Global Health Priority-Setting Beyond Cost-Effectiveness

Global health is at a crossroads. The 2030 Agenda for Sustainable Development has come with ambitious targets for health and health services worldwide. To reach these targets, many more billions of dollars need to be spent on health. However, development assistance for health has plateaued and domestic funding on health in most countries is growing at rates too low to close the financing gap.

National and international decision-makers face tough choices about how scarce health care resources should be spent. Should additional funds be spent on primary prevention of stroke, treating childhood cancer, or expanding treatment for HIV/AIDS? Should health coverage decisions take into account the effects of illness on productivity, household finances, and children's educational attainment, or just focus on health outcomes? Does age matter for priority setting or should it be ignored? Are health gains far in the future less important than gains in the present? Should higher priority be given to people who are sicker or poorer?

Global Health Priority-Setting provides a framework for how to think about evidence-based priority-setting in health. Over 18 chapters, ethicists, philosophers, economists, policy-makers, and clinicians from around the world assess the state of current practice in national and global priority setting, describe new tools and methodologies to address establishing global health priorities, and tackle the most important ethical questions that decision-makers must consider in allocating health resources.

Ole F. Norheim is a physician and a professor of medical ethics, Dept. of Global Public Health and Primary care, University of Bergen, Norway. He co-edited Inequalities in Health (OUP 2013).

Ezekiel J. Emanuel is an oncologist and professor of medical ethics and health policy at the University of Pennsylvania. He has written or edited 10 books, including Prescription for the Future (2017), Reinventing American Health Care (2014), Global Justice and Bioethics (OUP 2012), and the Oxford Textbook of Clinical Research Ethics (OUP 20017).

Joseph Millum holds a joint faculty appointment in the Clinical Center Department of Bioethics and the Fogarty International Center at the US National Institutes of Health. He is co-editor of the book Global Justice and Bioethics (OUP 2012) and the author of The Moral Foundations of Parenthood (OUP 2017).

Foreword: Tore Godal

Part I. Four Perspectives on Priority Setting in Global Health
Section Editor: Ezekiel Emanuel
1. Ezekiel Emanuel. A Donor Country Perspective
2. Addis Tamire Woldemariam. A Developing Country Perspective
3. Ingrid Miljeteig, Addisu Melkie, Frehiwot Berhane, Ermias Dessie, Kristine H. Onarheim. Priorities at the Bedside: Experiences of Catastrophic Health Expenditures in Ethiopia
4. Jesse Bump. What Really Sets Priorities? Method, Context, and Perspective from 150 Years of Priority Setting

Part II. Four Systematic Approaches to Priority Setting
Section editors: Stéphane Verguet and Dean T. Jamison
5. Jeremy Lauer, Melanie Bertram, Alec Morton. Cost-Effectiveness Analysis
6. Stéphane Verguet, Solomon Memirie, Mieraf Taddesse, Dean T. Jamison. Extended Cost-Effectiveness Analysis
7. Lisa Robinson, James Hammitt. Benefit-Cost Analysis
8. Matthew Adler. Social Welfare Functions

Part III. Distributional Concerns
Section editors: Ole F. Norheim and Trygve Ottersen
9. Alex Voorhoeve. Why Health-Related Inequalities Matter and Which Ones Do
10. Dean T. Jamison, Julian C. Jamison, Ole F. Norheim, Stéphane Verguet. Inequality in Survival
11. Ole F. Norheim, Trygve Ottersen, Mieraf Taddesse Tolla, Solomon Memirie, Kjell Arne Johansson. Incorporating Distributional Concerns into Practical Tools for Priority Setting

Part IV. Reconceptualizing Outcomes
Section editors: Kjell Arne Johansson and Joseph Millum
12. Govind Persad, Jess du Toit. The Case for Valuing Non-Health and Indirect Benefits
13. Hilary Greaves. Discounting Future Health
14. Joseph Millum, Espen Gamlund, Emery Ngamasana, Carl Tollef Solberg. Age and the Disvalue of Death

Part V. Process and Practice
Section editor: Jennifer Prah Ruger
15. Amanda Glassman, Kalipso Chalkidou, Ursula Giedion, Yot Teerawattananon. Building institutions for priority-setting: Recommendations from a Center for Global Development Working Group
16. Matthew McCoy, Harald Schmidt, Jennifer Prah Ruger, Marion Danis. The Role of Public Engagement in Priority Setting
17. Trygve Ottersen, Ole Frithjof Norheim. Setting Priorities in the Pursuit of Universal Health Coverage

Part VI. Conclusion: Where Do We Go from Here?
18. Trygve Ottersen, Joseph Millum, Jennifer Prah Ruger, Stéphane Verguet, Kjell Arne Johansson, Ezekiel Emanuel, Dean Jamison, Ole F. Norheim. The Future of Priority Setting in Global Health