Book Review

Disease Control Priorities in Developing Countries

N Engl J Med 2006; 355:1074-1075September 7, 2006

Article

Disease Control Priorities in Developing Countries
Second edition. Edited by Dean T. Jamison, Joel G. Breman, Anthony R. Measham, and others. 1401 pp., illustrated. New York, World Bank/Oxford University Press, 2006. $125. ISBN: 0-8213-6179-1 (The entire book is available online and free of charge at .)

Improving global health is beneficial to both rich and poor countries. It is vital to economic development, global security against emerging infections, and political stability in countries ravaged by famine and disease. A new generation of economists tells us that investments in disease prevention and health care in the developing world can bring substantial returns in economic growth and poverty reduction to these countries. Although long underfunded, the health community's efforts to address health problems in the developing world are now reaching a level of support and interest never witnessed before — a level that is beginning to meet the challenge.

This second edition of Disease Control Priorities in Developing Countries, published in conjunction with a companion book, by Alan Lopez and others, Global Burden of Disease and Risk Factors (New York: World Bank/Oxford University Press, 2006), serves as a roadmap for this challenge. It is a landmark reference for physicians, researchers, policymakers, and politicians who make decisions about improving the health of people in the developing world. The collaborative effort, led by economist Dean Jamison and including more than 300 contributors, was supported by the Fogarty International Center at the National Institutes of Health, the World Bank, the World Health Organization, and the Bill and Melinda Gates Foundation.

The first edition, published in 1993, and a companion document, World Development Report 1993: Investing in Health, published by the World Bank, helped change the landscape of health and development. These publications introduced a new metric for measuring disease outcome: the disability-adjusted life year, or DALY, which quantifies not only the years of health and potential life lost as a result of premature death but also the effect of disabilities inherent in chronic diseases, such as psychiatric disorders and arthritis. The second edition of Disease Control Priorities in Developing Countries assesses the value and cost-effectiveness of numerous clinical and public health interventions and identifies a smaller group of interventions that could be considered “best buys” for health. For policymakers, these best buys read like a shopping list of priorities to consider when preparing a country's health budget and addressing the question, “What is the best way to spend $1 million on health issues?” For health professionals in the field, the list indicates interventions that should be targeted now, and it broadens the horizon for future interventions.

Overall, the book constitutes an in-depth analysis of a wide range of health issues, with a focus on the diversity of interventions and their cost-effectiveness. The authors note that over the past four decades, life expectancy in the developing world, with the exception of Africa, has been increasing by several years per decade. In China, for example, a child born in 1960 could expect to live only 39 years, whereas a child born in 2000 could expect to live approximately 70 years. This increase is the greatest extension of life in history.

I recommend reading the first three chapters of the book, which summarize and introduce its overriding themes. The first chapter provides an overview of the work (by Jamison), the second a summary of key findings on the cost-effectiveness of interventions (by Ramanan Laxminarayan and colleagues), and the third a review of how to better manage health systems to improve access to care (by Anne Mills and colleagues). The book's remaining 70 chapters cover a broad spectrum of the diseases and strategies for control that confront policymakers in the developing world. For readers preferring an abbreviated version of this book, Jamison and colleagues offer Priorities in Health (New York: World Bank/Oxford University Press, 2006), which is available in six languages.

Who might make use of the lessons of this book, aside from the above-mentioned audience of physicians, researchers, policymakers, and politicians? The book is dedicated to Bill and Melinda Gates, whose “vision, leadership, and financing . . . have catalyzed global support for transforming the lives of the world's poor through inexpensive but powerful health interventions.” Bill Gates is reported to have read the first edition of this work and to have gained his interest in global health and philanthropy in part from his friendship with Warren Buffet, who reportedly gave him a copy of the 1993 World Development Report. Gates's leadership and commitment in this area have challenged political leaders to commit more than $50 billion to global health over the next decade through the Global Alliance for Vaccines and Immunization, the International Finance Facility, the Roll Back Malaria Partnership, the President's Emergency Program for AIDS Relief, and other initiatives. Added to Gates's leadership are the voices of new spokespersons — Bono, Nelson Mandela, Kofi Annan, Angelina Jolie, President Jimmy Carter, President Bill Clinton, and President George H.W. Bush — people who, in the course of a mere decade, have been helping to radically change the future of global health. The second edition of Disease Control Priorities in Developing Countries will provide a new menu of activities from which its readers can choose to continue the most sensible path toward investing in health, removing inequities in health care, and promoting economic development and peace. Perhaps like Gates, other philanthropists will read it and be motivated to act.

Roger Glass, M.D., Ph.D.
National Institutes of Health, Bethesda, MD 20892