05746nas a2201045   4500000000100000008004100001100002500042700002000067700001700087700001600104700001800120700001800138700001800156700001700174700001400191700001700205700001800222700001800240700001700258700001500275700002100290700002000311700001700331700001700348700001600365700002200381700001700403700001700420700001800437700001600455700002100471700002200492700001600514700001700530700001400547700002000561700001800581700002000599700001700619700001900636700001900655700001600674700002000690700001600710700001900726700001600745700001700761700001500778700001600793700001800809700002100827700001800848700001900866700002500885700001600910700001300926700001600939700001700955700001600972700002000988700002301008700001701031700001501048700002001063700001801083700001601101700001801117700002501135700001801160700001301178700001701191700001501208700001801223700001801241700003201259700002101291700002001312700001501332700002201347700002001369700002201389700001801411700001601429700001301445245012601458300001401584490000801598520308001606022001404686       2018                            d1 aPrabhakaran Dorairaj1 aBhutta Zulfiqar1 aPatel Vikram1 aWu Yangfeng1 aWatkins David1 aKruk Margaret1 aPatton George1 aJamison Dean1 aAlwan Ala1 aMock Charles1 aNugent Rachel1 aAdeyi Olusoji1 aAnand Shuchi1 aAtun Rifat1 aBertozzi Stefano1 aBinagwaho Agnes1 aBlack Robert1 aBlecher Mark1 aBloom Barry1 aBrouwer Elizabeth1 aBundy Donald1 aChisholm Dan1 aCieza Alarcos1 aCullen Mark1 aDanforth Kristen1 ade Silva Nilanthi1 aDebas Haile1 aDonkor Peter1 aDua Tarun1 aFleming Kenneth1 aGallivan Mark1 aGarcia Patricia1 aGawande Atul1 aGaziano Thomas1 aGelband Hellen1 aGlass Roger1 aGlassman Amanda1 aGray Glenda1 aHabte Demissie1 aHolmes King1 aHorton Susan1 aHutton Guy1 aJha Prabhat1 aKnaul Felicia1 aKobusingye Olive1 aKrakauer Eric1 aLachmann Peter1 aLaxminarayan Ramanan1 aLevin Carol1 aLooi Lai1 aMadhav Nita1 aMahmoud Adel1 aMbanya Jean1 aMeasham Anthony1 aMedina-Mora María1 aMedlin Carol1 aMills Anne1 aMills Jody-Anne1 aMontoya Jaime1 aNorheim Ole1 aOlson Zachary1 aOmokhodion Folashade1 aOppenheim Ben1 aOrd Toby1 aPeabody John1 aQi Jinyuan1 aReynolds Teri1 aRuacan Sevket1 aSankaranarayanan Rengaswamy1 aSepúlveda Jaime1 aSkolnik Richard1 aSmith Kirk1 aTemmerman Marleen1 aTollman Stephen1 aVerguet Stéphane1 aWalker Damian1 aWalker Neff1 aZhao Kun00aUniversal health coverage and intersectoral action for health: key messages from Disease Control Priorities, 3rd edition.  a1108-11200 v3913 a<p>
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.
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