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Editor's Choice

Economics first; health third, fourth, or nowhere

BMJ 2004; 328 doi: (Published 29 January 2004) Cite this as: BMJ 2004;328:0-g
  1. Richard Smith, editor (rsmith{at}

    Editors of medical journals look with admiration and envy at the Economist (or at least I do). It has managed to break out of a specialist ghetto and influence the world. It could do so because everything from world politics to football is driven by economics. But doesn't health also relate to everything? Could a journal run by those concerned with health legitimately consider everything? It might, but I doubt if it would ever have the influence of the Economist. Similarly a health forum that considered the big issues would probably not attract the most powerful in the world.

    In contrast, the World Economic Forum, which is held in the Swiss ski resort of Davos each year, attracts many of the world's most powerful people. This year Bill Clinton spoke at the beginning and Dick Cheney near the end. In between there were presidents, prime ministers, and a king, and the audience was so glutted by power that Bertie Aherne, the Taoiseach and president of the European Union, spoke to a hall that was mostly empty. But then the audience comprises chief executives of the world's biggest companies, glittering academics, archbishops, politicians of every stripe, social entrepreneurs, writers, artists, and Nobel prize winners.

    The forum is “committed to improving the state of the world” and “provides critical insight to global leaders” so that they can do a better job of running the globe. This year's meeting had the theme of “Partnering for security and prosperity.” The argument is that you can't have security without prosperity and vice versa. Health is a crucial component of both security and prosperity—and the forum considers health extensively—but I couldn't help but notice that “the big guys” I heard didn't mention health once.

    Dick Cheney, the American vice president, used the word freedom perhaps 50 times and the word democracy almost as often. Governments had three responsibilities to achieve security and prosperity and defeat terrorism: promote democracy; cooperate; and be willing to go to war when all else failed. Many of the chief executives at the conference believed that security could never be achieved in a world of gross inequity, but Cheney didn't mention poverty reduction.

    Bertie Aherne gave a workaday speech on Ireland's agenda to improve competitiveness in the European Union, but it was an inward looking speech for a world forum. Ironically with the vogue for democracy, inspiration and vision came not from an elected politician but from a hereditary king—His Majesty King Abdullah II, King of the Hashemite Kingdom of Jordan. A Harvard Business School style king, he was most concerned with justice. “Peace, equity, and justice are not just lofty goals. They are critical to the success of every nation… and the hopes of every individual… the credibility of the world's commitment to justice is being tested.”

    Health must now—and perhaps for ever—take a subservient place to lofty goals.


    • Embedded Image Richard Smith's Davos diary can be found on

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