Global health challenges: The need for an expanded discourse on bioethics

Although the 20th century saw a major expansion of the world economy, impressive military/security advances, and spectacular progress in science and technology, the grim reality in the first decade of the new millennium is that human life, health, and security remain under severe threat—but now from the adverse effects of inexorably widening disparities in wealth, health, and knowledge within and between nations. The gap between the income of the richest and poorest 20% of people in the world increased from a 9-fold difference at the beginning of the 20th century to 30-fold by 1960—and since then to over 80-fold by 2000 (Figure 1). Although life expectancy has improved dramatically worldwide during this century, this trend has been reversed in the poorest countries in recent years [1]. The challenge of achieving improved health for a greater proportion of the world's population is one of the most pressing problems of our time and is starkly illustrated by the threat of infectious diseases