Many populations in the world have entered the health transition, leading to population increases and ageing. The rising awareness of the health benefits of prevention and treatment causes and enormous competition for scarce resources among rich and poor. The book quantifies the effects of health determinants on lifetime health for priority setting. It accounts for uncertainties, using demographic techniques. It distinguishes macro-determinants, income, literacy, food and water, and micro-determinants, like smoking and specific interventions. It examines how some 'roads to health' may lead to more lifetime health and at the expense of fewer resources than others.
Populations follow their own path towards health defined by its patterns of determinants, as shown for India, Mexico, and the Netherlands. Analyses show 1) competing health risks causing inertia in disease elimination, and 2) huge potentials for both prevention and treatment. High income may lead to better health; literacy and health services make their own contribution. The stroke example shows that costly care for acute patients yields higher population benefits and is more cost-efficient than prevention of more strokes. A diabetes example shows that, given low budgets, cost-effective care of complications is more useful than expensive diabetes control.
Information on health gains and costs enables policy makers to choose those interventions that, given available resources, maximise health.
Louis Niessen is a senior medical scientist at Erasmus MC, Erasmus University. The past ten years he did research in developed and developing countries, also for WHO. His interests are in priorities, disease burden, and allocative efficiency. He is a registrar in public health with MScs in Health Planning & Finance (London) and Epidemiology (Amsterdam). Trained in obstetrics & surgery he worked in the Peruvian Amazon and Nepalese Himalayas. Next, at the RIVM, he worked on fertility and health, contributing to the UN Environmental Programme.
