July 2006
Literature Review
Advancement of global health: key messages from the Disease Control Priorities Project
Go to full text in PubMed: Laxminarayan R, Mills AJ, Breman JG, et al. Lancet 2006;367;1193
The Disease Control Priorities Project is a joint effort of the Fogarty International Center, NIH, WHO, World Bank and Gates Foundation which was launched in 2001 to identify policy changes and interventions to deal with health problems in developing countries. The following is a selected summary of their conclusions for interventions in a multitude of different health problems expressed as cost effective according to disability-adjusted life years averted.
| Diseases/Intervention | DALY* |
Tuberculosis | $5-35 $40-170 $4,000-25,000 $70-450 |
| HIV/AIDS Prevention-counseling high risk groups Voluntary testing & counseling Condom promotion & distribution Blood & needle safety Treatment of STDs Treatment of HIV | $1-74 $14-261 $19-205 $4-51 $16-105 $350-500 |
| Vaccine preventable diseases DPT, polio, & measles Rotavirus immunization Cholera immunization | $13-24 $1402-8357 $1658-8274 |
| Diarrheal disease Oral rehydration Breast-feeding promotion Water sanitation | $132 $527-2001 $1118-14,901 |
| Malaria Insecticide treated bednets Insecticide spraying | $5-17 $13-24 |
*DALY = Disability-adjusted life-years
The authors conclude with a tabulation of what they consider to be four important challenges that face the world in the 21st century.
- High levels of non-communicable conditions in developing countries (such as heart disease, cancer, traffic accidents and smoking)
- The HIV pandemic
- The possibility of an influenza pandemic similar to that of 1918
- The persistence of population subgroups with high levels of preventable disease (such as malaria, tuberculosis, diarrhea, and pneumonia)
They urge wider use of interventions that have already proven cost-effective and more attention to some of the non-communicable diseases noted above. They also urge more research to identify those prevention and treatment programs that are likely to be most effective.
Literature Review by John G. Barlett, M.D. Professor, Division of Infectious Diseases