The world looked on in anticipation as a new American president was elected on 4 November 2008. Discussion in American health policy circles focused on the question of how the next president might reform the American health system.1 However, the rest of the world will be more concerned about the implications for global health. This is something that demands urgent attention because the first 100 days of the new administration can be expected to set the tone for the rest of the presidential term.

From what can be glimpsed so far, the election of Barack Obama seems to have four major implications for health worldwide. The first relates to assistance in international development. Obama has called for a substantial increase in development aid. He would like to increase funding for the President’s Emergency Plan for AIDS Relief (PEPFAR) by $1bn (£0.6bn; €0.7bn) over five years and double overall foreign assistance to $50bn a year by …