A global effort on health could inspire, unite, and produce substantial improvement

The life expectancy of the 642 million people in sub-Saharan Africa is 51 years, 27 years less than that of those who live in rich countries. Mortality among those aged under 5 is 25 times higher in Africa than in rich countries. The World Health Organization's Commission on Macroeconomics and Health, which reported at the end of 2001, estimates that by 2010 about 8 million lives a year could be saved in low income countries by investing large sums and acting through simple and effective interventions. 1 2 But will it happen? The rich countries have a poor record in fulfilling their promises to poor countries. Nevertheless, a small group of people with considerable influence on global health who met recently in California agreed that the lives might be saved. Raising expectations too high could lead to huge disappointment, but the opportunities for substantial improvement in global health are probably better now than at any time in the past 20 years.

Perhaps because of the report of the Commission on Macroeconomics and Health health is “fashionable” with world leaders in a way that it never has been before. Some 60 world leaders—including both Fidel Castro and George Bush—vied with each other to emphasise their commitment to health at the recent meeting on development financing in Monterrey, Mexico. The general assembly of the United Nations for the first time last year devoted a session to a health topic—HIV and …