Abstract

Curt Carnemark/The World Bank

The 20th century differed markedly from previous history with its rapid economic growth, health improvements, and plummeting mortality rates. Improved health has contributed significantly to economic welfare. These trends are likely to continue, and even those countries with limited resources can expect major improvements from cost–effective interventions. The pace at which knowledge of effective health interventions is diffused within a country, more than the level of income, will determine the pace of improvement.

Four critical challenges face developing countries today: high levels and rapid growth of noncommunicable diseases; the unchecked HIV/AIDS pandemic; the possibility of a successor to the influenza pandemic of 1918; and the persistence of high but preventable levels of diseases such as malaria, tuberculosis, diarrhea, and pneumonia for which malnutrition is a critical risk factor.

New findings highlight types of interventions and resources needed to reduce the global burden of disease and injury. For example, care during a child's first 28 days of life is crucial to reduce child mortality, because 50 percent of child deaths worldwide occur during this period, yet relatively little attention has been paid to this population group. Cardiovascular disease is shown to create an unexpectedly high burden in developing countries. Lifelong management of risk factors in individuals at risk for stroke or heart attack is cost–effective and would benefit millions.

Based on successful interventions in the past half–century, it is concluded that provider incentives and provider experience matter. Development assistance for health from high–income countries would be more effectively used if a larger share were devoted to research and development. The generation and diffusion of new knowledge and products are essential to continued progress.