Priority-setting in global health
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In global health, priority-setting is a term used for the process and strategy of deciding which health interventions to carry out. Priority-setting can be conducted at the disease level (i.e. deciding which disease to alleviate), the overall strategy level (i.e. selective primary healthcare versus primary healthcare versus more general
health systems strengthening Health systems strengthening (also health system strengthening, abbreviated HSS) is a term used in global health that roughly means to improve the health care system of a country. Within this general definition, it can mean increasing funding for h ...
), research level (i.e. which health research to carry out), or other levels.


Definitions

Priority-setting is the act of deciding which health interventions to carry out, and can occur at several levels of granularity. Priority-setting can occur at the following levels: * health budget level (i.e. deciding how much to spend on health overall) * overall strategy level (i.e. selective primary healthcare versus primary healthcare versus more general
health systems strengthening Health systems strengthening (also health system strengthening, abbreviated HSS) is a term used in global health that roughly means to improve the health care system of a country. Within this general definition, it can mean increasing funding for h ...
) * disease level (i.e. deciding which disease to alleviate) * intervention level within each disease (i.e. restricting to a specific disease and prioritizing among interventions for that disease) * drug level * research level (i.e. which health research to carry out) Synonymous terms include "prioritization in health care and health research", "priority determination", "health priorities", and "agenda-setting".


Metrics

Various metrics have been used to compare interventions. These include: *
Disability-adjusted life year The disability-adjusted life year (DALY) is a measure of overall disease burden, expressed as the number of years lost due to ill-health, disability or early death. It was developed in the 1990s as a way of comparing the overall health and life ex ...
per unit cost (used by e.g. Disease Control Priorities Project), quality-adjusted life year, and other forms of
cost-effectiveness analysis Cost-effectiveness analysis (CEA) is a form of economic analysis that compares the relative costs and outcomes (effects) of different courses of action. Cost-effectiveness analysis is distinct from cost–benefit analysis, which assigns a monetar ...
* Reasons that the
disease burden Disease burden is the impact of a health problem as measured by financial cost, mortality, morbidity, or other indicators. It is often quantified in terms of quality-adjusted life years (QALYs) or disability-adjusted life years (DALYs). Both o ...
has persisted * Adequacy of funding


Who sets the priorities?

Priority-setting can be done by various actors. These include: * Governments: "In most countries, health spending by governments vastly outpaces international health aid, so governments set most health priorities." * Non-profits and companies that assist governments * If a country is using a Health in All Policy (HiAP) approach, then priority-setting is done by stakeholders who do not directly deal with health. * International organizations * Foundations * Private donors (including
high-net-worth individual High-net-worth individual (HNWI) is a term used by some segments of the financial services industry to designate persons whose investible wealth (assets such as stocks and bonds) exceeds a given amount. Typically, these individuals are defined ...
s and ultra-high-net-worth individuals): "A common outcome is a negotiated set of priorities that reflect some domestic needs and some technical, political, and economic considerations defined largely by the interests of donors." In some highly aid-dependent countries, donors "have huge influence on health priorities". According to
Devi Sridhar Devi Lalita Sridhar FRSE (born 1984) is an American public health researcher, who is both professor and chair of global public health at the University of Edinburgh, Scotland. Her research considers the effectiveness of public health intervent ...
, professor of global health at the
University of Edinburgh The University of Edinburgh ( sco, University o Edinburgh, gd, Oilthigh Dhùn Èideann; abbreviated as ''Edin.'' in post-nominals) is a public research university based in Edinburgh, Scotland. Granted a royal charter by King James VI in 15 ...
, "the priorities of funding bodies largely dictate what health issues and diseases are studied". Usually at a level of equity and are done by decision-makers closely working alongside marginalized communities and people being influenced. Stakeholder engagement involvements is critical in priority-settings as it establishes if the decisions made by the various actors reflect what the population needs as well as if they are appropriate and accurate. Priority setting decision-makers often make it a point to not only provide assistance and resources but to also give voices to those who are often unheard and invisible in the privileged system. Oftentimes, these priorities address more than just socioeconomic status but also inequalities such as gender, race, and religion inequalities. Policies take a long time to process because of how specific they tend to be. Once a consensus has been reached between the priority setting makers and the communities, there might be challenges and problems that could arise based on the health intervention being pushed by the priority. Due to the complexity of the inequalities, aspects such as the levels of population health and the distribution of health are being considered which could also be looked at through economical lenses. Although decision makers have the power to constraint and provide aid, there also tends to be an asymmetric information as health organizations might overestimate which priorities are desired.


History of organizations and programs working on priority-setting

Global-level priority-setting has occurred since at least the 1980s, though these efforts have only focused on a few aspects. The following table is a timeline of organizations and programs working on priority-setting.


Reception

Rudan et al. says that priority-setting efforts have relied on "consensus reached by panels of experts" and as a result have not been systematic enough, and that this has "often made it difficult to present the identified priorities to wider audiences as legitimate and fair". Glassman et al. notes that criticisms of priority-setting include "the weak data on which estimates of burden, cost, and effectiveness relied; the value judgments implicit in disability-adjusted life year age weighting and discounting decisions; and treatment of equity issues, as well as the political difficulties associated with translating a ground zero package into a public budget based on historical inputs"; and the consideration of only health maximization at the expense of other objectives such as fairness. Glassman et al. also notes how there are more cost-effectiveness studies for LMICs (in the thousands), but that these are unlikely to be actually applied to priority-setting processes. Jeremy Shiffman has said that some bodies such as the Institute for Health Metrics and Evaluation and ''
The Lancet ''The Lancet'' is a weekly peer-reviewed general medical journal and one of the oldest of its kind. It is also the world's highest-impact academic journal. It was founded in England in 1823. The journal publishes original research articles, ...
'' are prominent in priority-setting due to their dominion rather than data and analysis, and also notes that the process of creating the
Sustainable Development Goals The Sustainable Development Goals (SDGs) or Global Goals are a collection of 17 interlinked objectives designed to serve as a "shared blueprint for peace and prosperity for people and the planet, now and into the future".United Nations (2017) R ...
was not sufficiently transparent.


See also

*
Timeline of global health This page is a timeline of global health, including major conferences, interventions, cures, and crises. Big picture Late 1700s–1930s (pre-WWII era) During this pre-WWII era, there are three big trends that operate separately, but sometimes ...
*
Effective altruism Effective altruism is a philosophical and social movement that advocates "using evidence and reason to figure out how to benefit others as much as possible, and taking action on that basis". People who pursue the goals of effective altruism, c ...
* Cost-benefit analysis *
Global Burden of Disease Study The Global Burden of Disease Study (GBD) is a comprehensive regional and global research program of disease burden that assesses mortality and disability from major diseases, injuries, and risk factors. GBD is a collaboration of over 3600 researche ...
*
10/90 gap The 10/90 gap is the term adopted by the Global Forum for Health Research to highlight the finding by the Commission on Health Research for Development in 1990, that less than 10% of worldwide resources devoted to health research were put towards he ...
* Health economics *
Health care rationing Health care rationing refers to mechanisms that are used for resource allocation (''viz.'' ration) in health care. Overall health care United States Healthcare rationing in the United States of America is largely accomplished through market forc ...
* Impact evaluation * Impact assessment *
Open Philanthropy Project Open Philanthropy is a research and grantmaking foundation that makes grants based on the doctrine of effective altruism. It was founded as a partnership between GiveWell and Good Ventures. Its current co-chief executive officers are Holden K ...
, which does broader prioritization work


References

{{reflist, 30em Global health