Prioritarianism for Global Health Investments: Identifying the Worst Off
Prioritarianism for Global Health Investments: Identifying the Worst Off
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DOI：
10.1111/japp.12142
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发表时间：
2018-02-01
影响因子：
1.1
通讯作者：
Millum, Joseph
中科院分区：
文献类型：
--
作者：
Sharp, Daniel;Millum, Joseph
可用于全球卫生援助的资源远远超过需求。面对这种稀缺性，许多人赞同一个原则，即最优先考虑最贫困的人。然而，为了使这一优先原则对分配决策有用，决策者需要知道贫穷意味着什么。在这篇文章中，我们概述了一个不利的概念，适用于确定最坏的小康卫生资源分配决策的目的。根据我们的总体优势观点：（1）处境最差的人是那些在一生中处于最大总体劣势的人;（2）由于过早死亡而放弃的优势，应该像对待其他一次处于劣势的方式一样对待;（3）一个人的处境有多糟糕，取决于在没有干预的情况下会发生在她身上的实际结果，而不是她一次的前景;以及（4）所有重要形式的不利条件都可以用来决定谁的境况最差，而不仅仅是与健康有关的不利条件。最后，我们指出总体优势观点的两个重要影响：第一，英年早逝者属于全球最贫穷的群体;第二，全球疾病负担从传染性疾病向非传染性疾病的流行病学转变不应导致全球卫生支出优先事项的相应转变。
The available resources for global health assistance are far outstripped by need. In the face of such scarcity, many people endorse a principle according to which highest priority should be given to the worst off. However, in order for this prioritarian principle to be useful for allocation decisions, policy-makers need to know what it means to be badly off. In this article, we outline a conception of disadvantage suitable for identifying the worst off for the purpose of making health resource allocation decisions. According to our total advantage view: (1) the worst off are those who have the greatest total lifetime disadvantage; (2) advantage foregone due to premature death should be treated in the same way as other ways of being disadvantaged at a time; (3) how badly off someone is depends on the actual outcomes that will befall her without intervention, not her prospects at a time; and (4) all significant forms of disadvantage count for determining who is worst off, not just disadvantage relating to health. We conclude by noting two important implications of the total advantage view: first, that those who die young are among the globally worst off, and second, that the epidemiological shift in the global burden of disease from communicable to non-communicable diseases should not lead to a corresponding shift in global health spending priorities.