Understanding why these changes are happening is vitally important. At a time when there is much discussion about globalization, it should be recognized that health itself has become globalized The rapid increases in international travel and trade and the mass movement of populations witnessed in the last few decades mean that infectious diseases can spread from one continent to another in a matter of hours or days, whether they are conveyed by individual travellers or in the cargo holds of aircraft or ships. However, the transition in which other forms of health risk appear to be shifting from one part of the world to another usually occurs much more slowly, more indirectly and less visibly, often requiring years to Nevertheless, as globalization continues to affect societies everywhere, the risk transi tion seems to be gaining speed. Today, more people than ever before are exposed to prod ucts and patterns of living imported or adopted from other countries that pose serious long-term risks to their health. The fact is that so-called"Western"risks no longer exist such. There are only global risks, and risks faced by developing countries Increasingly, tobacco, alcohol and some processed foods are being marketed globally by multinational companies, with low and middle income countries their main targets for expansion. Changes in food processing and production and in agricultural and trade poli cies have affected the daily diet of hundreds of millions of people. At the same time, changes in living and working patterns have led to less physical activity and less physical labour.The television and the computer are two obvious reasons why people spend many more hours of the day seated and relatively inactive than a generation ago. The consumption of to bacco, alcohol and processed or"fast"foods fits easily into such patterns of life These changing patterns of consumption and of living together with global population ageing, are associated with a rise in prominence of diseases such as cancers, heart disease, stroke, mental illness, and diabetes and other conditions linked to obesity. Already com mon in industrialized nations, they now have ominous implications for many low and iddle income countries which are still dealing with the traditional problems of poverty such as undernutrition and infectious diseases confronting them. Demands on their heal frequently unable to meet the health challenges Unfortunately, these latter countries systems are increasing but resources for health remain scarce. Governments find themselves under pressure from the global demands of market forces and free trade. Such demands often imply the absence or reduction of appro- priate laws, regulations and standards intended to protect the health and welfare of their citizens As The World Health Report 1999 predicted, over a billion people entered the 21st century without having benefited from the health revolution: their lives remain short and scarred by predominantly "old"diseases. For many countries, this amounts to the notorious"do ble burden"-struggling to control the disease burden of the poor while simultaneously responding to rapid growth in noncommunicable diseases In short, while many risks have been reduced, others at least as serious have taken their place and are being added to those that still persist. And as the terrorist actions of 2001 showed, some previously unimaginable risks must now be confronted Meanwhile, large numbers of individuals, although not poor, fail to realize their full potential for better health because of a lack of enlightened policies and decisions in many sectors and the tendency of health systems to allocate resources to interventions of low quality or of low efficacy related to cost.Protecting the People 5 Understanding why these changes are happening is vitally important. At a time when there is much discussion about globalization, it should be recognized that health itself has become globalized. The rapid increases in international travel and trade and the mass movement of populations witnessed in the last few decades mean that infectious diseases can spread from one continent to another in a matter of hours or days, whether they are conveyed by individual travellers or in the cargo holds of aircraft or ships. However, the transition in which other forms of health risk appear to be shifting from one part of the world to another usually occurs much more slowly, more indirectly and less visibly, often requiring years to be detectable. Nevertheless, as globalization continues to affect societies everywhere, the risk transi￾tion seems to be gaining speed. Today, more people than ever before are exposed to prod￾ucts and patterns of living imported or adopted from other countries that pose serious long-term risks to their health. The fact is that so-called “Western” risks no longer exist as such. There are only global risks, and risks faced by developing countries. Increasingly, tobacco, alcohol and some processed foods are being marketed globally by multinational companies, with low and middle income countries their main targets for expansion. Changes in food processing and production and in agricultural and trade poli￾cies have affected the daily diet of hundreds of millions of people. At the same time, changes in living and working patterns have led to less physical activity and less physical labour. The television and the computer are two obvious reasons why people spend many more hours of the day seated and relatively inactive than a generation ago. The consumption of to￾bacco, alcohol and processed or “fast” foods fits easily into such patterns of life. These changing patterns of consumption and of living, together with global population ageing, are associated with a rise in prominence of diseases such as cancers, heart disease, stroke, mental illness, and diabetes and other conditions linked to obesity. Already com￾mon in industrialized nations, they now have ominous implications for many low and middle income countries which are still dealing with the traditional problems of poverty such as undernutrition and infectious diseases. Unfortunately, these latter countries are frequently unable to meet the health challenges confronting them. Demands on their health systems are increasing but resources for health remain scarce. Governments find themselves under pressure from the global demands of market forces and free trade. Such demands often imply the absence or reduction of appro￾priate laws, regulations and standards intended to protect the health and welfare of their citizens. As The World Health Report 1999 predicted, over a billion people entered the 21st century without having benefited from the health revolution: their lives remain short and scarred by predominantly “old” diseases. For many countries, this amounts to the notorious “dou￾ble burden” – struggling to control the disease burden of the poor while simultaneously responding to rapid growth in noncommunicable diseases. In short, while many risks have been reduced, others at least as serious have taken their place and are being added to those that still persist. And as the terrorist actions of 2001 showed, some previously unimaginable risks must now be confronted. Meanwhile, large numbers of individuals, although not poor, fail to realize their full potential for better health because of a lack of enlightened policies and decisions in many sectors and the tendency of health systems to allocate resources to interventions of low quality or of low efficacy related to cost