Key points

• Almost all preventable deaths of children, and of women in pregnancy and childbirth, occur in poor countries. Poor people carry the greatest burden from communicable diseases, and non-communicable diseases are increasing in poor countries.

• Reducing income poverty, through economic development, debt relief and fairer trade, will improve health status, but faster progress will be made by increasing access to health services including affordable medicines.

• Around half of all poor people live in countries where the state institutions are weak or ineffective, including during and after armed conflicts. International agencies have a particular responsibility to address the health needs of such populations.

• Different models of financing and organising health services are appropriate for different contexts. Robust, effective heath systems accessible to and used by poor people are key. There is no one ‘right’ model.

• The impact of health systems in poor countries must be strengthened by: protecting poor people from large out-of-pocket expenditure on health; improving equity of access to health services; ensuring sustainable health-care worker capacity.

• Better data systems are needed to monitor the impact of health policies and to measure health-service quality.

• There has been a proliferation of agencies and initiatives working to address global health needs since the 1990s. Greater co-ordination is urgently needed to increase the impact of the many agencies and initiatives which aim to improve global health.

• More research is needed in prevention and management of diseases of poverty, including chronic conditions, and ways of reaching the poorest people with proven cost-effective life-saving interventions.

Introduction

This chapter extends the consideration of the changing global burden of diseases begun in Chapter 2 and discusses what is required to mount an effective response to the public health challenges, particularly in poor countries. It considers the role of international development assistance and the responsibilities of the international community in improving the health of poor people.