Defining global health: who is responsible for the world's burden of disease?

First of a two-part series. This year, the Organization for Economic Cooperation and Development reported that its 30 member countries, most from the developed world, spent record amounts on health care in 2001. The United States tops this list, spending $4,900 per capita in public and private dollars combined. As developed countries spend more and more in both public and private funds for health care within their own borders, nations and organizations around the world are also paying attention to health across international boundaries. According to the U.S. Census Bureau, 90% of the planet's births and 77% of its deaths in 1998 took place in lesser-developed countries. The developing world has very different primary health risks— malnutrition, vitamin and mineral deficiencies, unsafe drinking water, and unsafe sex—than those in the developed world. However, the World Health Organization (WHO) has noted a " risk transition " in recent years; factors historically important only in industrialized countries—blood pressure, cholesterol, tobacco, alcohol, and obesity—have become prevalent in developing nations. This shift in risk-factor prevalence could mean an enormous shift in the burden of disease around the globe, and it raises the question of who will provide the care and pay the bills as people in resource-poor countries experience different patterns of disease. Global health—the new buzzword used to describe cooperative efforts to eradicate and control disease around the world—is gaining popularity as governments and organizations develop programs and initiatives to reach out to other nations. At the same time, there is still debate about the meaning of global health and where the burden of responsibility lies for addressing the world's burden of disease. A large part of global health boils down to developed nations, which have the resources, reaching out to the developing world, which carries much of the burden of disease. " Since 85% of the world's population lives in developing countries, global health must be particularly oriented to developing countries, " said Ian Magrath, M.D., president and medical and scientific director of the International Network for Cancer Treatment and Research in Brussels, Belgium. " It's a kind of 'us versus them' philosophy, occasionally arousing suspicion that affluent countries are interested in health in developing countries only because it may affect them, not for humanitarian or even economic reasons. But health should be a global issue …. Health is a critically important element to the success of all economies, and in this …