Chris James

Expenditures on health in many developing countries are being disproportionately spent on health services that have a low overall health impact, and that disproportionately benefit the rich. Without explicit consideration of priority setting, this situation is likely to remain unchanged: resource allocation is too often dictated by historical patterns, and maintains vested interests. This paper explores how prioritization between different health interventions can be rationalised by the use of clearly defined criteria. A number of key efficiency and equity criteria are examined, in particular analysing how potential tradeoffs could be incorporated into the decision making process.

Sometime, at your leisure—if you want to know what philosophy is—go into a large bookstore and browse. Check a variety of books in psychology, anthropology, physics, chemistry, archeology, astronomy, and other nonfiction fields. Look at the last chapter in each book. In a surprising number of cases, you will find that the author has chosen to round out his work with a final summation of what the book is all about. That is, having written a whole book on a specialized subject in which he is probably an authority, he finds that he also has ideas about the larger meaning of the facts that he has written about. The final chapter may be called “Conclusions,” “Epilogue,” “Postscript,” “My Personal View,” “Implications,” “Comments," ,“ “Speculations,” or (as in one case) “So What?” But in every instance, the author is trying to elucidate the larger implications of his subject matter and to clarify how he thinks it relates to other fields or to life. He has an urge to tell us the meaning of all his facts taken together. He wants to share with us the philosophic implications of what he has written. When he does this, the author has moved beyond the role of a field specialist. He is a philosopher