vill The World Health Report 1999 Opportunity entails responsibility. Working together we have the opportunity to trans form lives now debilitated by disease and fear of economicruin into lives filled with realistic opes. I have pledged to place health at the core of the global development agenda. That is where it belongs. Wise investments in health can prove to be the most successful strategies to lead people out of poverty This report argues that improvements in health have contributed to spur human and conomic development in the past-and that this will also prove true in the future I have always believed that you cannot make real changes in society unless the eco- nomic dimension of the issue is fully understood. I firmly believe that this is what took"the environment"from being a cause for the committed few to becoming a societal issue for the attention of major players. The scientific facts were gathered.The true costs of environmen- tal degradation were analysed and enumerated in figures. Then, gradually, governments and parliaments started to vote incentives to change behavioural patterns among industry and consumers. There is still far to go in the field of environment and sustainable devele ment, but the trend has been started A new trend may be set in motion as we see and understand the broader implications of poverty. For the World Health Organization this means real inspiration. We intend to col- lect, analyse and spread the evidence that investing in health is one major avenue towards overty alleviation. We must be realistic: there will be setbacks and difficulties. A greater collective effort will generate more demands on each of us individually and on the institutions we represent national and international, public and private Compressing the time required to accom- sh major and tangible results is the task for leadership in the 21st century. This leadership must be technical. It must be political. And it must be moral PROGRESS AND CHALLENGES An historic conference in Alma-Ata in 1978 established the goal of Health for All by the year 2000. It defined this goal as"the attainment by all peoples of the world by the year 2000 of a level of health that will permit them to lead a socially and economically produc tive life". This report describes how the past few decades-the period following the decla ration of Alma-Ata- have witnessed revolutionary gains in life expectancy. These gains build on progress that began for some countries in the late 19th century Among todays high income countries, life expectancy increased by 30 to 40 years in this century. Most of todays low and middle income countries have experienced even more dramatic gains, although remaining inequalities needlessly burden disadvantaged populations and pro- long their poverty. Under WHOs leadership the world eradicated smallpox, one of the lost devastating diseases of history, and today a substantial majority of the worlds popu lation faces relatively low risk from infectious diseases of any sort These health gains have transformed quality of life and created conditions favouring stained fertility reductions and consequent demographic change. In many developing countries, for example, the total fertility rate -the expected number of children a woman will bear over her lifetime -declined from over six in the late 1950s to about three at present. These health and demographic changes have cont directly to the global diffusion rapid economic growth that, like the health revolution, constitutes an extraordinary accom plishment of the century now closing In an important sense, then, the world has made great progress towards better Health for All. Inspiration and guidance from Alma-Ata, with its major emphasis on the criticalviii The World Health Report 1999 Opportunity entails responsibility. Working together we have the opportunity to trans￾form lives now debilitated by disease and fear of economic ruin into lives filled with realistic hopes. I have pledged to place health at the core of the global development agenda. That is where it belongs. Wise investments in health can prove to be the most successful strategies to lead people out of poverty. This report argues that improvements in health have contributed to spur human and economic development in the past – and that this will also prove true in the future. I have always believed that you cannot make real changes in society unless the eco￾nomic dimension of the issue is fully understood. I firmly believe that this is what took “the environment” from being a cause for the committed few to becoming a societal issue for the attention of major players. The scientific facts were gathered. The true costs of environmen￾tal degradation were analysed and enumerated in figures. Then, gradually, governments and parliaments started to vote incentives to change behavioural patterns among industry and consumers. There is still far to go in the field of environment and sustainable develop￾ment, but the trend has been started. A new trend may be set in motion as we see and understand the broader implications of poverty. For the World Health Organization this means real inspiration. We intend to col￾lect, analyse and spread the evidence that investing in health is one major avenue towards poverty alleviation. We must be realistic: there will be setbacks and difficulties. A greater collective effort will generate more demands on each of us individually and on the institutions we represent – national and international, public and private. Compressing the time required to accom￾plish major and tangible results is the task for leadership in the 21st century. This leadership must be technical. It must be political. And it must be moral. PROGRESS AND CHALLENGES An historic conference in Alma-Ata in 1978 established the goal of Health for All by the year 2000. It defined this goal as “the attainment by all peoples of the world by the year 2000 of a level of health that will permit them to lead a socially and economically produc￾tive life”. This report describes how the past few decades – the period following the Decla￾ration of Alma-Ata – have witnessed revolutionary gains in life expectancy. These gains build on progress that began for some countries in the late 19th century. Among today’s high income countries, life expectancy increased by 30 to 40 years in this century. Most of today’s low and middle income countries have experienced even more dramatic gains, although remaining inequalities needlessly burden disadvantaged populations and pro￾long their poverty. Under WHO’s leadership the world eradicated smallpox, one of the most devastating diseases of history, and today a substantial majority of the world’s popu￾lation faces relatively low risk from infectious diseases of any sort. These health gains have transformed quality of life and created conditions favouring sustained fertility reductions and consequent demographic change. In many developing countries, for example, the total fertility rate – the expected number of children a woman will bear over her lifetime – declined from over six in the late 1950s to about three at present. These health and demographic changes have contributed directly to the global diffusion of rapid economic growth that, like the health revolution, constitutes an extraordinary accom￾plishment of the century now closing. In an important sense, then, the world has made great progress towards better Health for All. Inspiration and guidance from Alma-Ata, with its major emphasis on the critical