WHO's world health report 2003

Editor—Walt's editorial on the World Health Report 2003 highlights the challenges of health and inequality.¹ The report makes grim reading and shows the failure of past initiatives.² It has taken the world 25 years to realise the importance of strengthening health systems and developing primary health care. The return to the Alma Ata declaration of 1978 may be welcome, but whether its pronouncements and initiatives are more than just rhetoric and slogans remains to be shown.

Despite the failure of most of its previous targets, such as health for all, and specific disease eradication initiatives, such as malaria, tuberculosis, kala azar, etc, the report is still setting up new targets—for example, giving 3 million people anti-retroviral treatment by 2005.² The health parity cannot be achieved by isolated specific disease initiatives without strengthening health systems, alleviating poverty, and improving infrastructure.

Poverty is strongly correlated with ill health. About 1300 million people (20% of the world's population) live in absolute poverty. HIV/AIDS, malaria, tuberculosis, diarrhoeal diseases, malnutrition, maternal mortality, and child mortality all disproportionately affect poor people (WHO Regional Office for the Western Pacific, conference, Manila, September 2000). As many as 1.1 billion people have no access to clean water, and 2.4 billion have inadequate sanitation; 2 million still die every year from water related illnesses.³ Can health be improved without providing basic amenities such as clean water and sanitation?

Poor health retains people in poverty, and poverty keeps them in poor health.⁴ To break this vicious circle and liberate the poor from poverty and ill health we need more meaningful and effective programmes.