Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
Oxford Policy Management Ltd, Oxford, UK.
Health Syst Reform. 2019;5(4):307-321. doi: 10.1080/23288604.2019.1660104. Epub 2019 Oct 29.
In the absence of good data on the costs and comparative benefits from investing in health emergency and disaster risk management (EDRM), governments have been reluctant to invest adequately in systems to reduce the risks and consequences of emergencies and disasters. Yet they spend heavily on their response. We describe a set of key functional areas for investment and action in health EDRM, and calculate the costs needed to establish and operate basic health EDRM services in low- and middle-income countries, focusing on management of epidemics and disasters from natural hazards.We find that health EDRM costs are affordable for most governments. They range from an additional 4.33 USD capital and 4.16 USD annual recurrent costs per capita in low-income countries to 1.35 USD capital to 1.41 USD recurrent costs in upper middle-income countries. These costs pale in comparison to the costs of not acting-the direct and indirect costs of epidemics and other emergencies from natural hazards are more than 20-fold higher.We also examine options for the institutional arrangements needed to design and implement health EDRM. We discuss the need for creating adaptive institutions, strengthening capacities of countries, communities and health systems for managing risks of emergencies, using "all-of-society" and "all-of-state institutions" approaches, and applying lessons about rules and regulations, behavioral norms, and organizational structures to better implement health EDRM. The economic and social value, and the feasibility of institutional options for implementing health EDRM systems should compel governments to invest in these common goods for health that strengthen national health security.
在缺乏关于投资卫生应急和灾害风险管理（EDRM）的成本和相对效益的良好数据的情况下，各国政府一直不愿意充分投资于降低应急和灾害风险和后果的系统。然而，他们在应对方面投入了大量资金。我们描述了卫生 EDRM 投资和行动的一系列关键功能领域，并计算了在中低收入国家建立和运营基本卫生 EDRM 服务所需的成本，重点是管理传染病和自然灾害造成的灾害。我们发现，卫生 EDRM 成本对大多数政府来说都是负担得起的。它们的范围从低收入国家每人每年额外的 4.33 美元资本和 4.16 美元经常性成本，到中上收入国家每人每年 1.35 美元资本和 1.41 美元经常性成本。这些成本与不采取行动的成本相比相形见绌——传染病和其他自然灾害紧急情况的直接和间接成本要高出 20 多倍。我们还研究了设计和实施卫生 EDRM 所需的体制安排的选择。我们讨论了需要创建适应性机构，加强国家、社区和卫生系统管理应急风险的能力，利用“全社会”和“国家所有机构”的方法，并借鉴有关规则和条例、行为规范和组织结构的经验教训，以更好地实施卫生 EDRM。实施卫生 EDRM 系统的经济和社会价值以及体制选择的可行性，应该迫使政府为这些加强国家卫生安全的卫生共同利益进行投资。
