A formidable challenge

At the end of the 20th century, the future of our planet looks uncertain. While one half of the world is enjoying the fruits of economic integration and advances in science, technology and communications, the other half is struggling with basic issues of survival. These disparities no longer exist just between industrialized and developing nations or between North and South. They are evident in every society in every country and provide an ideal breeding ground for crime, violence - and conflict.

Forces of man and nature

Hopes that the end of the Cold War would usher in an era of peace have proved illusory. The clash of ideologies that opposed East and West has been succeeded by a host of other conflicts fuelled by nationalistic, religious or ethnic ideals or by the quest for power and resources. There are other potential hot spots, where smouldering tensions or unrest could flare up at any moment.

Many of these conflicts are conducted in a manner reminiscent of the Middle Ages, without even a semblance of order or restraint, in which murder, rape, mutilation and forced displacement of women, men and children and the looting and burning of homes and property have become everyday currency. In such contexts, local traditions and universal values, let alone humanitarian rules, hold little meaning for the plethora of factions, groups and individuals who resort to arms to further their aims. No problem getting their hands on a gun weapons are freely available on markets across the world.

People are more vulnerable today to the effects of "natural" disaster than ever before. Land exploitation and deforestation have left vast areas defenceless against flooding and landslides, and greenhouse gas emissions are eroding the earth's protective ozone layer. Although "global warming" is a gradual process, the effects are already beginning to be felt in extreme climatic events such as storms, floods and droughts causing death and destruction on an unprecedented scale. Demographic pressure is obliging people to occupy land that is at much greater risk of flooding, and the steady flow from the countryside to the cities has created massive concentrations of people in small areas. These migrants often live in substandard housing or shanty towns, with poor water and sanitation and little protection from the elements. Already there are slums with populations in excess of a million but without any basic infrastructure.

On a global level, the picture of health is not a pretty one. Far from achieving the World Health Organization's (WHO) ideal of "Health for all by the year 2000", the health situation of millions of people has worsened over the last two decades. Widespread poverty, rapid urbanization, poor nutrition and lack of clean water and sanitation have meant that many in the developing world are still in poor health and severely undernourished. Large numbers of women are dying as a result of ill health and inadequate health care during pregnancy and childbirth, and every year millions of children succumb to preventable diseases.

True, life expectancy has risen, infant mortality has decreased, smallpox has been eradicated and polio is on its way out. But few advances in medical science and technology have benefited the vast majority of people in the developing world who can ill afford such costly "luxuries".

Diseases such as tuberculosis (TB), diphtheria, meningitis, cholera, malaria and yellow fever, which were thought to be on the wane, are making a comeback, while new and even deadlier ones are appearing on the scene. HIV/AIDS is on the rise in many parts of the world. In some African countries it has reached catastrophic proportions and is offsetting the gains of the last two decades. It is estimated that this pandemic will wipe out 20 years of life expectancy in sub-Saharan Africa by the year 2020.

Many States, grappling with economic and social problems or sapped by years of internal strife, are finding it increasingly difficult to provide for the welfare of their citizens. The public infrastructure is crumbling in certain countries. Under pressure to implement structural adjustment policies, developing nations are cutting their health and social welfare budgets. In the industrialized world, governments are cutting back on their role as service providers and are privatizing health systems. As a result many of the people in greatest need of health care are often those least likely to have access to it.

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