LETTERS
LEROY ET AL. RESPOND We read Woolf and Johnson’s letter with great interest. The similarity of the findings for developing countries and the United States is impressive,1 as they reflect the influence of the shared assumptions in the research community that lead to low investments in research to improve the fidelity (quality) of health care delivery and utilization. We have a slight correction to make to their letter. Our research shows that 6 million (not 4 million) lives can be saved by improved delivery and utilization without any additional or improved technology. In addition, 2 million children could be saved by new technology (for which current technology is inadequate) if the new technology were delivered and utilized at present rates, and 2 million could be saved by improving both technology and delivery and utilization. Thus, the prevention of 80% of child deaths requires improving delivery and utilization, which nevertheless only receives 3% of research funding.2 We do not believe that resource allocation needs to be a zero-sum game, that is, that existing funds must be used either for research on delivery and utilization or for development of new technology. We argued in our study for more funding for the former relative to the latter, not that funds be taken away from the latter to fund the former. We hope that the empirical evidence in both studies will help to persuade the research community that greater research attention to issues of delivery and utilization is essential if the benefits of currently available technology are to be realized.
Universidad No. 655, Col. Sta. María Ahuacatitlán, Cuernavaca, Morelos, Mexico 62508 (e-mail:
[email protected]). This letter was accepted April 25, 2007. doi:10.2105/AJPH.2007.116772
References 1. Woolf SH, Johnson RE. The break-even point: when medical advances are less important than improving the fidelity with which they are delivered. Ann Fam Med. 2005;3:545–552. 2. Leroy JL, Habicht JP, Pelto G, Bertozzi SM. Current priorities in health research funding and lack of impact on the number of child deaths per year. Am J Public Health. 2007;97:219–223.
Jef L. Leroy, PhD, MSc Jean-Pierre Habicht, MD, PhD, MPH Gretel Pelto, PhD, MA Stefano M. Bertozzi, MD, PhD
About the Authors Jef L. Leroy and Stefano M. Bertozzi are with the Mexican National Institute of Public Health (Instituto Nacional de Salud Publica), Cuernavaca, Mexico. Stefano M. Bertozzi is also with the Center for Economics Research and Education, Mexico City, and the University of California, Berkeley. Jean-Pierre Habicht and Gretel Pelto are with the Division of Nutritional Sciences, Cornell University, Ithaca, NY. Requests for reprints should be sent to Jef L. Leroy, PhD, MSc, Instituto Nacional de Salud Publica, Avenida
October 2007, Vol 97, No. 10 | American Journal of Public Health
Letters | 1733
