Reviews Book

Global Crises, Global Solutions

BMJ 2005; 330 doi: (Published 27 January 2005) Cite this as: BMJ 2005;330:261
  1. Henry Greenberg (hmg1{at}, associate professor of clinical medicine
  1. Columbia University College of Physicians and Surgeons, New York, United States

What an intriguing idea. Convene serious thinkers to create a list of critical issues facing the global community that are amenable to governmental intervention, prune and prioritise the list to the top 10, enlist leading economists to outline the challenges, add thoughtful commentaries, and then rank the final 10. A group called the Copenhagen Consensus under the leadership of Bj⊘rn Lomborg did just this and teamed up with the Economist to disseminate the results. Global Crises, Global Solutions is the result, and disappointing it is, garnering at best two stars.

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Ed Bj⊘rn Lomborg

Cambridge University Press, £19.99, pp 670 ISBN 0521606144

Rating: GraphicGraphic

Instead of presenting innovation based on prior work, the book is constrained by reflection and limited by a lack of anticipation. Economists, it turns out, are not effective lead authors. They are too comfortable building complex edifices on data acknowledged as weak; they seem reluctant to transpose what is known, even if inexact, into design models for future problem alleviation; their emphasis on cost benefit analysis inhibits a larger view that might encompass such critical factors as governance and custom. In addition, this text is poorly edited. Co-authors are not identified; abbreviations essential to a chapter are not highlighted; proofreading lapses abound; many pieces are overly long, testing the perseverance of the most dogged reader.

Of the 10 challenges identified, three impinge upon medicine: communicable disease, malnutrition and hunger, and sanitation and access to clean water. Of concern is the failure of the Copenhagen Consensus to accord greater priority to chronic illness and its global burden of disease and over-nutrition with impeding epidemics of diabetes and heart disease in most of the developing world.

Contributors Anne Mills and Sam Shill-cut restrict their discussion of communicable disease to HIV/AIDS and malaria in Africa. They barely discuss treatment of HIV/AIDS and its inevitable conversion to a chronic disease, and they limit their discussion of primary medical care to a few paediatric diseases.

Jere Behrman, Harold Alderman, and John Hoddinott recreate what is known about the deleterious effects of malnutrition. Instead of revisiting the problems of low birth weight and micronutrient deficiencies, a more engaging piece leading towards innovative interventions would focus on governance, a lack of civil society, women's education, land inheritance policy, and enlightened rather than self-serving donor agency policies.

“Sanitation and access to clean water” by Frank Rijsberman is shorter, freer of jargon, and more willing to accept problems of governance and management. The problems and opportunities are better defined and addressed. Rijsberman blends component assessments of cost benefit analyses into larger overviews that anticipate feasible interventions.

Rather than read Global Crises, Global Solutions, the curious physician looking for insights into the complex societal and economic issues that cloud the future would be better off subscribing to the Economist.

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