Charlson F J, Dieleman J, Singh L, Whiteford H A
School of Public Health, University of Queensland, Brisbane, Queensland, Australia.
Queensland Centre for Mental Health Research, Brisbane, Queensland, Australia.
PLoS One. 2017 Jan 3;12(1):e0169384. doi: 10.1371/journal.pone.0169384. eCollection 2017.
A recent report by the Institute for Health Metrics and Evaluation (IHME) highlights that mental health receives little attention despite being a major cause of disease burden. This paper extends previous assessments of development assistance for mental health (DAMH) in two significant ways; first by contrasting DAMH against that for other disease categories, and second by benchmarking allocated development assistance against the core disease burden metric (disability-adjusted life year) as estimated by the Global Burden of Disease Studies.
In order to track DAH, IHME collates information from audited financial records, project level data, and budget information from the primary global health channels. The diverse set of data were standardised and put into a single inflation adjusted currency (2015 US dollars) and each dollar disbursed was assigned up to one health focus areas from 1990 through 2015. We tied these health financing estimates to disease burden estimates (DALYs) produced by the Global Burden of Disease 2015 Study to calculated a standardised measure across health focus areas-development assistance for health (in US Dollars) per DALY.
DAMH increased from USD 18 million in 1995 to USD 132 million in 2015, which equates to 0.4% of total DAH in 2015. Over 1990 to 2015, private philanthropy was the most significant source (USD 435 million, 30% of DAMH), while the United States government provided USD 270 million of total DAMH. South and Southeast Asia received the largest proportion of funding for mental health in 2013 (34%). DAMH available per DALY in 2013 ranged from USD 0.27 in East Asia and the Pacific to USD 1.18 in the Middle East and North Africa. HIV/AIDS received the largest ratio of funds to burden-approximately USD150 per DALY in 2013. Mental and substance use disorders and its broader category of non-communicable disease received less than USD1 of DAH per DALY.
Combining estimates of disease burden and development assistance for health provides a valuable perspective on DAH resource allocation. The findings from this research point to several patterns of unproportioned distribution of DAH, none more apparent than the low levels of international investment in non-communicable diseases, and in particular, mental health. However, burden of disease estimates are only one input by which DAH should be determined.
健康指标与评估研究所（IHME）最近的一份报告强调，尽管心理健康是疾病负担的主要原因，但却很少受到关注。本文从两个重要方面扩展了先前对心理健康发展援助（DAMH）的评估；首先，将心理健康发展援助与其他疾病类别的援助进行对比；其次，将分配的发展援助与全球疾病负担研究估计的核心疾病负担指标（伤残调整生命年）进行基准对比。
为了跟踪发展援助资金，IHME整理了来自经审计的财务记录、项目层面数据以及主要全球卫生渠道的预算信息。将这组多样的数据进行标准化处理，并换算成单一的经通胀调整的货币（2015年美元），从1990年到2015年，每支出一美元都被分配到至多一个卫生重点领域。我们将这些卫生融资估计数与《2015年全球疾病负担研究》得出的疾病负担估计数（伤残调整生命年）相结合，以计算各卫生重点领域的标准化指标——每伤残调整生命年的卫生发展援助（以美元计）。
心理健康发展援助从1995年的1800万美元增加到2015年的1.32亿美元，这相当于2015年卫生发展援助总额的0.4%。在1990年至2015年期间，私人慈善是最重要的资金来源（4.35亿美元，占心理健康发展援助的30%），而美国政府提供了2.7亿美元的心理健康发展援助总额。南亚和东南亚在2013年获得了心理健康资金的最大份额（34%）。2013年每伤残调整生命年可获得的心理健康发展援助从东亚和太平洋地区的0.27美元到中东和北非地区的1.18美元不等。艾滋病毒/艾滋病获得的资金与负担之比最大——2013年约为每伤残调整生命年150美元。精神和物质使用障碍及其更广泛的非传染性疾病类别每伤残调整生命年获得的卫生发展援助不到1美元。
将疾病负担估计数与卫生发展援助相结合，为卫生发展援助资源分配提供了有价值的视角。这项研究的结果指出了卫生发展援助分配不均衡的几种模式，最明显的莫过于对非传染性疾病，尤其是心理健康的国际投资水平较低。然而，疾病负担估计数只是确定卫生发展援助时应考虑的一个因素。
