Global health, personal action.

For those concerned about disparities in health between rich and poor nations, 1993 was a momentous year. First, the World Bank's World Development Report for 1993, subtitled " Investing in Health " [1], forcefully put forward the thesis that improving the health of the poor is an engine for economic development. This is the case because healthier workers are better able to cope with both the intellectual and the physical demands of work and, therefore, are not only healthier but also more economically productive. Second, the World Bank published a book entitled Disease Control Priorities in Developing Countries [2] that, for the first time, assessed the cost-effectiveness of a set of tools designed to address the major health problems of the poor in developing countries and provided a means for developing nations to prioritize interventions on the basis of disease burden, available resources , and maximum impact per dollar invested. To be sure, it would be preferable if these nations had the resources necessary to provide for the basic health needs of their populations; however, as that is not the case, there is utility in using analysis of cost-effectiveness to guide decision making. In the past decade, considerable work has been done to measure the burden of disease due to specific conditions and to predict the distribution of these disease-specific burdens over the next several decades [3]. These studies have largely made use of the newly created metric of disability adjusted life years (DALYs). This metric is designed to weigh and cumulate the burden imposed by premature death plus years lived with disabilities due to the diseases and conditions considered. In 1990, the burden due to infectious diseases (which accounted for the majority of DA-LYs at the time) was predicted to diminish and the burden due to noncommunicable illnesses was predicted to rise considerably, under the assumption that control of infectious diseases was both feasible and achievable. This scenario now seems overly optimistic. Although great advances have been made, these have not resulted in the control of infectious diseases. Rather, the spread of HIV infection (and, with it, tuberculosis) has continued, and, in developing countries, there has been growing resistance among tuberculosis, malaria, and common bacterial enteric and respiratory illnesses to commonly used drugs—a problem magnified by the failure to eliminate vaccine-preventable diseases by comprehensive and sustainable immunization programs in these settings [4]. In the current issue of Clinical Infectious …