In 2015, member states of the United Nations adopted the ambitious Sustainable Development Goals (SDGs), which included 17 global goals that targeted economic and social development. Goal 3, “to ensure healthy lives and promote well-being for all at all ages,” targets specifically marked progress in universal health coverage; improved access to safe, effective, and affordable medicines; and the end of the HIV, malaria, and tuberculosis epidemics by 2030. Although these goals can spur innovation, social and political commitment, and a drive to achieve greater health gains for less money, financial support is necessary to achieve them.
Joseph Dieleman, PhD, is an Associate Professor of Health Metrics Sciences at the Institute for Health Metrics and Evaluation (IHME) at the University of Washington. In this role, he leads the Resource Tracking research team, which focuses on tracking development assistance for health, health spending by disease, and government health spending. Dr. Dieleman's interests are the intersection of novel quantitative methods, health economics, and health policy. In addition to research tracking resources for health, he has ongoing projects assessing the financing needed for the eradication of malaria, bringing more attention to non-communicable diseases, and highlighting the role of social correlates of health. Dr. Dieleman is also passionate about teaching and mentoring students and research fellows. He serves as co-Director of PhD program in Global Health, Metrics track.
Dr. Dieleman studied at Calvin College in Grand Rapids, Michigan, earning his undergraduate degree in Economics, and at the University of Washington, where he received his PhD in Economics. He has also spent time living and working in Tegucigalpa, Honduras.
IHME was established at the University of Washington in Seattle in 2007. Its mission is to deliver to the world timely, relevant, and scientifically valid evidence to improve health policy and practice.
Chang AY, Bryazka D, Dieleman JL. Estimating health spending associated with chronic multimorbidity in 2018: An observational study among adults in the United States. PLOS Medicine. 4 April 2023. doi: 10.1371/journal.pmed.1004205.
Bollyky TJ, Castro E, Aravkin AY, et al. Assessing COVID-19 pandemic policies and behaviours and their economic and educational trade-offs across US states from Jan 1, 2020, to July 31, 2022: an observational analysis. The Lancet. 23 March 2023. doi: 10.1016/S0140-6736(23)00461-0.
Global Burden of Disease 2021 Health Financing Collaborator Network. Global investments in pandemic preparedness and COVID-19: tracking development assistance and domestic spending on health between 1990 and 2026. The Lancet Global Health. 24 January 2023. doi: 10.1016/S2214-109X(23)00007-4.
Moitra M, Patel NK, Cogswell I, et al. Tracking development assistance for health from India to low- and middle-income countries, 2009–2020. PLOS ONE. 12 December 2022. doi: 10.1371/journal.pone.0277799.
Duan KI, Birger M, Au DH, et al. US health care spending on respiratory diseases, 1996-2016. American Journal of Respiratory and Critical Care Medicine. 31 August 2022. doi:10.1164/rccm.202202-0294OC.
Johnson EK, Wojtesta MA, Crosby SW, et al. Varied health spending growth across US states was associated with income, price levels, and Medicaid expansion, 2000-19. Health Affairs. 1 August 2022. doi: 10.1377/hlthaff.2021.01834.
Weaver MR, Joffe J, Ciarametaro et al. Health care spending effectiveness: estimates suggest that spending improved US health from 1996 to 2016. Health Affairs. 5 July 2022. doi: 10.1377/hlthaff.2021.01515.
Catherine O. Johnson, Alexandra S. Boon-Dooley, Nicole K. DeCleene, et al; Life Expectancy for White, Black, and Hispanic Race/Ethnicity in U.S. States: Trends and Disparities, 1990 to 2019. Ann Intern Med. [Epub 28 June 2022]. doi:10.7326/M21-3956.
Micah, A.E., Solorio, J., Stutzman, H. et al. Development assistance for human resources for health, 1990–2020. Hum Resour Health 20, 51 (2022). https://doi.org/10.1186/s12960-022-00744-x.
Pedroza Velandia P, Miller-Petrie MK, Chen C, Chakrabarti S, Chapin A, Hay S, Tsakalos G, Wimo A, Dieleman JL. Global and regional spending on dementia care from 2000–2019 and expected future health spending scenarios from 2020–2050: An economic modelling exercise. eClinicalMedicine. 12 March 2022. doi: 10.1016/j.eclinm.2022.101337.
GBD 2019 Ageing Collaborators. Global, regional, and national burden of diseases and injuries for adults 70 years and older: systematic analysis for the Global Burden of Disease 2019 Study. BMJ. 10 March 2022. doi: 10.1136/bmj-2021-068208.
Bollyky TJ, Graetz N, Dieleman J, Miller-Petrie MK, Schoder D, Joyce S, Guillot M, Hay SI. Growing up and moving out: Migration and the demographic transition in low- and middle-income nations. Population Studies. 23 February 2022. doi: 10.1080/00324728.2022.2034919.
COVID-19 National Preparedness Collaborators. Pandemic preparedness and COVID-19: an exploratory analysis of infection and fatality rates, and contextual factors associated with preparedness in 177 countries, from Jan 1, 2020, to Sept 30, 2021. The Lancet. 1 February 2022. doi:10.1016/S0140-6736(22)00172-6.
Ikilezi G, Micah AE, Bachmeier SD, Cogswell IE, Maddison ER, Stutzman HN, Tsakalos G, Brenzel L, Dieleman JL. Estimating total spending by source of funding on routine and supplementary immunisation activities in low-income and middle-income countries, 2000–17: a financial modelling study. The Lancet. 4 November 2021. doi: 10.1016/S0140-6736(21)01591-9.
Woody Scott K, Liu A, Chen C, Kaldjian AS, Sabatini AK, Duber HC, Dieleman JL. Healthcare spending in U.S. emergency departments by health condition, 2006–2016. PLoS One. 27 October 2021. doi: 10.1371/journal.pone.0258182.
Global Burden of Disease 2020 Health Financing Collaborator Network. Tracking development assistance for health and for COVID-19: a review of development assistance, government, out-of-pocket, and other private spending on health for 204 countries and territories, 1990–2050. The Lancet. 22 September 2021. doi: 10.1016/S0140-6736(21)01258-7.
Dieleman JL, Murray CJL, Chen C, Crosby SW, Liu A, McCracken D, Pollock IA, Sahu M, Tsakalos G, Dwyer-Lindgren L, Haakenstad A, Mokdad AH, Roth GA, Scott KW. US Health Care Spending by Race and Ethnicity, 2002-2016. JAMA. 17 August 2021. doi: 10.1001/jama.2021.9937.
Schneider MT, Chang AY, Crosby SW, Gloyd S, Harle AC, Lim S, Lozano R, Micah AE, Tsakalos G, Su Y, Murray CJL, Dieleman JL. Trends and outcomes in primary health care expenditures in low-income and middle-income countries, 2000–2017. BMJ Global Health. 12 August 2021. doi: 10.1136/bmjgh-2021-005798.
Templin T, Dieleman JL, Wigley S, Mumford JE, Miller-Petrie M, Kiernan S, Bollyky TJ. Democracies Linked To Greater Universal Health Coverage Compared With Autocracies, Even In An Economic Recession. Health Affairs. 2 August 2021. doi: 10.1377/hlthaff.2021.00229.
Schneider MT, Chang AY, Chapin A, Chen CS, Crosby SW, Harle AC, Tsakalos G, Zlavog BS, Dieleman JL. Health expenditures by services and providers for 195 countries, 2000–2017. BMJ Global Health. 30 July 2021. doi: 10.1136/bmjgh-2021-005799.
Ikilezi G, Bachmeier SD, Cogswell IE, Maddison ER, Stutzman HN, Tsakalos G, Brenzel L, Dieleman JL, Micah AE. Tracking government spending on immunization: The joint reporting forms, national health accounts, comprehensive multi-year plans and co-financing data. Vaccine. 8 June 2021. doi: 10.1016/j.vaccine.2021.04.047.
Dieleman JL. Kaldjian AS, Sahu M, Chen C, Liu A, Chapin A, Woody Scott K, Aravkin S, Zheng P, Mokdad A, Murray CJL, Schulman K, Milstein A. Estimating health care delivery system value for each US state and testing key associations. Health Services Research. 24 May 2021. doi: 10.1111/1475-6773.13676.
Moitra M, Cogswell I, Maddison E, Simpson K, Stutzman H, Tsakalos G, Dieleman J, Micah AE. Factors associated with the disbursements of development assistance for health in low-income and middle-income countries, 2002–2017. BMJ Global Health. 23 April 2021. doi:10.1136/bmjgh-2020-004858.
Wigley S, Bollyky TJ, Dieleman JL, Templin T, Mumford JE. Autocratisation and universal health coverage: synthetic control study. BMJ. 23 October 2020. doi:10.1136/bmj.m4088.
Bolnick HJ, Bui AL, Chen C, Chapin A, Lomsadze L, Mokdad AH, Millard F, Dieleman JL. Health-care spending attributable to modifiable risk factors in the USA: an economic attribution analysis. The Lancet Public Health. 1 October 2020. doi: 10.1016/S2468-2667(20)30203-6.
Global Burden of Disease Health Financing Collaborator Network. Health sector spending and spending on HIV/AIDS, tuberculosis, and malaria, and development assistance for health: progress towards Sustainable Development Goal 3. The Lancet. 23 April 2020. doi:10.1016/S0140-6736(20)30608-5.
Su Y, Baena IG, Harle AC, Crosby SW, Micah AE, Siroka A, Sahu M, Tsakalos G, Murray CJL, Floyd K, Dieleman JL. Tracking total spending on tuberculosis by source and function in 135 low-income and middle-income countries, 2000–17: a financial modelling study. The Lancet Infectious Diseases. 23 April 2020. doi:10.1016/S1473-3099(20)30124-9.
Dieleman JL, Cao J, Chapin A, Chen C, Li Z, Liu A, Horst C, Kaldjian A, Matyasz T, Scott KW, Bui AL, Campbell M, Duber HC, Dunn AC, Flaxman AD, Fitzmaurice C, Naghavi M, Sadat N, Shieh P, Squires E, Yeung K, Murray CJL. US Health Care Spending by Payer and Health Condition, 1996–2016. JAMA. 3 March 2020. doi:10.1001/jama.2020.0734.
Micah AE, Zhao Y, Chen CS, Zlavog BS, Tsakalos G, Chapin A, Gloyd S, Jonas J, Lee PH, Liu S, Ng MTA, Phillips MR, Rubagotti E, Tang K, Tang S, Younis M, Zhang Y, Murray CJL, Dieleman JL. Tracking development assistance for health from China, 2007–2017. BMJ Global Health. 8 October 2019. doi:10.1136/bmjgh-2019-001513.
Feachem RGA, Chen I, Akbari O, Bertozzi-Villa A, Bhatt S, Binka F, Boni MF, Buckee C, Dieleman J, Dondorp A, Eapen A, Feachem NS, Filler S, Gething P, Gosling R, Haakenstad A, Harvard K, Hatefi A, Jamison D, Jones KE, Karema C, Kamwi RN, Lal A, Larson E, Lees M, Lobo NF, Micah AE, Moonen B, Newby G, Ning X, Pate M, Quiñones M, Roh M, Rolfe B, Shanks D, Singh B, Staley K, Tulloch J, Wegbreit J, Woo HJ, Mpanju-Shumbusho W. Malaria eradication within a generation: ambitious, achievable, and necessary. The Lancet. 8 September 2019. doi:10.1016/S0140-6736(19)31139-0.
Dieleman JL, Cowling K, Agyepong IA, et al. The G20 and development assistance for health: historical trends and crucial questions to inform a new era. The Lancet. 27 June 2019. doi:10.1016/S0140-6736(19)31333-9.
Global Burden of Disease Health Financing Collaborator Network. Past, present, and future of global health financing: a review of development assistance, government, out-of-pocket, and other private spending on health for 195 countries, 1995–2050. The Lancet. 24 April 2019. doi: http://dx.doi.org/10.1016/S0140-6736(19)30841-4
Haakenstad A, Moses MW, Tao T, Tsakalos G, Zlavog B, Kates J, Wexler A, Murray CJL, Dieleman JL. Potential for additional government spending on HIV/AIDS in 137 low-income and middle-income countries: an economic modelling study. The Lancet HIV. 24 April 2019. doi: http://dx.doi.org/10.1016/S1473-3099(19)30165-3
Haakenstad A, Harle AC, Tsakalos G, Micah AE, Tao T, Anjomshoa M, Cohen J, Fullman N, Hay S, Mestrovic T, Mohammed S, Mousavi SM, Nixon MR, Pigott D, Tran K, Murray CJL, Dieleman JL. Tracking spending on malaria by source in 106 countries, 2000–16: an economic modelling study. The Lancet Infectious Disease. 24 April 2019. doi: http://dx.doi.org/10.1016/S1473-3099(19)30165-3
Bollyky TJ, Templin T, Cohen M, Schoder D, Dieleman JL, Wigley S. The relationships between democratic experience, adult health, and cause-specific mortality in 170 countries between 1980 and 2016: an observational analysis. The Lancet. 13 March 2019. doi:10.1016/S0140-6736(19)30235-1
Chang AY, Skirbekk VF, Tyrovolas S, Kassebaum NJ, Dieleman JL. Measuring population ageing: an analysis of the Global Burden of Disease Study 2017. The Lancet Public Health. 6 March 2019, 4: e159–67. doi:10.1016/S2468-2667(19)30019-2.
Micah AE, Chen SC, Zlavog BS, Hashimi G, Chapin A, Dieleman JL. Trends and drivers of government health spending in sub-Saharan Africa, 1995–2015. BMJ Global Health. 13 Jan 2019;4(1):e001159. doi:10.1136/bmjgh-2018-001159.
Micah AE, Zlavog BS, Chen CS, Chapin A, Dieleman JL. Donor financing of human resources for health, 1990–2016: an examination of trends, sources of funds, and recipients. Globalization and Health. 17 Oct 2018;14(1):98. doi:10.1186/s12992-018-0416-z.
Lim SS, Updike RL, Kaldjian AS, Barber RM, Cowling K, York H, Friedman J, Xu R, Whisnant JL, Taylor HJ, Leever AT, Roman Y, Bryant MF, Dieleman J, Gakidou E, Murray CJL. Measuring human capital: a systematic analysis of 195 countries and territories, 1990–2016. The Lancet. 24 September 2018. doi: 10.1016/S0140-6736(18)31941-X.
Phillips DE, Dieleman JL, Shearer JC, Lim SS. Childhood vaccines in Uganda and Zambia: Determinants and barriers to vaccine coverage. Vaccine. 5 Jul 2018; doi:10.1016/j.vaccine.2018.05.116
Global Burden of Disease Health Financing Collaborator Network. Spending on health and HIV/AIDS: domestic health spending and development assistance in 188 countries, 1995–2015. The Lancet. 17 Apr 2018.
Global Burden of Disease Health Financing Collaborator Network. Trends in future health financing and coverage: future health spending and universal health coverage in 188 countries, 2016–40. The Lancet. 17 Apr 2018.
Micah AE, Zlavog B, Friedman S, Reynolds A, Chapin AL, Schneider MT, Dieleman JL. The US provided $13 billion in development assistance for health in 2016, less per person than many peer nations. Health Affairs. 4 Dec 2017; 36:12. doi:10.1377/hlthaff.2017.1055.
Dieleman JL, Squires E, Bui AL, Campbell M, Chapin A, Hamavid H, Horst C, Li Z, Matyasz T, Reynolds A, Sadat N, Schneider MT, Murray CJL. Factors associated with increases in US health care spending, 1996–2013. JAMA. 7 Nov 2017; 318(17):1668-1678. doi:10.1001/jama.2017.15927.
Shretta R, Zelman B, Birger ML, Haakenstad A, Singh L, Liu Y, Dieleman J. Tracking development assistance and government health expenditures for 35 malaria-eliminating countries: 1990–2017. Malaria Journal. 14 Jun 2017: 16:251. DOI: 10.1186/s12936-017-1890-0
Skirbekk V, Ottersen T, Hamavid H, Sadat N, Dieleman JL. Vast majority of development assistance for health funds target those below age sixty. Health Affairs. 2017 May; 36(5):926-930. doi: 10.1377/hlthaff.2016.1370.
Global Burden of Disease Health Financing Collaborator Network. Future and potential spending on health 2015–2040: development assistance for health, and government, prepaid private, and out-of-pocket health spending in 184 countries. The Lancet. 19 April 2017. http://dx.doi.org/10.1016/S0140-6736(17)30873-5
Global Burden of Disease Health Financing Collaborator Network. Evolution and patterns of global health financing 1995–2014: development assistance for health, and government, prepaid private, and out-of-pocket health spending in 184 countries. The Lancet. 19 April 2017. http://dx.doi.org/10.1016/S0140-6736(17)30874-7
Charlson F, Dieleman JL, Singh L, Whiteford H. Donor financing of global mental health, 1995-2015: an assessment of trends, channels, and alignment with disease burden. PLOS ONE. 2017;12(2):0172259. doi: 10.1371/journal.pone.0169384.
Dieleman JL, Baral R, Birger M, et al. US spending on personal health care and public health, 1996–2013. JAMA. 2016 Dec 17.
Bui AL, Dieleman JL, Hamavid H, Birger M, Chapin A, Duber HC, Horst C, Reynolds A, Squires E, Chung PJ, Murray CJL. Spending on children’s personal health care in the United States, 1996–2013. JAMA Pediatrics. 2016 Dec 27. doi:10.1001/jamapediatrics.2016.4086.
Hamavid H, Birger M, Bulchis AG, Lomsadze L, Joseph J, Baral R, Bui AL, Horst C, Johnson E, Dieleman JL. Assessing the complex and evolving relationship between charges and payments in US hospitals: 1996 – 2012. PLoS ONE. 2016 Jul 8; 11(7):e0157912. doi: 10.1371/journal.pone.0157912.
Dieleman JL, Schneider MT, Haakenstad A, Singh L, Sadat N, Birger M, Reynolds A, Templin T, Hamavid H, Chapin A, Murray CJL. Development assistance for health: past trends, associations, and the future of international financial flows for health. The Lancet. 2016 Apr 13. doi: 10.1016/S0140-6736(16)30168-4.
Dieleman JL, Templin T, Sadat N, Reidy P, Chapin A, Foreman K, Haakenstad A, Evans T, Murray CJL, Kurowski C. National spending on health by source for 184 countries between 2013 and 2040. The Lancet. 2016 Apr 13. doi: 10.1016/S0140-6736(16)30167-2.
Schneider MT, Birger M, Haakenstad A, Singh L, Hamavid H, Chapin A, Murray CJL, Dieleman JL. Tracking development assistance for HIV/AIDS: the international response to a global epidemic. AIDS. 2016 Apr 13. doi: 10.1097/QAD.0000000000001081.
Haakenstad A, Birger M, Singh L, Liu P, Lim S, Ng M, Dieleman JL. Vaccine assistance to low- and middle-income countries increased to $3.6 billion in 2014. Health Affairs. 2016 Feb 8.
Bollyky TJ, Templin T, Andridge C, Dieleman JL. Understanding the relationships between non-communicable diseases, unhealthy lifestyles, and country wealth. Health Affairs. 2015 Sep; 34(9):1464-1471. doi: 10.1377/hlthaff.2015.0343.
Olivier J, Tsimpo C, Gemignani R, Shojo M, Coulombe H, Dimmock F, Nguyen MC, Hines H, Mills EJ, Dieleman JL, Haakenstad A, Wodon Q. Understanding the roles of faith-based health care providers in Africa: review of the evidence with a focus on magnitude, reach, cost, and satisfaction. The Lancet. 2015 Jul 6. doi: 10.1016/S0140-6736(15)60251-3.
Dieleman JL, Graves C, Johnson E, Templin T, Birger M, Hamavid H, Freeman M, Leach-Kemon K, Singh L, Haakenstad A, Murray CJL. Sources and focus of health development assistance, 1990–2014. JAMA. 2015 Jun 16. 313(23):2359-2368. doi:10.1001/jama.2015.5825.
Haakenstad A, Johnson E, Graves C, Olivier J, Duff J, Dieleman JL. Estimating the development assistance for health provided to faith-based organizations, 1990–2013. PLOS One. 2015 June 4. doi: 10.1371/journal.pone.0128389.
Bui AL, Lavado RF, Johnson EK, Brooks BPC, Freeman MK, Graves CM, Haakenstad A, Shoemaker B, Hanlon M, Dieleman JL. National health accounts data from 1996 to 2010: a systematic review. Bulletin of the World Health Organization. 2015 May 15. Article ID: BLT.14.145235.
Dieleman JL, Yamey G, Johnson EK, Graves CM, Haakenstad A, Meara JG. Tracking global expenditures on surgery: gaps in knowledge hinder progress. The Lancet Global Health. 2015 April 27. doi: 10.1016/S2214-109X(15)70075-6.
Graves CM, Haakenstad A, Dieleman JL. Tracking development assistance for health to fragile states: 2005–2011. Globalization and Health. 2015 March 19; 11:12. doi:10.1186/s12992-015-0097-9.
Dieleman JL, Templin T. Random-effects, fixed-effects and the within-between specification for clustered data in observational health studies: a simulation study. PloS One. 2014 Oct 24. doi: 10.1371/journal.pone.0110257.
Ng M, Fullman N, Dieleman JL, Flaxman AD, Murray CJL, Lim SS. Effective coverage: a metric for monitoring universal health coverage. PLoS Medicine. 2014 Sept 22. doi: 10.1371/journal.pmed.1001730.
Dieleman JL, Graves CM, Templin T, Johnson E, Baral R, Leach-Kemon K, Haakenstad AM, Murray CJL. Global health development assistance remained steady in 2013 but did not align with recipients’ disease burden. Health Affairs. 2014 Apr. doi: 10.1377/hlthaff.2013.1432.
Hanlon M, Graves CM, Brooks BPC, Haakenstad A, Lavado R, Leach-Kemon K, Dieleman JL. Regional variation in the allocation of development assistance for health. Globalization and Health. 2014; 10:8.
Dieleman JL, M Hanlon. Measuring the displacement and replacement of government health expenditure. Health Economics. 2014; 23(2).
Dieleman JL, C Graves, M Hanlon. The fungibility of health aid: reconsidering the reconsidered. Journal of Development Studies. 2013; 49(12).
Leach-Kemon K, Chou DP, Schneider MT, Tardif A, Dieleman JL, Brooks BPC, Hanlon M, Murray CJL. The global financial crisis has led to a slowdown in growth of funding to improve health in many developing countries. Health Affairs. 2012; DOI: 10.1377/hlthaff.2011.1154.
April 25, 2019
July 26, 2017
On May 23, 2017, President Donald Trump released his FY 2018 budget request to Congress that includes approximately $2.5 billion in cuts to global health. In t
March 23, 2017
Although knowledge about global health financing has expanded over the past two decades, major gaps remain. We know little, for example, about how much governments spend on major disease areas, how these amounts have evolved over time and how countries compare. A global health financing data revolution is sorely needed. The suite of papers that make up this special issue underline the importance of reliable information about financial resources for health.
November 8, 2016
After more than a decade of immense growth, development assistance for health has flatlined. DAH fueled a scale up of antiretrovirals, insecticide-treated bed nets, vaccinations and a host of important global health interventions. Over the same period, the spread of a number of infectious diseases was reversed, reducing premature death and disability across the developing world. The plateau in international funding may threaten to slow progress or even roll back these gains.
January 2, 2015
In The Lancet Global Health, Stephen Resch and colleagues’ study benchmarks 12 countries’ government expenditure on HIV/AIDS. This important research emphasizes that many governments are not meeting spending goals, and in many countries the financing gaps are so great that, even if they met the spending goals, expenditure would still fall short of what is needed (expenditure would cover only 64% of estimated future funding requirements, leaving a gap of around a third of the total US$7.9 billion needed).
January 8, 2013
We reported that for every dollar a government received in development assistance for health, the government's domestic expenditure on health decreased by $0.46 (95% confidence interval: 0.24, 0.67). Subsequent research questioned those findings, including Batniji and Bendavid in PLOS Medicine who have since admitted mistakes in their statistical model. We argue that these subsequent studies fail to account for the complex, dynamic connection between domestic and foreign funding sources.