Interview respondents identified the following trends and emerging issues that will impact global health in a variety of ways. These should be taken into account as the Council considers strategic directions for the organization and the field of global health as a whole. Emergence and re-emergence of infectious and communicable diseases Of particular concern are those diseases that are becoming drug resistant (malaria, TB, viruses such as SARS, the looming threat of avian influenza, and other pandemics). The huge impact of HIV/AIDS Current users of ARVs will continue to need lifelong treatment and home-based care, many infected people do not yet have access to ARVs and more people are being infected. Climate change, global warming and environmental degradation Changes in the environment affect rain and drought and foster diseases in new places. Health inequity There are pervasive inequities in access to health information, services and treatment attributable to gender, ethnicity, rural-urban residence, misallocation of resources and other factors. Recognition of lifestyle contributors to poor health Increasing prevalence of obesity, diabetes, hypertension, tobacco, alcohol and other substance abuse, and other lifestyle conditions suggest the need for public health programs to address these causes of death and disability. Political instability and violence Violence and conflict affect the health of many populations – directly through deaths and casualties as a result of armed conflict, and indirectly through the destruction and/or disruption of health facilities and services, disrupted livelihoods, and shifts in funding priorities. Globalization International trade and economy, increased travel, global communication and integration, as well as the prevalence of multinational businesses working in developing countries, create positive and negative impact on health, the environment, political systems, culture and general well-being of people. In addition, respondents commented on the “brain drain” as health professionals seek better-paying and more satisfying jobs in more developed countries. Regional differences in health status There are static or declining health indicators in many parts of Africa, while those in Latin America and Asia are generally improving (albeit with pockets of population that remain static). Countries such as Brazil, Thailand, Taiwan, Korea, parts of India, Mexico, and others that are improving economically, are more similar to the developed world in that their health indicators also have a greater emphasis on chronic conditions such as diabetes, obesity, hypertension and cancers. Demographic shifts In more developed countries the population is aging; in less developed countries, the population remains relatively youthful despite declining birth rates — in over 100 countries approximately 40% of the population is under the age of 24. Older populations are experiencing more chronic diseases and conditions, whereas younger populations are more prone to childhood illnesses, sexual/reproductive health issues, tobacco and other substance addictions, and violence-related health issues. Increasing mobility, migration and urbanization This year is the first in which more people are living in cities than in rural areas and this trend will continue. The health needs of urban populations and the systems for delivering care often differ markedly from those living in rural areas. Technologies The rapid growth of information and communication technologies presents greater possibilities for connection, dialogue, and networking, though many people lack access to these technologies. New vaccines, microbicides and diagnostics are being developed. There will be increasing opportunities to integrate services with the help of technology. Several respondents said that new technology may be helpful (or harmful), but the real challenge is how to effectively and efficiently deliver proven technologies. Finally, some respondents expressed concern about potential negative effects that new technologies may have on health and the need for more research to understand their potential consequences. Fragile health systems in developing countries that cannot provide basic health care Donor funding priorities have supported vertical programs, while giving inadequate attention to building the capacity of the overall health system to provide basic health care and prevention services. Many developing countries lack the financial and human resources to meet their basic health system needs. Absorbing increasing resources can prove challenging for weak health systems and this problem may get worse without basic health system strengthening. Roles of public and private sector The greatly increased role of the private sector as donor and implementer of health programs raises serious concerns about priorities, coordination among a proliferating set of actors and coherence between private action and public policy. On the public sector side, there are concerns about the impact of foreign assistance re-structuring on US global health programs, the need for a more comprehensive approach to US global health policy, the optimal role of development finance institutions and aligning health policy with best evidence. The role of donors and private sector actors must also respond to and support developing country governments, which ultimately have responsibility for meeting the basic health needs of their populations. Funding and health care financing To meet the basic health needs of the world’s poorest people, there will have to be a very substantial increase in the available resources; e.g., billions more will be needed simply to respond to the requirement for anti-retroviral treatment among those infected with HIV. Available funds must be optimally allocated so they respond to the most pressing health needs of the poor and deploy the most cost-effective strategies. Innovative financing mechanisms (e.g., the Global Fund Against AIDS, Tuberculosis and Malaria, GAVI, advanced market commitments, etc.) should be encouraged while ensuring they inure to the benefit of the world’s poorest. Changes in the global health “architecture” The proliferation of health donors, advocates, analysts, assistance agencies and implementing agencies has enormously complicated the development and implementation of rational policy. There is a need for more coordination, collaboration and a common set of priorities with a clear, coordinated strategy to work on a large scale. Developing countries need help prioritizing and coordinating with developed countries to avoid duplication of efforts and maximize the use of resources.