THE DEVELOPING WORLD I n considering the health information needs of develop- ing countries, one cannot ignore the essential fact that poverty is the leading cause of poor health across the globe. 1'2 900 years ago, A1 Asuli, the great physician of Islam, living in Bokhara (now Kazakhstan) wrote a med- ical pharmacopoeia. He divided this monumental treatise into two parts: "diseases of the rich" and "diseases of the poor". The passage of so many centuries has not made the dichotomy obsolete. As we race to a new millennium, the divide between rich and poor is widening--within indus- trialised nations, but more so between developing and Health information in the developing world Bernard Lown, Fred Bukachi, Ramnik Xavier developed countries. In 1996, 358 billionaires controlled assets greater than the annual incomes of countries repre- senting 45% of the world's population--2'5 billion peo- ple. 3 The poor countries In this age of potential abundance, more are hungry than ever before. Oxfam reports that a third of people in Asia, Africa, Latin America, and the Caribbean are too mal- nourished to lead fully productive lives.4 The disparities between rich and poor nations are prodigious. The indus- trialised countries (21% of the world's population), account for 85% of the global gross national product, of world trade, and of energy consumption. By contrast, the poorest quintile contribute a meagre 1-4% to the global gross national product and engage in only 0'9% of world trade. 5 This formidable divide continues to grow. According to the United Nations, from 1960 to 1990, income per head increased four times among poor nations compared with an eight-fold rise among the wealthy ones. The difference in annual income is now more than 60 fold2 As of 1996, 89 countries out of 174 were worse off economically than they were in the 1960s and 1970s. 4 The policies of struc- tural adjustment, imposed on developing countries by the World Bank and the International Monetary Fund, have emphasised debt repayment based on maximising exports at the expense of agricultural self-sufficiency and domestic social programmes. These economic strictures h'ave cur- tailed the already small funding for health services, educa- tion, and the environment. According to World Bank projections, by 2005 sub-Saharan Africa will, be back to lev- els of income per head that it had in the 1970sj In Africa, as in other regions of the poor world, there is a noteworthy dis- parity between a mammoth disease burden and the small numbers of trained physicians. In east Africa, there is less than one physician per 10 000 people. Many African countries have far fewer physicians. The low status of women is an additional contributor to morbidity and premature death. Endless drudgery, early marriage, teenage pregnancy, high fertility, inadequate nutrition, anaemia, and chronic infections are some of the risk factors that account for the inordinate child-bearing mortality. Death in pregnancy is related to a woman's sta- tus and is reflected by her level of education. 8 Although science and technology promise a way out from poverty, it is difficult to be optimistic on that score. In the decade of the 1970s, the increase in the number of scientists per million population was 637 in the industri- alised countries compared with 42 (<0.1%) in the devel- oping world (tables 6 and 10 in ref 9). Only 10% of the US$55 billion spent globally on health research is allo- cated to the needs of poor countries, 1° where more than 90% of the years of potential life is lost. The grim coin also has a more hopeful side. While the north-south gap has widened in terms of income and ernard Lown is emeritus professor at Harvard School of Pub c Health and senior physic an at the Brigham and Women's Hospital, Boston. He is the author of 450 sc entif c art cles, three medical books, onbehalf of IPPNW~ Professor Lown is also the founder and chairman of SatetLife. Lown Cardiovascular Center. 23. Longwood Avenue, Brook/ine, MA 02146, USA (e-mail: belown@lgc.apc.org) ~)amnik Xavier graduated from Godfrey Huggins School of Medicine, University of Zimbabwe. He trained in r~ internal medicine in gastroenterology an(~ molecular biology at the Massachusetts General Hospital, Boston and joined the staff there in 1996. Senior medical advisor to SatelLife, Dr Xavier is also the editor of HealthNet News. Departmentof Molecular Biology, Massachusetts GeneralHospital, Boston. Massachusetts 02114-2696, USA Fred Bukachi s Hea thNet Regiona D rector for Africa, and an honorary physician at Kenyatta National r- Hospita, Nairob, KenYa He obta ned a master of med c ne n nternat med cine at the Univers ty of Nairobi Medical School, and has published several itemsin local scientific journals and newsletters on health informatJcs. His current research interests are telemedicine and hypertensive heart disease. SatelUfe HealthNet Kenya, Medical School Library Bloc, Rm 1. off Ngong Road. PO Box 29750, Nairobi, Kenya Sli34 THE LANCET 175 • Vol 352 • October • 1998