One of the most highly beloved institutions in the UK, the National Health Service (NHS), was created after the second world war as a way to provide healthcare for all British citizens, free at the point of purchase. While this did not entirely eradicate healthcare inequality within the UK (rich British citizens still have far better health than their poorer counterparts), it has meant that all British citizens do have access to some of the best healthcare facilities the world has to offer, with around £3,000 spent per person per year in the UK on healthcare. Partially as a result of this, few people in the UK today die from easily treatable communicable diseases.
While this is the case in many high-income countries, millions of people, largely concentrated in sub-Saharan Africa, still suffer from easily preventable diseases and have little to no access to high-quality healthcare. This has led to enormous suffering in these regions, with communities plagued by diseases that are prevented or treated in high-income countries with effective and well-funded healthcare systems.
Access to healthcare has been steadily improving throughout the world, but a significant proportion of humanity still have healthcare that pales in comparison to that which is available in high-income countries, and millions of people in poverty die every year as a result of illnesses that many nations would prevent or treat without a second thought.
In this second session, we will be evaluating the state of global health, the burden of disease in low-middle income countries, and recent progress in this area.
Core Reading (~120 mins)
Global Health
What’s a DALY?
Global Burden of Disease
Spend ~10 minutes exploring the differences between the burden of disease in high-income countries and low- and middle-income countries.
- On the treemap (boxes in a rectangle), see how many of the world’s DALYs are caused by communicable diseases (seen in red)
- Change the location to “Low SDI” (Socio-demographic Index) then change to “High SDI” to compare the types of illnesses affecting people in low- vs high-income countries, especially related to communicable, maternal, neonatal and nutritional diseases.
- Go to settings, then in the results column, change to life expectancy to see how life expectancy differs across the world
What are some of the common diseases in low-income countries like?
Spend ~15 minutes reading about the causes of these common diseases, how widespread they are, and how they can be prevented or treated.
Malaria
Parasitic worms
Vitamin A deficiency
Healthcare costs in different regions
- This article discusses how much the NHS is willing to spend to reduce a certain amount of disease burden in the UK, using QALYs as a metric (related to the DALY, however we aim to get the most QALYs while we want to minimise DALYs).
- It suggests the NHS is willing to pay for treatments that are cheaper than £20,000 per extra year of healthy life (per QALY) provided
- This document discussed different methods used to determine the “value of life” - a controversial topic, but necessary for governments to allocate resources effectively.
- These estimates for the value of life (~35 QALYs is a common definition) range from £100,000 to £10,000,000.
- This spreadsheet comes from GiveWell’s annual cost-effectiveness model, and shows (in the results) that charities such as the Against Malaria Foundation can “save a life” for around £3,000 ($4,100).
- With a “life saved” equivalent to 35 QALYs (35 additional years of healthy life), it’s suggested that AMF can help to provide one QALY for around £100.
Discussion
Questions to think about when reading and reflecting upon this literature
- Can quantitative estimates of impact be useful even if they’re imprecise? How can we go about comparing different interventions/cause areas?
- How useful are QALYs?
- How useful is considering importance, tractability, and neglectedness?
- How useful is expected value (EV)?
- How much should we prioritise easily treatable diseases when thinking about charitable giving?
- Why do you think high-income countries are mostly affected by non-communicable diseases, while low-income countries are affected by communicable diseases?
- What are some of the best ways for governments to decide how to allocate scarce healthcare resources?
- How useful are metrics like DALYs to determine where global healthcare resources should be allocated?
- What did you previously think were the most widespread illnesses that might affect people in low-income countries? How has your understanding changed after the reading, if at all?
