Who should pay for global health, and how much?

Our article was published in PLOS Medicine (Carrasco, Coker, Cook). We devise a new way to identify the expected contributions to global health from each country in the world. We propose a global health cost-effectiveness threshold coupled to a DALY (disability-adjusted life year) credit market.

The idea is simple, high or middle-income countries or health projects in these countries that allocate resources to not very cost-effective projects need to buy DALY credits from highly cost-effective projects in low income countries to carry on with their projects.

For instance, if we want to adopt a very costly vaccine in Singapore, we would need to contribute a little bit to very cost-effective children immunization vaccines in Sub-Saharan Africa. Given how cheap is to avert DALYs in low-income countries compared to high income countries, we would only need to contribute an equivalent to ~0.1–0.5% of the costs of the project. We believe that this system could help to prevent the tragedy of the commons in global health by promoting a massive scale-up of global health donations to low-income countries.

The paper pdf and supporting information is open can be found here.


Maternal health in Afghanistan.

Source: Merlin, Wikipedia.


Carrasco LR, Coker R, Cook AR (2013) Who Should Pay for
Global Health, and How Much? Plos Medicine 10: e1001392. doi:10.1371/journal.pmed.1001392




  • Mechanisms to establish the expected financial contribution from each country to achieve the health Millennium Development Goals (MDGs) could encourage scaling-up of contributions.
  • Mirroring global carbon permit markets to mitigate climate change, we propose a cap-and-trade system consisting of a global cost-effectiveness criterion and a disability-adjusted life year (DALY) global credit market.
  • Under this system, high-income and middle-income countries should contribute, respectively, 74% and 26% of the additional US$36–US$45 billion annually needed to attain the health MDGs. The change relative to current contributions would vary, with some countries needing to scale-up substantially their expected annual contributions under the proposed market (e.g., US, US$7–US$10 billion; China, US$2–US$3 billion; Japan, US$2 billion; Germany, US$1.5–US$2 billion), while a few already meet or exceed their required contributions (i.e., Norway, the United Arab Emirates, Luxembourg, and the UK).
  • A DALY tradable credit market offers the potential to increase the efficiency of global health investments while promoting international obligations to the pursuit of an agreed global common good.


carbon credits, DALYs, global health, health aid, vaccination.



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