Priority-setting in global health

In global health, priority-setting is a term used for the process and strategy of deciding which health interventions to carry out. Priority-setting can be conducted at the disease level (i.e. deciding which disease to alleviate), the overall strategy level (i.e. selective primary healthcare versus primary healthcare versus more general health systems strengthening), research level (i.e. which health research to carry out), or other levels.

Priority-setting is the act of deciding which health interventions to carry out, and can occur at several levels of granularity. Priority-setting can occur at the following levels:

Synonymous terms include "prioritization in health care and health research", "priority determination", "health priorities", and "agenda-setting".

Various metrics have been used to compare interventions. These include:

Priority-setting can be done by various actors. These include:

According to Devi Sridhar, professor of global health at the University of Edinburgh, "the priorities of funding bodies largely dictate what health issues and diseases are studied".

According to Amanda Glassman et al., global-level priority-setting has occurred since at least the 1980s, though these efforts have only focused on a few aspects.

The following table is a timeline of organizations and programs working on priority-setting.

Rudan et al. says that priority-setting efforts have relied on "consensus reached by panels of experts" and as a result have not been systematic enough, and that this has "often made it difficult to present the identified priorities to wider audiences as legitimate and fair".

Glassman et al. notes that criticisms of priority-setting include "the weak data on which estimates of burden, cost, and effectiveness relied; the value judgments implicit in disability-adjusted life year age weighting and discounting decisions; and treatment of equity issues, as well as the political difficulties associated with translating a ground zero package into a public budget based on historical inputs"; and the consideration of only health maximization at the expense of other objectives such as fairness.

Glassman et al. also notes how there are more cost-effectiveness studies for LMICs (in the thousands), but that these are unlikely to be actually applied to priority-setting processes.

Jeremy Shiffman has said that some bodies such as the Institute for Health Metrics and Evaluation and The Lancet are prominent in priority-setting due to their dominion rather than data and analysis, and also notes that the process of creating the Sustainable Development Goals was not sufficiently transparent.

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