Education and debate

The World Bank and world health

Healthcare strategy

BMJ 1999; 318 doi: 10.1136/bmj.318.7188.933 (Published 3 April 1999)
Cite this as: BMJ 1999;318:933

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  1. Kamran Abbasi, assistant editor. (kabbasi@bmj.com)
  1. BMJ, London WC1H 9JR

    The World Bank estimates that 1.3 billion people live in absolute=20 poverty, which means that about a quarter of the world's population earns less than $1 a day. With the world's population projected to almost double over the next century (from 5.3 billion in 1990 to around 10 billion by 2100, and mostly in poorer populations) malnutrition, childhood infections, poor maternal health, and high fertility will remain substantial challenges in real terms. Overall, however, the pattern of the global disease burden is shifting away from communicable diseases to non-communicable diseases as high fertility and mortality are being replaced by low fertility and mortality (fig 1). By 2020, the bank estimates that the share of the global disease burden from non-communicable diseases will be 57% (up from 36% in 1990), and the contribution from infectious diseases, pregnancy, and perinatal causes will have fallen to 22% (from 49% in 1990) (fig 2.)1

    Fig 1

    Known and projected worldwide life expectancy and fertility rates

    Summary points

    • A quarter of the world's population earns less than $1 a day

    • The World Bank believes that governments need to find an “optimal balance” between public and private sectors in the financing and delivery of health care

    • The bank's priorities focus on mobilising the female work force, enhancing the performance of healthcare systems, and ensuring sustainability of health care

    • However, it accepts that it needs to sharpen focus through greater selectivity, more rigorous evaluation of projects, and greater collaboration with governments and other agencies

    • Critics argue that the bank's policies do not have the flexibility to achieve their goals

    Fig 2

    Causes of death among rich and poor, worldwide

    Despite the magnitude of the healthcare challenge, the bank believes that affordable solutions are available, but it blames governments and the private sector for rendering policies ineffective. The bank's prescription for global health care is the marriage of …

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