Many domestic and international health policies are likely to be controversial

When George W Bush returns to the White House after his inauguration ceremony, health is unlikely to be at the top of his agenda. In the months ahead he must devise strategies that will tackle record budget and trade deficits and pave the way for an exit from an increasingly unpopular war in Iraq. Yet many of the other decisions that he and his administration must make will have profound consequences for the health of America's people and for those in many other countries.

That the American healthcare system is in a mess has long been apparent. Despite spending vast and ever increasing amounts of money (now over a third more per person than Switzerland, the next highest spender), uniquely among industrialised countries the United States does not attempt to provide cover for all its citizens, and the number of uninsured people has increased from 42 million to 45 million in the past four years. Although …