BMJ on Health in South Asia

In South Asia, which contains a quarter of the world's population, half the population lives below the poverty line. Thirty-four percent of the world's child deaths occur in the region, which has almost two thirds of the global burden of malnutrition. Of the nearly 4 million child deaths a year, over two thirds are attributable to infection. In addition, India has the second highest burden of HIV and AIDS in the world, with 4.58 million people infected with HIV. India has more people with diabetes than any other country, and a third of Pakistanis over 45 have hypertension. In India about half of deaths from cardiovascular disease occur in people under 70—compared with a quarter in the developed world. The region also has increasing deaths from road crashes and violence. In the United States health expenditure per person is around $4000. In Nepal the government spends $3 per person, while the Indian, Pakistani, and Afghani governments spend $4 per person. Less than half of children in Afghanistan are fully vaccinated against diphtheria, pertussis, tetanus, and measles, and only slightly more than half of children in India and Pakistan are vaccinated against measles. Yet in Sri Lanka 99% of children are vaccinated against all these infections. The British Medical Journal is publishing this theme issue on South Asia. Zulfiqar Bhutta, Samiran Nundy, and Kamran Abbasi, the three main drivers of the issue, point out how wise investment in Sri Lanka and Kerala (India) - in primary care, vaccination, family planning, and education, particularly of girls has reaped rich rewards. The BMJ aspires to be global, and true globalisation would mean the rich accepting much more responsibility for the poor. Rich countries transfer a quarter of their gross national products within their borders in order to fulfil the social contract of providing education, health care, social services, income support, and the like. Yet the rich countries transfer only a fraction of 1% of their wealth to the poor world. A true global society would mean a global social contract between rich and poor.