The World Bank is publishing nine volumes of Disease Control Priorities, 3rd edition
(DCP3) between 2015 and 2018. Volume 9, Improving Health and Reducing Poverty, summarises
the main messages from all the volumes and contains cross-cutting analyses. This Review
draws on all nine volumes to convey conclusions. The analysis in DCP3 is built around
21 essential packages that were developed in the nine volumes. Each essential package
addresses the concerns of a major professional community (eg, child health or surgery)
and contains a mix of intersectoral policies and health-sector interventions. 71 intersectoral
prevention policies were identified in total, 29 of which are priorities for early
introduction. Interventions within the health sector were grouped onto five platforms
(population based, community level, health centre, first-level hospital, and referral
hospital). DCP3 defines a model concept of essential universal health coverage (EUHC)
with 218 interventions that provides a starting point for country-specific analysis
of priorities. Assuming steady-state implementation by 2030, EUHC in lower-middle-income
countries would reduce premature deaths by an estimated 4·2 million per year. Estimated
total costs prove substantial: about 9·1% of (current) gross national income (GNI)
in low-income countries and 5·2% of GNI in lower-middle-income countries. Financing
provision of continuing intervention against chronic conditions accounts for about
half of estimated incremental costs. For lower-middle-income countries, the mortality
reduction from implementing the EUHC can only reach about half the mortality reduction
in non-communicable diseases called for by the Sustainable Development Goals. Full
achievement will require increased investment or sustained intersectoral action, and
actions by finance ministries to tax smoking and polluting emissions and to reduce
or eliminate (often large) subsidies on fossil fuels appear of central importance.
DCP3 is intended to be a model starting point for analyses at the country level, but
country-specific cost structures, epidemiological needs, and national priorities will
generally lead to definitions of EUHC that differ from country to country and from
the model in this Review. DCP3 is particularly relevant as achievement of EUHC relies
increasingly on greater domestic finance, with global developmental assistance in
health focusing more on global public goods. In addition to assessing effects on mortality,
DCP3 looked at outcomes of EUHC not encompassed by the disability-adjusted life-year
metric and related cost-effectiveness analyses. The other objectives included financial
protection (potentially better provided upstream by keeping people out of the hospital
rather than downstream by paying their hospital bills for them), stillbirths averted,
palliative care, contraception, and child physical and intellectual growth. The first
1000 days after conception are highly important for child development, but the next
7000 days are likewise important and often neglected.