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October 2, 2002

International Health: Purpose, Value, Challenges

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JAMA. 2002;288(13):1648. doi:10.1001/jama.288.13.1648-JMS1002-2-1

At the 2002 International Conference on Financing for Development, the United States pledged an increase in foreign assistance to developing countries for the first time in several decades.1 This policy shift reflects a trend of international engagement that has pervaded the economic, political, and health sectors of American life in the past year. Recent health threats of international origin have raised concerns about the implications of globalization for US public health. Threats of bioterrorism and surges in the incidence of emerging pathogens such as West Nile virus have helped underscore the domestic dangers of diseases from abroad.

Prior to this new swell of attention on health problems of global reach, however, industrialized nations were already allocating resources toward the control of pandemics such as HIV/AIDS, tuberculosis, and malaria.2 The urgency with which the commitments were made came in response to the devastation wrought by these diseases. The impact of HIV, in particular, is reflected by the grim fact that a 15-year-old living in a country with a 15% prevalence of HIV infection has a one-third lifetime risk of dying of AIDS.3 Although statistics such as these have made the mandate for global collaborations in international health clear, the path to stabilizing and improving the health of the world's populations remains obscured.

In order to engage in the ongoing debates about US involvement in global health initiatives, it is necessary first to understand the reasons and aims for international health endeavors. This issue of MSJAMA examines the purpose, value, and challenges of conducting research and practicing medicine across continents. Robert Luo discusses the destabilizing influence of the HIV/AIDS pandemic on national infrastructures as well as family units. Paula Braveman addresses the inadequacy of current health statistics to gauge and ultimately eliminate health inequities both between and within nations. Jeffrey Greenberg and Rebecca Mazar argue for more international training opportunities for US medical students in order to meet the increasing demand for global health professionals. Jennifer Singler and Paul Farmer describe a sustainable program to provide HIV treatment in Haiti, the poorest nation in the Western hemisphere.

Policymakers recently met in Johannesburg for the UN World Summit on Sustainable Development. Leaders in medicine, politics, and economics all echoed previous calls for affluent nations to make good on their past declarations to implement plans to improve the livelihood of all members of the global community.4 Action requires political will and financial commitment. But comprehension of the rationale for and barriers to the control of disease at an international level will be equally vital to the improvement of global health and stability.

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