Introduction

A variety of development priorities have been proposed for 2030 as Sustainable Development Goals (SDGs) to follow the highly-influential 2015 Millennium Development Goals (MDGs). These proposed goals cover a wide range of development objectives, including SDG3, “Ensure healthy lives and promote well-being for all at all ages.” Within the overarching health goal, many subgoals have been proposed, some of which are realistic and others that are not (Norheim et al., 2014). Common frameworks to evaluate these disparate goals are required by national governments and global agencies.

One proposed method to evaluate goals is benefit-cost analyses (BCAs), expressed as some monetary value of the benefits divided by the costs (benefit-cost ratios, or BCR) of achieving these benefits. A BCR greater than one for an assessed intervention indicates that it is socially beneficial compared to the next best use of the same resources. A ranking of interventions by the size of their BCRs is one step in allowing the prioritization according to the relative benefits they provide to society. (Note that a goal with a high societal benefit, such as universal education of girls, might not necessarily have a higher BCR than other interventions). In the case of health, high coverage of individual interventions are seldom achieved without an extensive delivery system comprising community outreach of services, first referral, and specialty hospitals, as well as supportive services for quality, patient safety, monitoring and evaluation, and other services (Jha and Laxminarayan, 2009). Moreover, some interventions (such as immunization) reduce deaths beyond the specific diseases they cover, by, for example, increasing the nutritional standing of children. The impact of increased access through universal healthcare is also not easily quantified through BCA. Therefore, traditional BCA, applied to individual interventions, fails to fully capture the cumulative and synergistic benefits or costs of implementation within a health system and in tandem with other health-promoting activities.

Thus, overall goals of reducing child and adult mortality are required as an overarching framework target. However, it should also be emphasized that within this framework, careful consideration be given to the specific subpopulation needs for each major age group (0–4, 5–49, and 50–69 years), as they differ in disease patterns.