Message from the Director-General role of primary health care, contributed in no small measure to the health revolution. Con- tinued improvement in living standards has also played a role. More important, though, has probably been the generation and application of new knowledge about diseases and their control. These factors have yielded substantial success by any measure, but problems and challenges remain. Some problems emerge from the reduction in mortality from infectious disease and accompanying declines in fertility: the very successes of the past few decades will, inexora- bly, generate a"demographic transition"from traditional societies where almost everyone is young to societies with rapidly increasing numbers of the middle-aged and elderly. With this transition a new set of diseases rises to prominence: cancers, heart disease, stroke and mental illness figure prominently among them. Available interventions against these dis- eases, including preventive ones, yield less decisive results than we have achieved for most infectious diseases And their costs can be very high indeed Furthermore, as this report documents, over a billion people will enter the 21st century without having benefited from the health revolution: their lives remain short and scarred by disease. Many countries must deal with these disease problems of the poor while simul taneously responding to rapid growth in noncommunicable diseases: they face a double burden. Large numbers of other individuals, while not poor, fail to realize their full poten tial for better health because health systems allocate resources to interventions of low qual ity or of low efficacy related to cost. Increasing numbers of people forego or defer essential care or suffer huge financial burdens resulting from an unexpected need for expensive services.The continuing challenges to health ministries and to countries thus remain enor- mous. New problems constantly arise: witness the emergence of the HIV epidemic, the threat of resurgent malaria or the unexpected magnitude and consequences of the tobacco epidemic. Achieving better health for all is an ever-changing task. Success will make a major difference in the quality of life worldwide. And the difference for the poor will be not only in improving their quality of life but also, through increasing their productivity, in ddressing one of the root causes of poverty Global leadership and advocacy for health remain critical missing ingredients in the formula for making a difference and conveying evidence to the highest level of govern ent. We need to remind prime ministers and finance ministers that they are health min isters themselves and that investments in the health of the poor can enhance growth and reduce poverty. Leadership must motivate and guide the technical community to bring todays powerful tools to bear on the challenges before us Let us review the challenges to be addressed in order to improve the world's health First and foremost, there is a need to reduce greatly the burden ofexcess mortality and morbid- ity suffered by the poor. The OECD's Development Assistance Committee has establishe the target of halving the number of people living in absolute poverty by the year 2015 This goal is attainable, but it will require major shifts in the way that govemments all over the world use their resources. It will mean focusing more on interventions that we know can achieve the greatest health gain possible within prevailing resource limits.It will mean giving renewed attention to diseases like tuberculosis, which disproportion ately affect poor people, as well as malaria and HIVAIDS, which we now recognize as major constraints to economic growth. Women and children suffer poverty more than men: there is therefore a need for maternal and childhood nutrition. Reducing the burden of excess mortality andm.8 greater investment in reducing matemal mortality-and finding ways of improvinMessage from the Director-General ix role of primary health care, contributed in no small measure to the health revolution. Con￾tinued improvement in living standards has also played a role. More important, though, has probably been the generation and application of new knowledge about diseases and their control. These factors have yielded substantial success by any measure, but problems and challenges remain. Some problems emerge from the reduction in mortality from infectious disease and accompanying declines in fertility: the very successes of the past few decades will, inexora￾bly, generate a “demographic transition” from traditional societies where almost everyone is young to societies with rapidly increasing numbers of the middle-aged and elderly. With this transition a new set of diseases rises to prominence: cancers, heart disease, stroke and mental illness figure prominently among them. Available interventions against these dis￾eases, including preventive ones, yield less decisive results than we have achieved for most infectious diseases. And their costs can be very high indeed. Furthermore, as this report documents, over a billion people will enter the 21st century without having benefited from the health revolution: their lives remain short and scarred by disease. Many countries must deal with these disease problems of the poor while simul￾taneously responding to rapid growth in noncommunicable diseases: they face a double burden. Large numbers of other individuals, while not poor, fail to realize their full poten￾tial for better health because health systems allocate resources to interventions of low qual￾ity or of low efficacy related to cost. Increasing numbers of people forego or defer essential care or suffer huge financial burdens resulting from an unexpected need for expensive services. The continuing challenges to health ministries and to countries thus remain enor￾mous. New problems constantly arise: witness the emergence of the HIV epidemic, the threat of resurgent malaria or the unexpected magnitude and consequences of the tobacco epidemic. Achieving better health for all is an ever-changing task. Success will make a major difference in the quality of life worldwide. And the difference for the poor will be not only in improving their quality of life but also, through increasing their productivity, in addressing one of the root causes of poverty. Global leadership and advocacy for health remain critical missing ingredients in the formula for making a difference and conveying evidence to the highest level of govern￾ment. We need to remind prime ministers and finance ministers that they are health min￾isters themselves and that investments in the health of the poor can enhance growth and reduce poverty. Leadership must motivate and guide the technical community to bring today’s powerful tools to bear on the challenges before us. Let us review the challenges to be addressed in order to improve the world’s health. • First and foremost, there is a need to reduce greatly the burden of excess mortality and morbid￾ity suffered by the poor. The OECD’s Development Assistance Committee has established the target of halving the number of people living in absolute poverty by the year 2015. This goal is attainable, but it will require major shifts in the way that governments all over the world use their resources. It will mean focusing more on interventions that we know can achieve the greatest health gain possible within prevailing resource limits. It will mean giving renewed attention to diseases like tuberculosis, which disproportion￾ately affect poor people, as well as malaria and HIV/AIDS, which we now recognize as major constraints to economic growth. Women and children suffer poverty more than men: there is therefore a need for greater investment in reducing maternal mortality – and finding ways of improving maternal and childhood nutrition. Reducing the burden of excess mortality and mor-