61© The Author(s) 2016 D.H. Barrett et al. (eds.), Public Health Ethics: Cases Spanning the Globe, Public Health Ethics Analysis 3, DOI 10.1007/978-3-319-

61© The Author(s) 2016
D.H. Barrett et al. (eds.), Public Health Ethics: Cases Spanning the Globe,
Public Health Ethics Analysis 3, DOI 10.1007/978-3-319-23847-0_3

Chapter 3
Resource Allocation and Priority Setting

Norman Daniels

3.1 Resource Allocation in Public Health

There has been much discussion of resource allocation in medical systems, in the
United States and elsewhere. In large part, the discussion is driven by rising cost s
and the resulting budget pressures felt by publicly funded systems and by both
public and private components of mixed health systems. In some publicly funded
systems, resource allocation is a pressing issue because resources expended on one
disease or person cannot be spent on another disease or person. Some of the same
concern arises in mixed medical systems with multiple funding sources.

Although much has been written on resource allocation issues in medicine, there
has been less discussion about how resource allocation affects public health. Federal,
state, and local public health budgets in the United State s constrain investments in
health at those levels. In this regard, they are more like some foreign medical
systems than the more fragmented and mixed public-private medical system of the
United States. In the context of budget cuts domestically and in many countries
responding to an economic downturn, how to invest (and allocate) public health
resources is a pressing issue.

Most investments in public health aim to reduce population health risk s, but
some risks are greater than others, and resource allocation decisions must respond
to risks. Sometimes resource allocation decisions focus on the immediate payoff of
reducing risks from a specifi c disease, whereas other resource allocation decisions
affect the infrastructure needed to respond to health risks over time. In addition,
resource allocation decisions may determine who faces risks—the distribution of

The opinions, fi ndings, and conclusions of the author do not necessarily refl ect the offi cial position,
views, or policies of the editors, the editors’ host institutions, or the author’s host institution.

N. Daniels , PhD (*)
Department of Global Health and Population , Harvard T.H. Chan School of Public Health ,
Boston , MA , USA
e-mail: [email protected]

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risks matters, no