Winterthur, Switzerland—The world needs to unite for a massive effort against diseases of poverty, said Dr Gro Harlem Brundtland, Director-General of the World Health Organization here Tuesday at a meeting of organizations active in the fight against these diseases world-wide.

"A few main diseases, such as malaria, HIV/AIDS, tuberculosis and childhood killers, plus reproductive health conditions, are directly biting into the economic growth of poor countries. There is increasing recognition of the sheer difficulty faced by developing nations as they seek to counter these health threats," Dr Brundtland said.

She said that a number of effective health interventions that drastically reduce mortality of main killers exist. "Quite simply, if we can take these interventions to scale—and by that I mean to a global scale—we have in our hands a concrete, result-oriented, and measurable way of starting to reduce poverty," she said. This process, she said, has been given the working title: "Massive Effort against Diseases that Cause or Perpetuate Poverty."

Dr Brundtland spoke at the opening of an advocacy forum aimed at building popular support for this new global movement. "The Massive Effort is a process, a road to follow, a framework for thinking and a set of values that underpin it all," Dr Brundtland said.

The forum is attended by 200 experts on health, advocacy, and public relations from 70 countries, representing non-governmental organizations, advocacy groups and private companies.

The forum follows recent announcements by the G8 nations that targets have been set to reduce the burden of malaria and tuberculosis by 50% within 10 years and to reduce the spread of HIV/AIDS by 25% within the same time period. The forum also comes after the creation of a new policy framework by the European Commission aimed at focusing the European Union's aid efforts on reaching these targets.

Dr Brundtland said that although the world long had known that illness and poverty are closely linked, new data over the past few years have shown a much more devastating economic impact on developing country economies by a few infectious diseases.

Analysis of data from thirty-one African countries during the period 1980 to 1995 showed that the annual loss of economic growth due to malaria has been as high as 1.3% per year, and if this loss had been compounded for 15 years the GNP level would have been reduced by nearly 20% during that time.

When HIV prevalence reaches 8% of the population—as is the case in at least 21 African countries—per capita growth is reduced by 0.4 percentage points each year. Given that annual per capita growth in Africa for the past three years has averaged 1.2%, this is a significant reduction. Similar analysis can, or is, being done on the other diseases and conditions.

The fight against these diseases will demand high investments in health. Current estimates suggest that an additional US $1 billion dollars will be required annually to combat malaria effectively. But the annual pay-off from this investment could be a

US $12 billion boost to the combined GDP of countries in sub-Saharan Africa. The situation with tuberculosis is similar. Another one billion dollars annually spent on drugs—linked to work on health systems—could result in a 50% drop in mortality over the next five years. For HIV/AIDS, a greater amount of funding is necessary. Sums in the order of US $2.5 billion dollars annually are needed for prevention alone. Add the cost of care, and the figures rise dramatically.

These are long-term investments. Dr Brundtland believes that in order to maintain this political commitment, a popular movement is needed to keep up the pressure on decision makers; that would stimulate people in all countries to find their own best ways of carrying forward the Massive Effort.

"It must be a movement that is based on a shared and strong set of values. It must be a movement that is oriented towards action—with measurable, clear goals and outcomes," said Dr Brundtland. "And it must be a movement that celebrates plurality and new ideas."