Intended for healthcare professionals

Education And Debate

Time to reassess strategies for improving health in developing countries

BMJ 2005; 331 doi: (Published 10 November 2005) Cite this as: BMJ 2005;331:1133
  1. David B Evans, director (,
  2. Taghreed Adam1, health economist,
  3. Tessa Tan-Torres Edejer2, coordinator,
  4. Stephen S Lim, research fellow3,
  5. Andrew Cassels, director4,
  6. Timothy G Evans5, assistant director general assistant director general for the the WHO Choosing Interventions that are Cost Effective (CHOICE) Millennium Development Goals Team
  1. 1 Health Systems Financing, Evidence and Information for Policy, World Health Organization, Geneva, Switzerland
  2. 2 Costs, Effectiveness, Expenditure and Priority Setting, World Health Organization
  3. 3 School of Population Health, University of Queensland, Australia
  4. 4 Department of Millennium Development Goals, Health and Development Policy, World Health Organization
  5. 5 Evidence and Information for Policy, World Health Organization
  1. Correspondence to: D B Evans
  • Accepted 12 October 2005


A girl born today in Malawi is 35 times more likely to die before reaching the age of 5 years than a girl born in the United Kingdom. If she reaches her fifth birthday, she can look forward to a life in which she has a 37 times greater chance of contracting tuberculosis than her British counterpart and is 180 times more likely to die during pregnancy or childbirth.1 Malawian girls can expect a life span of only 42 years, 39 years less than that of British girls.1 These differences are typical of the health gaps between rich and poor countries. Contributing factors are numerous and complex and include poverty, low levels of education (particularly for women), environmental hazards, limited access to health services, and the low volumes, unpredictability, and volatility of aid flows. In recognition, after a decade of discussion, 189 countries committed to accelerate development in poor countries by endorsing an interrelated set of development goals, outlined in the Millennium Declaration of September 2000.2

Health goals

Improving health received considerable prominence in the millennium development goals. Three of the eight goals focused on reducing key causes of mortality in poor countries: maternal and perinatal conditions, diseases affecting children and infants, and the major communicable diseases (box 1). These remain priorities, although non-communicable diseases and injuries are increasingly important even in poor countries (table 1).

View this table:
Table 1

Leading causes of death in developing and developed countries, 20004

Targets and indicators for each goal were developed to help monitor and evaluate progress (table 2). Tuberculosis is the only disease other than HIV and AIDS and malaria specifically mentioned in the last health goal.

View this table:
Table 2

Targets and indicators for millennium development health goals3

The millennium development goals have been criticised on several fronts: that they are too ambitious and therefore …

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