Chronic Diseases seem to finally be attracting more attention within the Global Health Policy community.  This December’s issue of Health Affairs takes a real “global” look at the topic and it contains a series of interesting research articles that look at house a number of countries, mostly from Latin America but also in Europe, are tackling these diseases worldwide.  There is some fascinating stuff here and I would encourage you to have a browse if you are interested in this stuff.


A few highlights from the issue:

1.  Amanda Glassman and colleagues, the newest member of the CGD Global Health Team, looks at the burden of chronic diseases throughout Latin America in the Caribbean.  Some startling facts: almost one in ten residents of Mexico City are believed to have diabetes and more than half of urban residents of Brazil are believed to have high cholesterol.

2.  My NYU colleague James Macinko and co-authors look at how the expansion of primary care services in Brazil may have led to decreased hospitalizations for chronic diseases.

3.  Ricardo Bitran and colleagues look at how expansion of health insurance in Chile may have led to lower rates of hospitalization and mortality.  When I was studying my masters in Health Policy and Management at the Harvard School of Public Health I spent a month in Chile studying the design and adoption of these health reforms, so it is exciting to see research on the outcomes of these reforms.

There is more good stuff there, so have a look.

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A new report, which was launched Tuesday morning in New York City by the Institute for Health Metrics and Evaluation, provides new estimates of the levels and trends in Development Assistance for Health (DAH) as well as government financing of health services in low and middle-income countries around the world.  The findings on DAH represent a significant update to previous estimates of DAH, in particular those related by the same organization last year.

In true IHME-style, the report is based on their own methodology to estimate DAH, rather than rely upon the datasets that currently exist to track DAH.  The IHME dataset on DAH, however, is the first dataset that has been specifically designed to track development assistance for health, rather than all forms of development assistance.  Some of the main features of their dataset are that they:

1.  Distinguished between the source of funding as well as the channel through which the monies flow, which is important in that the landscape of global health donors has become increasingly complicated in recent year, and trying to track money flows has become increasingly complex.

2.  Added data from non-governmental organizations, which play a significant role in financing health services around the world. However, the methods they have used to value the in-kind contributions of non-governmental organizations and other enterprises is different than it has been in the past, and therefore the most recent estimates of NGO channeled DAH are lower than before.

3.  Tracked funding allocated to particular diseases areas, such as HIV, malaria, maternal and newborn health, as well as health system support.  Clearly this is something that is useful when it comes to analyzing global health financing trends.

Since most of the findings of this report are mostly updates on previous estimates, most of what was presented was not particularly groundbreaking news.

However, there are some new and interesting things in this new report:

Normally in order to estimate DAH there is a lag of a few years before aggregate estimates are released by those agencies responsible for reporting DAH flows.  Rather than waiting for these agencies to collect data from agencies and then release their estimates, the IHME has instead made its own projections of donor aid flows for health through the end of 2010 (yes, even into the future).  According to their projections, DAH has actually continued to climb over the past few years – despite the global financial crises.  That is right, funding has increased, despite what some people have claimed.  A bit more detailed analysis, however, suggests that these increases have really only resulted because of increases in spending from the US, the UK, GAVI, and the Global Fund.  If we take these donors out of the picture, donor financing actually peaked in 2008.  Nonetheless, development assistance for health has continued to roll in.

Of course, as I said this finding is based on projections, not reports of actual contributions.  I was actually in attendance at the report launch on Tuesday morning and asked Chris Murray about how good he thought these projections really were (I am not sure he appreciated my comparing projecting DAH flows to trying to project housing prices a few years back!).  Chris argued that in the past what bilateral donors have said that they would allocated has been quite close in reality to what they have actually allocated, but of course, it is a whole new world today.  Similarly it is possible some of the money projected to be received by the UN agencies and non-governmental organizations might actually be lower than expected.  So I think we should see these as upper limits but probably reasonable estimates.

The other big and interesting finding is that the channel of assistance that seems to have contracted the most during the financial crises was funding from non-governmental organizations, specifically the funding that comes from individual citizens to these organization.  There has been a lot of talk about expanding funding from private citizens for global health and I think this points to a big weakness of relying on private citizens to fund important programs: they are fickle donors.  It also means that other channels have more than compensated for these declines, again pointing to a much rosier picture of development assistance than has perhaps been portrayed in the media.

Still lacking in any of this, however, is any understanding of what these monies do.  It is hard to answer questions of this nature without good data.  So once again the IHME has given us a new set of global health estimates to help us address some of these more important questions.

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