BMJ  2007;335 (27 October), doi:10.1136/bmj.39377.555324.47

Editor's Choice

Make health inequality history

James Tumwine, professor of paediatrics in Kampala, reckons most people would agree on the need for urgent action to reduce mortality in children in resource constrained countries. We have good evidence to underpin that action, he urges, and yet "expenditure on health has not improved substantially, and the hospital wards in many of these countries are best described as pathetic" (doi: 10.1136/bmj.39371.586076.80).

Three years ago 1 in 8 children with malaria in the national hospital in Guinea-Bissau were dying as inpatients. The introduction of special drug kits for children with severe and complicated malaria had not cut mortality, and it became clear that something else had to be done. So Sidu Biai and colleagues tested in a randomised trial whether strict monitoring of patients, removal of prescription charges for families, and small financial incentives for the staff could reduce mortality on the paediatric ward. It worked. Mortality from malaria on the children's ward, once people's poverty was tackled head on, was just 5% in the intervention group and 10% for controls (doi: 10.1136/bmj.39345.467813.80).

This week's BMJ is our contribution to a remarkable collaboration: a global theme issue on poverty and human development coordinated by the US National Institutes of Health (NIH) and the Council of Science Editors (CSE). More than 200 journals took part, and seven of their most outstanding articles were picked for presentation at the launch in the US on 22 October, including—we're delighted to say—this BMJ trial from Guinea-Bissau (doi: 10.1136/bmj.39378.458032.DB). Coming up soon will be the outputs from another truly international event: the Global Forum for Health Research meeting in Beijing from 29 October to 2 November. The forum is an independent foundation that promotes new research to combat the main sources of ill health and health inequalities in less developed countries, and this year it's focusing on equitable access to health care (www.globalforumhealth.org/Site/004__Annual%20meeting/001__Forum%2011/001__Home.php).

We've also published this week a randomised controlled trial from India (doi: 10.1136/bmj.39341.608519.BE) and one from Brazil (doi: 10.1136/bmj.39339.448819.AE) on calming or sedating acutely disturbed patients in under-resourced settings, a population based study on funding proper care for hypertension in Mexico (doi: 10.1136/bmj.39350.617616.BE), and a call for donors to put one tenth of their funding towards the infrastructure of public health in less developed countries (doi: 10.1136/bmj.39356.406377.BE). Two articles unpick the associations between health and poverty within countries as well as between them: Greenhalgh and colleagues by examining what works in programmes to feed disadvantaged children in schools (doi: 10.1136/bmj.39359.525174.AD), and Dorling and colleagues by showing that the impact on health of the gap between rich and poor is even worse in Africa than it is in affluent nations (doi: 10.1136/bmj.39349.507315.DE).

What about the hungry elephants in the room: overconsumption (coupled with anthropogenic climate change) and overpopulation? There's only so much we could squeeze into one theme issue, and we wanted to give most space to original research on improving access to health care. But if you have important, original, actionable, and health improving evidence on poverty, development, climate change, or population control, please keep it coming.

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