。估计的总成本相当可观：约占低收入国家（当前）国民总收入的9.1%，占中低收入国家国民总收入的5.2%。为持续干预慢性病提供的资金约占估计增量成本的一半。对于中低收入国家来说，实施EUHC所带来的死亡率下降只能达到可持续发展目标所要求的非传染性疾病死亡率下降的一半左右。要充分实现这一目标，就需要增加投资或持续采取部门间行动，财政部采取行动，对吸烟和污染排放征税，并减少或取消对化石燃料的补贴（往往是大量补贴），这似乎至关重要。DCP 3旨在成为国家层面分析的一个模型起点，但各国的具体成本结构、流行病学需求和国家优先事项通常会导致EUHC的定义因国而异，也与本审查中的模型不同。由于欧盟卫生保健委员会的实现越来越依赖于更多的国内资金，而全球卫生发展援助更多地侧重于全球公益物，因此，《发展合作方案3》尤其具有相关性。除了评估对死亡率的影响外，DCP 3还研究了EUHC的结果，这些结果不包括在残疾调整生命年指标和相关成本效益分析中。其他目标包括财政保护（上游可能更好地提供，使人们远离医院，而不是下游为他们支付医院账单），避免死产，姑息治疗，避孕以及儿童身体和智力发育。怀孕后的前1000天对孩子的发育非常重要，但接下来的7000天也同样重要，而且往往被忽视。
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.