The world's biggest killer and the greatest cause of ill-health and suffering across the globe is listed almost at the end of the International Classification of Diseases. It is given the code Z59.5 - extreme poverty.

　　Poverty is the main reason why babies are not vaccinated, why clean water and sanitation are not provided, why curative drugs and other treatments are unavailable and why mothers die in childbirth. It is the underlying cause of reduced life expectancy, handicap, disability and starvation. Poverty is amajor contributor to mental illness, stress,  suicide, family disintegration and substance abuse. Every year in the  developing world 12.2 million children under 5 years die, most of them  from causes which could be prevented for just a few US cents per child. They die largely because of world indifference, but most of all they die  because they are poor.

　　In the time it takes to read this sentence, somewhere in the world a baby has died it its mother s arms. For that mother, the message that her neighbour's infant will live is no consolation. It does not stem her grief to know that 8 out of 10 children in the world have been vaccinated against the five major killer diseases of childhood, or that globally since 1980 infant mortality has fallen by 25%, while overall life expectancy has increased by more than 4 years, to about 65 years.

　　Beneath the heartening facts about decreased mortality and increasing  life expectancy, and many other undoubted health advances, lie  unacceptable disparities in health. The gaps between rich and poor,  between onepopulation group and another, between ages and between  the sexes, are widening. For most people in the world today every step  of life, from infancy to old age, is taken under the twin shadows of  poverty and inequity, and under the double burden of suffering and  disease.

　　For many, the prospect of longer life may seem more like a punishment  than a gift. Yet by the end of the century we could be living in a world  without poliomyelitis, a world without new cases of leprosy, a world  without deaths from neonatal tetanus and measles. But today the money  that some developing countries have to spend per person on health care  over an entire year is just US $4 - less than the amount of small change  carried in the pockets and purses of many people in developed countries.

　　A person in one of the least developed countries in the world has a life expectancy of 43 years according to 1993 calculations. A person in one of the most developed countries has a life expectancy of 78 - a difference of more than a third of a century. This means a rich, healthy man can live twice as long as a poor, sick man.

　　That inequity alone should stir the conscience of the world - but in  some ofthe poorest countries the life expectancy picture is getting  worse. In five countries life expectancy at birth is expected to  decrease by the year 2000, whereas everywhere else it is increasing. In the richest countries life expectancy in the year 2000 will reach 79  years. In some of the poorest it will go backwards to 42 years. Thus  the gap continues to widen between rich and poor, and by the year 2000  at least 45 countries are expected to have alife expectancy at birth of  under 60 years.

　　In the space of a day

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