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Universal health coverage and intersectoral action for health: key messages from Disease Control Priorities, 3rd edition
Open accessAbstract
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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- Chang AY, Horton S, Jamison DT. Chapter 9. Benefit–cost analysis. In: Jamison DT, Gelband H, Horton S, et al, eds. Disease control priorities, 3rd edn. Volume 9. Disease control priorities: improving health and reducing poverty. Washington, DC: World Bank (in press).
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- Jamison DT, Alwan A, Mock CN, et al. Chapter 1. Universal health coverage and intersectoral action for health. In: Jamison DT, Gelband H, Horton S, et al, eds. Disease control priorities, 3rd edn. Volume 9. Disease control priorities: improving health and reducing poverty. Washington, DC: World Bank (in press).
- Watkins DA, Jamison DT, Mills AJ, et al. Chapter 3. Universal health coverage and essential packages of care. In: Jamison DT, Gelband H, Horton S, et al, eds. Disease control priorities, 3rd edn. Volume 9. Disease control priorities: improving health and reducing poverty. Washington, DC: World Bank (in press).
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Metadata
- Authors
- Jamison, D. T., Alwan, A., Mock, C. N., Nugent, R., Watkins, D., Adeyi, O., Anand, S., Atun, R., Bertozzi, S., Bhutta, Z., Binagwaho, A., Black, R., Blecher, M., Bloom, B. R., Brouwer, E., Bundy, D. A. P., Chisholm, D., Cieza, A., Cullen, M., Danforth, K., de Silva, N., Debas, H. T., Donkor, P., Dua, T., Fleming, K. A., Gallivan, M., Garcia, P. J., Gawande, A., Gaziano, T., Gelband, H., Glass, R., Glassman, A., Gray, G., Habte, D., Holmes, K. K., Horton, S., Hutton, G., Jha, P., Knaul, F. M., Kobusingye, O., Krakauer, E. L., Kruk, M. E., Lachmann, P., Laxminarayan, R., Levin, C., Looi, L. M., Madhav, N., Mahmoud, A., Mbanya, J. C., Measham, A., Medina-Mora, M. E., Medlin, C., Mills, A., Mills, J.-A., Montoya, J., Norheim, O., Olson, Z., Omokhodion, F., Oppenheim, B., Ord, T., Patel, V., Patton, G. C., Peabody, J., Prabhakaran, D., Qi, J., Reynolds, T., Ruacan, S., Sankaranarayanan, R., Sepúlveda, J., Skolnik, R., Smith, K. R., Temmerman, M., Tollman, S., Verguet, S., Walker, D. G., Walker, N., Wu, Y., & Zhao, K.
- Affiliations
- University of California, San Francisco (US)
- University of Washington (US)
- RTI International (US)
- World Bank Group (US)
- Stanford University (US)
- Harvard University (US)
- University of California, Berkeley (US)
- Aga Khan University (PK)
- Johns Hopkins University (US)
- National Treasury (ZA)
- Gates Foundation (US)
- World Health Organization Regional Office for Europe (DK)
- World Health Organization (CH)
- Kwame Nkrumah University of Science and Technology (GH)
- University of Oxford (GB)
- Metabiota (United States) (US)
- Universidad Peruana Cayetano Heredia (PE)
- Brigham and Women's Hospital (US)
- University of Toronto (CA)
- National Institutes of Health (US)
- Center for Global Development (US)
- University of the Witwatersrand (ZA)
- International Clinical Epidemiology Network (IN)
- University of Waterloo (CA)
- United Nations Children's Fund (US)
- Makerere University (UG)
- University of Cambridge (GB)
- Center for Disease Dynamics, Economics & Policy (US)
- University of Malaya (MY)
- Princeton University (US)
- Université de Yaoundé I (CM)
- London School of Hygiene & Tropical Medicine (GB)
- University of the Philippines Manila (PH)
- University of Bergen (NO)
- University of Ibadan (NG)
- The University of Melbourne (AU)
- Centre international de recherche sur le cancer (FR)
- Yale University (US)
- Aga Khan University Nairobi (KE)
- Peking University (CN)
- China National Health Development Research Center (CN)
- Corresponding author
- Jamison, Dean T
- ORCID
- Jamison, Dean T
- Alwan, Ala
- Mock, Charles N
- Nugent, Rachel
- Watkins, David
- Adeyi, Olusoji
- Anand, Shuchi
- Atun, Rifat
- Bertozzi, Stefano
- Bhutta, Zulfiqar
- Black, Robert
- Blecher, Mark
- Bloom, Barry R
- Brouwer, Elizabeth
- Bundy, Donald A P
- Chisholm, Dan
- Cieza, Alarcos
- Cullen, Mark
- Danforth, Kristen
- Donkor, Peter
- Dua, Tarun
- Gallivan, Mark
- Garcia, Patricia J
- Gawande, Atul
- Gaziano, Thomas
- Gelband, Hellen
- Glass, Roger
- Gray, Glenda
- Holmes, King K
- Horton, Susan
- Hutton, Guy
- Jha, Prabhat
- Kobusingye, Olive
- Krakauer, Eric L
- Kruk, Margaret E
- Lachmann, Peter
- Laxminarayan, Ramanan
- Levin, Carol
- Looi, Lai Meng
- Madhav, Nita
- Mbanya, Jean Claude
- Mills, Anne
- Mills, Jody-Anne
- Montoya, Jaime
- Norheim, Ole
- Olson, Zachary
- Omokhodion, Folashade
- Oppenheim, Ben
- Ord, Toby
- Patel, Vikram
- Patton, George C
- Peabody, John
- Prabhakaran, Dorairaj
- Qi, Jinyuan
- Reynolds, Teri
- Sankaranarayanan, Rengaswamy
- Sepúlveda, Jaime
- Smith, Kirk R
- Temmerman, Marleen
- Tollman, Stephen
- Verguet, Stéphane
- Walker, Damian G
- Walker, Neff
- Wu, Yangfeng
- Zhao, Kun
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 2018-03
- Volume
- 391
- Issue
- 10125
- Pages
- 1108-1120
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- PMC
- PMC5996988
- OpenAlex
- W2768714363
- Cited by
- 227
- References
- 47
- Citations by year
- 2026: 14 · 2025: 11 · 2024: 18 · 2023: 16 · 2022: 23 · 2021: 62 · 2020: 30 · 2019: 29 · 2018: 18
- FWCI
- 4.52
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- The Lancet (acceptedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- Ghent University Academic Bibliography (Ghent University) (submittedVersion)
- eCommons - AKU (Aga Khan University) (submittedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- Bill and Melinda Gates Foundation
- World Bank Group
- World Health Organization
- University of Washington
- National Institute of Diabetes and Digestive and Kidney Diseases (K23DK101826)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Healthcare Systems and Reforms
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Healthcare Systems and Practices
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Global Health Care Issues
- Keywords
- universal health coverage, intersectoral action, non-communicable diseases, health care financing, tobacco taxation, fossil fuel subsidies, financial protection, health information systems, health system governance, low- and middle-income countries
- MeSH terms
- Delivery of Health Care, Health Priorities, Humans, Global Health, Universal Health Insurance
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