BRICS and global health.

Editorials 386 The influence of the BRICS countries – Brazil, the Russian Federation, India, China and South Africa – in the international arena has risen enormously in recent decades. These five countries represent around 25% of the world's gross national income, more than 40% of the world's population and about 40% of the global burden of disease. Although great attention has been paid to their economic performance, less widely noted is the fact that they are also well positioned to exert a significant influence on global health. This theme issue on BRICS and global health looks at the main factors shaping how the five countries are already influencing global health, as well as some of their major domestic achievements and challenges. Each country has unique characteristics in terms of health performance and global health diplomacy. 3,4 Within BRICS, hundreds of millions of people have been lifted out of poverty. This has resulted in marked improvements in health and in substantial progress towards achieving the Millennium Development Goals. 5 The countries are also moving towards universal health coverage, although without any uniform approach and at an uneven pace. 6–8 Brazil, China and India are leading in the manufacturing of low-cost medicines and vaccines. 9 In just a few years BRICS have amassed a wealth of experience in universal health coverage and low-cost medicines and vaccines from which other low-and middle-income countries can draw valuable examples. BRICS continue to face major health problems. Although life expectancy has improved, noncommunicable diseases have increased significantly in these countries. BRICS account for half of the 8.6 million people developing tuberculosis every year. 10 There has also been a dramatic increase in injuries linked to road-traffic accidents, 11 as well as in diseases associated with air and water pollution. BRICS' share of the global burden of noncommunicable diseases is expected to grow in the future. With economic growth, health in-equity has remained a prominent issue in all BRICS countries. 12 The countries account for about 50% of the world's poor 13 and health inequity will have serious consequences for their populations if left unaddressed. The group's efforts towards universal health coverage are therefore encouraging. Moreover, the potential impact of expanded vaccine coverage in BRICS is evident. 14 BRICS have already become protagonists in international cooperation. With the exception of the Russian Federation, which prioritizes the Commonwealth of Independent States region, they are increasingly focusing on Africa. …