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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.