BMJ 2005;330:261 (29 January), doi:10.1136/bmj.330.7485.261
/re/views
Book
Global Crises, Global Solutions
*W*hat an intriguing idea. Convene serious thinkers to create^ a list of critical issues facing the global community that are^ amenable to governmental intervention, prune and prioritise^ the list to the top 10, enlist leading economists to outline^ the challenges, add thoughtful commentaries, and then rank the^ final 10. A group called the Copenhagen Consensus under the^ leadership of Bjørn Lomborg did just this and teamed^ up with the /Economist/ to disseminate the results. /Global Crises,^ Global Solutions/ is the result, and disappointing it is, garnering^ at best two stars.^
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Instead of presenting innovation based on prior work, the book^ is constrained by reflection and limited by a lack of anticipation.^ Economists, it turns out, are not effective lead authors. They^ are too comfortable building complex edifices on data acknowledged^ as weak; they seem reluctant to transpose what is known, even^ if inexact, into design models for future problem alleviation;^ their emphasis on cost benefit analysis inhibits a larger view^ that might encompass such critical factors as governance and^ custom. In addition, this text is poorly edited. Co-authors^ are not identified; abbreviations essential to a chapter are^ not highlighted; proofreading lapses abound; many pieces are^ overly long, testing the perseverance of the most dogged reader.^
Of the 10 challenges identified, three impinge upon medicine:^ communicable disease, malnutrition and hunger, and sanitation^ and access to clean water. Of concern is the failure of the^ Copenhagen Consensus to accord greater priority to chronic illness^ and its global burden of disease and over-nutrition with impeding^ epidemics of diabetes and heart disease in most of the developing^ world.^
Contributors Anne Mills and Sam Shill-cut restrict their discussion^ of communicable disease to HIV/AIDS and malaria in Africa. They^ barely discuss treatment of HIV/AIDS and its inevitable conversion^ to a chronic disease, and they limit their discussion of primary^ medical care to a few paediatric diseases.^
Jere Behrman, Harold Alderman, and John Hoddinott recreate what^ is known about the deleterious effects of malnutrition. Instead^ of revisiting the problems of low birth weight and micronutrient^ deficiencies, a more engaging piece leading towards innovative^ interventions would focus on governance, a lack of civil society,^ women's education, land inheritance policy, and enlightened^ rather than self-serving donor agency policies.^
"Sanitation and access to clean water" by Frank Rijsberman is^ shorter, freer of jargon, and more willing to accept problems^ of governance and management. The problems and opportunities^ are better defined and addressed. Rijsberman blends component^ assessments of cost benefit analyses into larger overviews that^ anticipate feasible interventions.^
Rather than read /Global Crises, Global Solutions/, the curious^ physician looking for insights into the complex societal and^ economic issues that cloud the future would be better off subscribing^ to the /Economist/.^
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*Henry Greenberg*, /associate professor of clinical medicine/ /Columbia University College of Physicians and Surgeons, New York, United States/
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