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Structuring an Argument: Cost-Effective Analysis in Public Health
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Arguing for change
Arguing for change
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Thesis
Thesis
When evaluating future projects in health, we need to extend our cost-effective analysis beyond the current 1 to 10 year period towards a 2 to 3 generational period.
We need to change the length of the GCEA period
We need to change the length of the GCEA period
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Why
Why
Today
Today
Many interventions that are dismissed today as being cost ineffective over a 1 year period would prove to be highly cost effective over a two to three generational period.
What could be: Anecdote
What could be: Anecdote
If the Russian president could have shown a cost effective analysis of treating MDR TB, with the health benefits over 3 generations, then he would have had a valid arguments to present to his people. Therefore, he would still be able to be elected.
A better future
A better future
Better health outcomes
at lower costs
Prompt
Prompt
How do we quantify the future benefits of a project in health?
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Short term analysis
Short term analysis
Depends on the organization the company is doing the assessment for
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World Health Organization (WHO)
World Health Organization (WHO)
Norm: 1 year
Norm: 1 year
5 years
5 years
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US gov offices
US gov offices
9 - 11 year
9 - 11 year
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Introduction
Introduction
Today we tend to quantify the future with cost-effective analysis.
General Cost Effective Analysis (GCEA) definition
General Cost Effective Analysis (GCEA) definition
Change in Cost divided by Change in Health Benefit. The smaller this fraction is, the more cost- effective an intervention is. Though, they also compare that to the results of no treatment.
Supporting Quote
Supporting Quote
Today's international health mentality is still very Utilitarian:
"These days, if you wanted money from big donors for health projects in poor countries, if you wanted to be taken seriously, your proposals had to pass a test, called cost-effectiveness analysis." -Tracy Kidder in "Mountains Beyond Mountains"
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How politics should work
How politics should work
Merit based presidency
Merit based presidency
Jim Kim also suggested in our class that presidential organizations for organizations like WHO should be merit based rather than power based. Maybe then, leaders would be less concerned about being safe and maintaining their power for a second election and more concerned with being bold, since they already have a reputation that put them in the presidential position in the first place.
Mix short and long term goals
Mix short and long term goals
Aid is a political game. Ultimately, what politicians need to be re-elected is some evidence of progress (some short term goals) which would allow them to have the popularity and support to pursue more meaningful, long term goals.
Today
Today
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Long term analysis
Long term analysis
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10+ years, over at least 2 generations into the future
10+ years, over at least 2 generations into the future
Annecdote
Annecdote
We need more projects like the human genome project which has been very successful and was carried out over a 13 year period with benefits which will last generations.
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How politics currently works
How politics currently works
Policy makers are
motivated to secure
political power
Policy makers are
motivated to secure
political power
favors
favors
favors
favors
to
to
drives
drives
from
from
supports
supports
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The political system needs to change
The political system needs to change
According to President Kim
Mix long term goals into short term goals
Mix long term goals into short term goals
Switch from power to merit based presidencies
Switch from power to merit based presidencies
The period of time over which you run a GCEA matters
The period of time over which you run a GCEA matters
to
to
4 - 8 year US
presidency
4 - 8 year US
presidency
Depends on
Depends on
5 year WHO
presidency
5 year WHO
presidency
from
from

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