NATURE MEDICINE • VOLUME 5 • NUMBER 11 • NOVEMBER 1999 1215

VOLUME 5• NUMBER 11 • NOVEMBER 1999

Is six billion a reason to celebrate?With the human population reaching thesix billion mark, the biomedical researchcommunity, among others, should reflecton how well we are meeting the needs ofthose six billion. Although it is asking toomuch to see a huge shift in research re-sources from wealthy to poor countries,the information and knowledge gener-ated by research-rich countries could bebetter shared.

On 12 October in Sarajevo’s KosevoHospital, the birth of Adnan Nevic waschosen by the United Nations tosymbolize the moment whenthe human population reachedsix billion. Can we accept TheWall Street Journal’s simplistic ar-gument (13 October, “Review &Outlook”) that resources are theproduct of human ingenuity andpeople create wealth, and there-fore “The More the Merrier”?The United Nations has an alto-gether more pessimistic take onthe six billion, reminding us that“Of the 4.8 billion people in developingcountries, nearly three-fifths lack basicsanitation. Almost a third have no accessto clean water. A quarter do not have ade-quate housing and a fifth have no accessto modern health services.” Not a verymerry picture.

A glance at how we reached six billion isinstructive. According to the UnitedNations Population Fund the first billioncame very slowly (see graph). From therethings speeded up, with the final one bil-lion added in just 12 years! This alarminggrowth is likely to continue for at least thenext 50 years or so. A year from now thesix billion will be sharing the planet witha further 78 million people. By 2050, it isquite possible that the human populationwill reach nine billion.

In which case, if The Wall Street Journaland others are right, we should indeed be

EDITORIAL

rejoicing, as before long we will havemore resources and wealth than we knowwhat to do with. What they forget (andcannot dismiss as mere neo-malthusian-ism) is that most of the six billion have lit-tle chance of contributing to theeconomic engine that drives the devel-oped world forward. Recall that the rich-est 20% of the human population control86% of the estimated global gross domes-tic product and that millions of peoplesurvive on about a dollar per day—hardly

the economic environment in which to“create wealth.”

But why should Nature Medicine—a jour-nal that is more accustomed to discussingcutting-edge therapeutics than environ-mental economics—be particularly inter-ested in this issue? Because the gapbetween rich and poor is never wider thanwhen it comes to medical research spend-ing. The World Health Organization hasestimated that more than $56 billion arespent on health research each year, butonly 10% of this is targeted at the diseasesthat affect 90% of the population.

The biomedical research communitymust urgently consider how better toserve all six billion and not just thewealthy elite who stand to benefit mostimmediately from biomedical advances.

A first step may be to question why weas a community pour more funding into,

for example, gene therapy than epidemi-ology. Delivering better health to theworld’s people is a far bigger challengethan simply working out at the molecularlevel what gene or drug it is that we wantto deliver.

The national agencies and majorbiotechnology and pharmaceuticalgroups that fund the bulk of medical re-search have either a duty or an economicneed to investigate those diseases andtherapies that are most relevant at home.

As such, it is probably unrealisticto expect a major shift in theallocation of these resources.However, much of the basic re-search at the heart of the biomed-ical research community is just asrelevant to the issues facing devel-oping countries as it is to thosethat conduct the research in devel-oping countries. Here perhapsprogress can be made by makingthis knowledge and informationmore widely available and afford-

able to developing countries.Even then, basic understanding of dis-

ease mechanism is just the first step. It isnecessary to develop a parallel under-standing of the epidemiological and pub-lic health issues—whether scientific,economic, social or otherwise—that mustbe taken into account when we think ofhow best to fight disease and promotehealth. Once again, the lessons learned inwealthy countries are relevant to poorercountries.

The Wall Street Journal concluded itscelebration of six billion human beings byarguing that each one of them representsa great opportunity and that each “childcomes with not only a mouth but amind.” True, and developed countriesmust do all they can to make sure both arefed. Then we might have reason tocelebrate.

© 1999 Nature America Inc. • http://medicine.nature.com©

199

9 N

atu

re A

mer

ica

Inc.

• h

ttp

://m

edic

ine.

nat

ure

.co

m