Global Health Watch 2, the second of the self claimed alternative world health reports, is published today.1 Like its 2005 predecessor, it is an approachable overview of why health inequities persist and what can be done to reduce them. The strength of this report is that it is a product of several civil society organisations and networks, and its inherent activism is strongly evidence based and carefully reasoned.

The report is divided into major sections on health systems, determinants of health, and accountability, and it includes essays on alternative development and on the politics of resistance to unhealthy policies, politics, and economics. A key argument is that our present approach to development divides the world’s three most important imperatives—to reduce poverty, improve health, and sustain the environment—into unattainable incoherence. For example, poverty reduction in low income countries, which is assumed to improve health, is driven by growth that is led by exports. These exports are consumed by people in high income countries at a level of consumption that is environmentally unsustainable. In an alternative paradigm, economic growth would be based on supporting production by poorer people in low income countries of goods and services needed by the poor.

The section of the report on health systems may be most appealing to practitioners, although it has no chapters on specific diseases. It accepts that some benefit derives from a disease focus, but it is critical of the dominating global model of targeted initiatives, technology …